If you are registered with a provincial health plan and have a health card from that plan, can you use it outside Canada? Inside Canada, provinces like BC, Alberta and Ontario allow each other’s health plans to be used by travellers to the other province, for example. But how about when you travel outside of Canada? What do the rules and regulations say?

As each province and/or territory has its own healthcare plan, let’s focus on Canada’s three largest anglophone provinces – Ontario, BC, and Alberta – to find the answer to that question.

 

Can I Use My British Columbia Services Card Abroad?

Here’s what BC’s Medicare Protection Act has to say on medical services outside the province:

(1) In this section, "medical practitioner" includes a medical practitioner or dentist who is authorized to practise medicine or dentistry in the jurisdiction where the services were rendered.
(2) If a beneficiary receives a service from a medical practitioner outside British Columbia that would be a benefit if rendered in British Columbia, the beneficiary may apply to the commission, in the manner required by the commission, to have payment made for the service in the amount the commission determines.
(3) If a beneficiary receives a service outside British Columbia from a medical practitioner that would not be a benefit if rendered in British Columbia, the beneficiary may apply to the commission to determine if the cost of this service should be paid and, if so, the amount to be paid for the service.
(4) A beneficiary is entitled to have payments made under subsection (2) or (3) if the commission considers the service was medically required and

  • (a) the need for the service arose unexpectedly while the beneficiary was outside British Columbia, or
  • (b) the regulations respecting out of British Columbia services have been complied with.

(5) If the government has made, with the government of another jurisdiction of Canada, an agreement that provides for arrangements to pay for medically required services rendered in that other jurisdiction, the agreement applies.

In other words, if you have a medical emergency while travelling outside the country and you use the services of a registered legal doctor or dentist in the foreign jurisdiction where you are travelling, you can apply to BC’s Medical Services Commission which is an appointed group of 9 experts who represent:

  • The medical association of BC
  • Beneficiaries of Medical Services in BC (patients)
  • The Government of BC.

The commission’s mandate is to provide reasonable access to quality medical care to residents of BC. The commission (or more accurately, employees who work for the commission) will determine if your expenses incurred abroad are valid and will decide on what amount to reimburse you for, based on the cost of similar services in BC.

Remember that you need to be registered with Medical Services and you should have your BC Services card with you when paying for services abroad so your foreign medical bills/receipts can indicate that you are a BC card holder who received those services outside the country.

Unfortunately, you will almost certainly receive a refund that is far less than the actual cost of those medical services you paid for outside Canada. For example, BC Medical Services pays CAD$75 per day for emergency in-patient hospital care. In the USA, the average cost for this is around US$1,0000 and in many other countries will also be well above CAD$75. It is always recommended that you take out travel insurance, including health insurance, when you go on vacation or travel abroad for business purposes. Make sure that your travel insurance includes provisions for:

  • Ambulance services
  • Hospital stays
  • Prescription costs (medication costs)
  • Transportation back to BC.

If you’re travelling within Canada, most other Canadian provinces will accept your BC Services card and bill Medical Services directly. However, in Quebec, you will have to pay for medical treatment and then seek reimbursement just as you have to when travelling abroad.

 

Can I Use My Ontario Health Card (OHIP Card) Overseas?

Ontario Health Card, used by permission

[Used by permission of cardholder]

The first thing you should do before travelling abroad is to make sure your OHIP card is valid. Make sure the expiry date is at least several months away and if not, you should renew your OHIP card before you travel. As well make sure:

  • Your name and birthdate are correct as all your personal information on any receipt for medical bills abroad must match perfectly with your OHIP personal information to ensure you receive reimbursements.
  • Your current address is on file at ServiceOntario.
  • If you have recently moved, go here to update your address online.
  • If your name has changed, you must go to a ServiceOntario location and bring the required documentation. Go here to find a list of required documents to prove you are a resident of Ontario and you are who you say you are.

There are a number of reasons why you might be abroad, and these can affect your ability to use your OHIP card in other countries. Let’s go through several basic scenarios:

  • If you are going to be outside Canada for more than 7 months per year in any given 12-month period, you may still be able to use your OHIP card abroad for up to 2 years. To qualify for this benefit, you must:
    • Have a valid OHIP card (see above);
    • Have Ontario as your primary residence;
    • Be in Ontario at least 153 days in EACH of the 2 years prior to your departure;
    • Go to the nearest ServiceOntario location with the following in order to ensure you can use your health card for up to 2 years
      • Your health card,
      • Proof of residency (mortgage, lease, or rental agreement, property tax bill, or driver’s license).
  • If you are going to be studying outside Canada, you and your immediate family members can still maintain your OHIP coverage if you:
    • Have a valid Ontario health card;
    • Are registered full-time in an academic program abroad;
    • Have proof of your enrollment in the educational institution – like an official letter from the school;
    • Will be in Ontario at least 153 days in EACH of the 2 years immediately prior to your leaving to study abroad;
    • Have Ontario as your principal home;
    • Have proof of residency in Ontario (mortgage, lease, rental agreements, property tax bill, driver’s license);
    • Go to the nearest ServiceOntario location with the following in order to ensure you can use your health card while studying abroad:
      • Your health card,
      • Proof of residency (mortgage, lease, or rental agreement, property tax bill, or driver’s license)
      • Proof of registration in a full-time academic program outside of Canada.
  • If you are going to be working temporarily (but on a full-time basis) outside of Canada, including working for a charity, you and your immediate family members can maintain your OHIP coverage as long as:
    • You have a valid Ontario health card;
    • You have proof of employment;
    • You will reside in Ontario for at least 153 days in EACH of the 2 years; immediately prior to going abroad to work;
    • You visit the nearest ServiceOntario centre in order to apply to maintain your coverage while working abroad with the following:
      • Health card
      • Proof of residence in Ontario
      • Proof of employment or charity work.

