- proof is required (such as a letter from international university or college confirming your enrollment)
- proof is required (such as your most recent income tax assessment, utility bill, valid Ontario driver’s licence)
Before you leave, take the following items to the nearest ServiceOntario centre to apply for an academic absence:
- your health card
- proof of residency (such as a mortgage, lease or rental agreement, property tax bill, valid driver’s licence)
- proof of registration in a full-time academic program outside of Canada (such as a letter from the international school)
Working outside Canada
If you’re planning to work (including for a charity) outside Canada on a full-time but temporary basis, you can apply for this coverage if you:
- have a valid Ontario health card
- have proof of full-time position from your employer or sponsoring registered charity
(such as an offer of employment, contract or letter from the charity) - have been in Ontario for at least 153 days in each of the two 12-month periods immediately before you leave the country
Before you leave take the following items to the nearest ServiceOntario centre to make sure your OHIP coverage stays active:
- your health card
- proof of residency (such as a mortgage, lease or rental agreement, property tax bill, valid driver’s licence)
- proof of employment or charity work (such as a contract/letter from employer/charity)
For family members
If you’re leaving Canada for full-time study or work only, immediate family members who travel with you may also be able to keep their OHIP coverage. This includes:
- your spouse
- dependent children under 22 years of age
- adult children over 22 years of age if they depend on you financially due to mental or physical disability
How to get out-of-country care
OHIP provides coverage for health services received outside of Canada when certain criteria are met. There are 2 kinds of out-of-country services that may be funded:
- out-of-country emergency health services for travellers
- prior approved out-of-country health services
How to qualify for the Travellers Program
You qualify if you:
- have a valid Ontario health card
- are meeting all of the physical presence and primary place requirements under the Health Insurance Act and its Regulations
The treatment or service must meet all of the following criteria. It must be:
- medically necessary
- provided at a licensed hospital or licensed health facility
- for an illness, disease, condition or injury that
- is acute and unexpected
- not pre-existing (you developed it outside of Canada)
- requires immediate treatment
We recommend that you buy private health insurance before leaving Ontario to cover any uninsured services you may need.
What is covered
Doctor services
OHIP will pay whichever of the following is less:
- the actual amount billed by doctor(s) who treated you outside Canada
- rates listed in and paid to Ontario physicians in the Ontario Schedule of Benefits for Physicians Services
Emergency outpatient services
OHIP will pay whichever of the following is less:
- up to $50 (Canadian) per day
- the amount billed by the hospital
Emergency inpatient services
OHIP will pay up to:
- $400 (Canadian) per day for services provided in:
- an operating room
- a coronary care unit
- an intensive care unit
- a neonatal or pediatric special care unit
How to get money back
If you paid for qualifying services outside Canada after January 1, 2020, you may be eligible to get some of your money back.
To submit a claim:- Fill out the Out of Province/Country Claims Submission form
- Attach a detailed statement in English or French with the:
- date you were admitted
- date you were discharged
- description of service(s)
- nature of any complications
- kind and number of any laboratory, radiological or other diagnostic tests performed
- nature of any treatment, procedure or surgery that was performed
- discharge diagnosis
- itemized fees for each service
- health card number (and version code, if applicable)
- your name and current address in Ontario
- Include original receipts for payment to the:
- hospital or health facility
- doctor or surgeon, if billed separately from the hospital or facility
You can submit your claim by email or mail.
Mail your claim to:
Ministry of Health
Out of Country Travellers Program
347 Preston Street, 4th floor
Ottawa, ON, K1S 3J4Understanding your OHIP reimbursement cheque
Once you’ve received your OHIP cheque, further information about the reimbursement claim amount can be found on the cheque stub using the below breakdown and Explanatory Codes.
Provider Surname:
- “United States” means that the invoices submitted were for medical services in the United States.
- “World Remain” means that the invoices submitted were for medical services received in another country other than the United States.
Patient – the first letters of the patient’s first name.
Claim Number – a number assigned by the Ministry of Health.
Initial Service – the date the medical service was received by the patient.
No of Services – the number of services the patient received.
Amount billed by provider – the billed amount from the invoice submitted.
Amount paid per MOH Schedule of Benefits – the amount the ministry will reimburse for insured services. Either OHIP rates or the amount billed, whichever is less (in CDN funds).
Explanation of codes
- 30 – This service is not a benefit of OHIP.
- 32 – Our records show that this service has already been submitted and paid.
- 50 – Paid according to the Schedule of Benefits for Physician Services.
- 65 – This service is included in the approved hospital daily rate.
- AP – This payment is made according to the legislated rate for the service rendered.
