Under the Canada Health Act, Canada established a national health insurance program to provide Canadians with access to medical services. This insurance comprises thirteen provincial and territorial health insurance plans that share common features and basic standards of coverage. The basic requirement for provincial or territorial health insurance is primary residency.
Each province or territory determines eligibility for benefits under its health insurance plan and can define minimum residency requirements accordingly. With that in mind, how do you use your health benefits outside of your province of residence? Can you? This is what we know so far.
What do provincial and territorial health insurance plans cover?
First of all, it is important to know what is insured by provincial and territorial health insurance plans and what is not. These plans cover inpatient and outpatient hospital services and other medical or physician services that maintain health, prevent disease, and diagnose or treat injury, illness, and disability.
These plans don’t cover services that are not considered medically necessary. For example, preferred hospital accommodation is not covered under these plans unless it is prescribed by a physician. These plans also don’t cover cosmetic services.
The health insurance plans differ from province to province and territory to territory. Under the jurisdiction of a province or territory, a health insurance plan could administer additional benefits that are funded and delivered directly by the provincial or territorial government. Hence, these services vary across provinces and territories. Currently, examples of these services include prescription drugs, dental care, optometric, chiropractic, and ambulance services.
Some provinces also charge premiums to better provide these services.
What happens when you are out of province?
You still have access to these services when you are out of province.
Moving to another province
If you are moving from one province or territory to another, you are covered under your initial provincial or territorial health insurance plan during the minimum waiting period by the province or territory you are moving to. During the waiting period, you are responsible for informing your province or territory that you are leaving and where you are moving in order to register with the province or territory that you are moving to. Thereafter, you become a part of your new province or territory of residence’s health coverage.
Travelling Canada
If you are travelling within Canada and require emergency medical care in another province or territory, you can see a doctor or visit a hospital under your health insurance plan. Under the Canada Health Act, all provinces and territories are required to extend their health coverage to residents who are travelling.
When this occurs, the province or territory providing the service also directly bills your home province/territory (except Quebec). Sometimes there may also be a requirement to pay upfront and seek reimbursement from your province or territory of residence. But this only happens as long as access to the insured and medically necessary service is not denied due to one’s inability to pay.
Despite portability provisions under the Canada Health Act, each province determines how long you can be away and still access or retain their health insurance coverage.
Temporarily elsewhere for work or study
Under the Canada Health Act, all provinces and territories are required to extend their health coverage to residents temporarily elsewhere for work or study too. Once again, each province determines how long you can be away from the province and still access or retain their health insurance coverage.
For example, in British Columbia (BC), residents who leave the province temporarily to attend a recognized educational institution in another province may retain eligibility for coverage for the period of their studies. BC determines their eligibility and stresses that students must contact Health Insurance BC to inform them about their departure and return to BC. Students must return to BC within the required timeframe to confirm eligibility.
In BC, residents who will be temporarily away for six months or more in a calendar year must also contact Health Insurance BC to confirm eligibility. In some circumstances, residents who are temporarily elsewhere for work or vacation may retain eligibility for coverage of up to 24 consecutive months, once in a five-year period. Therefore, it is important to check what the eligibility requirements are in your province.
Travelling to another country
If you get sick or injured while travelling outside Canada, your health insurance plan only covers your medical expenses to a certain extent. This differs depending on your province or territory of residence. Here are a few examples of provincial coverage for out-of-country expenses:
British Columbia
$75/day for emergency hospital services outside of Canada.
Ontario
Does not cover emergency medical expenses outside of Canada since October 1st, 2019.
Alberta
$100/day for hospital services, $50/day for outpatient services (must pay the health service provider first and then can submit a claim for reimbursement of out-of-country health expenses).
Manitoba
Out-of-Canada medical care from an emergency room or as a hospital outpatient is covered up to $100/visit.
Generally, these coverages only cover up to 10% of your medical expenses abroad. Because of this, Canadians are encouraged to buy private travel insurance to ensure they can access affordable and necessary healthcare abroad in an emergency. These insurances usually cover non-medical travel expenses such as cancelled flights and lost baggage. Currently, only 40% of Canadians buy travel insurance.
What happens to additional benefits?
Additional benefits, which include but are not limited to prescription drugs and ambulance services, are usually not available when you are out of province or country. For example, in Alberta, the Alberta Health Care Insurance Plan (AHCIP) does not cover all health services available in Alberta when you are outside of Alberta. Similarly, MSP in BC also does not provide any coverage for treatment by a non-physician health care practitioner, prescription drugs, medical supplies or ambulance services outside the province.
Travelling to another country for essential or elective treatment
You may need to travel abroad to receive medical treatment that is not available in Canada. Your provincial or territorial health plan may require you to gain prior approval and may not cover your expenses if you develop complications in the country where you are having the procedure. For example, New Brunswick will cover only emergency out-of-country physician and hospital services with prior approval, at a maximum of $100/day for inpatient services and $50/day for outpatient services. Many provincial and territorial plans also require prior approval to obtain extended coverage for out-of-country elective (non-emergency) health services.
Use Your Benefits At No Cost
Whether you are in a different province or country, it is important to check with your provincial or territorial health insurance offices to see what is covered under your health insurance to avoid high costs. Do you have many employees who work out of province and are concerned about what this may mean for them? Use Borderless for a truly frictionless experience to hire and retain talent from anywhere in Canada and the world.
Disclaimer
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