- DL – Allowed at listed fee for laboratory tests performed in the physician’s office.
- D7 – Not allowed in addition to the other procedure claimed.
- D8 – This service can only be paid when billed with another specific procedure.
- G1 – Other critical/comprehensive care already paid.
- S3 – Second surgical procedure allowed at 85% of fee listed in the Schedule of Benefits for Physician Services.
- S7 – Normal pre- and post-operative care included in fee paid for surgery these visits are not payable.
- M1 – The maximum fee/number of services payable has been reached for this service.
Contact the Claims Services Branch for further information on understanding your OHIP cheque.
Please keep your cheque stub as it may be required by your supplemental insurance company.
Reimbursement for renal care
The Out-of-Country Hemodialysis Reimbursement Program is available to Ontario patients who have hemodialysis treatments at a facility while travelling outside of Canada. It helps offset the costs of these treatments.
Submit claims to the Ontario Renal Network for hemodialysis treatments received out of country on or after January 1, 2020.
If you do not think your claim was paid in accordance with the regulatory requirements, you may request a hearing before the Health Services Appeal and Review Board ( HSARB ). Information on appealing your decision can be found in the Health Services Appeal and Review Board section.
Doctor-recommended out-of-country care
If recommended by your Ontario doctor, OHIP may cover some medical services in a licensed hospital or facility outside Canada, but you must get written prior approval from the Ministry of Health before you receive the services.
Applying for out-of-country prior approval
Before applying for out-of-country ( OOC ) prior approval, your Ontario doctor must:
- determine you need out-of-country healthcare services
- submit a prior approval application to the ministry for consideration
- submit written confirmation from a specialist that criteria for funding are met and include appropriate medical records
Out-of-country prior approval form
The application form (on00314) is available in PDF and HTML versions and should be completed and submitted electronically.
Form
Prior approved services
OOC services may be OHIP insured if the requested services and treatment meet all of the following criteria:
- performed at a hospital or licensed health facility
- not experimental or for research or for a survey
- accepted in Ontario as appropriate for a patient in the same medical circumstances
- not performed in Ontario by an identical or equal procedure or performed in Ontario but a delay in services would result in death or medically significant irreversible tissue damage
The ministry only covers costs for prior approved medical services.
Expenses not covered by OHIP include non-medical services such as travel, accommodations and meals unless they are part of insured hospital services.
Even when medical services have prior approval, you are encouraged to buy private medical travel insurance and understand what the private policy covers.
Processed applications
Once an application is processed, the ministry will send a decision letter to the submitting Ontario doctor by fax and a copy of the decision letter to you by mail or secure email.
If approved, this letter will outline:
- the approved services
- the medical or treatment facility to provide services
- any service limits and inclusion/exclusions of funding
The decision letter is based on the medical documentation provided with the application. Ontario doctors may submit another application or additional information if circumstances change.
Note: If you do not receive prior written approval from the ministry, OHIP will not fund your medical expenses. You will be responsible for all costs.
Prior approval application denial
If your application is not approved, you may request:
- an internal review
- a hearing before the Health Services Appeal and Review Board ( HSARB )
Internal review process
You may request an internal review in addition to, or instead of a hearing before the HSARB . To request an internal review or submit additional documentation, you or your referring physician can contact the ministry in writing by
- mail: Ministry of Health, Health Insurance Branch
49 Place d’Armes, PO Box 48
Kingston, ON K7L 5J3 - fax: 1-866-221-3536 or 613-536-3181
Once the internal review has been completed, the ministry will prepare a decision letter and will:
- fax the letter to the applying Ontario doctor
- courier a copy to you
The ministry will continue to re-examine applications if more relevant documentation is provided for review.
Health Services Appeal and Review Board ( HSARB )
If you wish to appeal the decision made under the Travellers Program or the Out-of-Country Prior Approval Program, you may request a hearing before the HSARB . You must do this within 30 days of receiving the written decision from the ministry.
Send the letter and any supporting information or documents to:
Health Services Appeal and Review Board
151 Bloor Street West, 9 th Floor
Toronto, ON M5S 2T5
Tel : 416-327-8512
Fax: 416-327-8524Or send notice via email to: hsarb@ontario.ca with subject line “Attention Registrar: Notice of Appeal” (preferred method).
Workplace Safety and Insurance Board ( WSIB )
Services for a person entitled under the Workplace Safety and Insurance Act are not insured by OHIP .
If your work-related accident requires out-of-country medical services, the prior approval process is not applicable. A form should not be submitted to the ministry.
You should contact the Workplace Safety and Insurance Board ( WSIB ) to discuss coverage.