To get reimbursed for medical expenses incurred abroad you must:

  • Submit a claim to OHIP within 12 months of paying for the services;
  • Go here to download the Out of Province/Country Claims Submission form;
  • Make sure you attach a detailed, written statement regarding the medical services you received and paid for. It should include:
    • Date admitted
    • Date discharged
    • Medical services received
    • Nature of any complications
    • Kind and number of tests taken including lab, radiological, or other diagnostic tests
    • Nature of treatment, procedure or surgery performed
    • Discharge diagnosis
    • Itemized list of services and fees paid
    • Health card number (and version code if applicable)
    • Name and current address in Ontario
    • Original receipts for all payments to hospitals or doctors.

As the Ontario Healthcare program states, the amount of coverage they will pay for is “very limited” compared to the cost of hospital and physician services abroad. Here are some of the reimbursement rates you should expect, according to OHIP:

For physician services, OHIP takes the LOWER of:

  • The actual amount of the bill for physician services abroad, OR
  • What OHIP’s cost for providing that service in Ontario is;
    • CAD$50 per day for outpatient emergency room services
    • CAD$200 for standard inpatient services in hospitals
    • CAD$400 for the following inpatient services in hospitals:
      • Operating room services
      • Coronary care unit services
      • Intensive care unit services
      • Neonatal or pediatric care special care unit services;

These rates of reimbursement cover all inpatient services provided including ambulance services, accommodation, meals, medication/drugs, surgically implanted devices, nursing services and ALL other inpatient services you had to pay for. You will NOT receive any additional reimbursement.

Once you have completed the form and attached any and all receipts or other supporting documents you should mail the completed form with the attached letter and receipts to one of the following addresses listed at the bottom of the form:

OHIP Claims Processing Office – London
130 Dufferin Ave. 4th floor
London ON
N6A 5R2
519 873-1303
OR
OHIP Claims Processing Office – Ottawa
75 Albert Street, 7th floor
Ottawa ON
K1P 5Y9
613 237-9100
OR
OHIP Claims Processing Office – Thunder Bay
435 James Street S. Suite 113
Thunder Bay ON
P7E 6T1
807 475-1353

 

For renal care (hemodialysis for kidneys) submit the claims to the Ontario Renal Network. Go here for more information.

As is the case with BC, you should take travel insurance that includes hospital stays, ambulance services, and any other medical emergency expense you may incur while abroad.

 

Can I Use My Alberta Health Care Card Abroad?

Here is what the Alberta Health Care Insurance Plan (AHCIP) states at their website regarding overseas medical expenses for Alberta AHCIP members:

Effective April 1, 2020, only the cost of insured emergency physician and/or hospital services received outside of Canada will be eligible for reimbursement under the Alberta Health Care Insurance Plan. Travel medical insurance is strongly recommended for travelers leaving the country.
Emergency services consist of insured services rendered in relation to an illness, disease or condition that is acute and unexpected, arose outside of Canada, and requires treatment without delay outside Canada.

In other words, you need to have become suddenly ill in an unexpected and severe manner that forced you to seek medical services while abroad. That is the standard by which the AHCIP assesses your medical expenses incurred abroad. It is a tough standard and implies – as they say – that you need to take out travel insurance that covers things like hospital and physician care as well as ambulance services if you plan to travel or be out of the province (and Canada) for any length of time.

The AHCIP also has a contact number for travellers:

To contact the AHCIP’s Out-of-country unit call the following number:

780-422-1954

 

For physician services claimed you will be reimbursed for either:

  • The amount you claimed, OR
  • The rate an Alberta physician is paid
  • Whichever of the two is LESS.

Hospital services paid for abroad must be:

  • Services that hospitals in Alberta provide under the AHCIP, AND
  • Be at a Public/General or Auxiliary hospital, NOT in a private hospital. (If you are treated at a Private hospital you will NOT be reimbursed.)

In-patient hospital services are valued at CAD$100 per day. Out-patient hospital services are valued at CAD$50 per day.

The following services obtained abroad are NOT covered:

  • Chiropractor
  • Acupuncturist
  • Massage Therapist
  • Homeopath
  • Nutritionist
  • Psychologist
  • Podiatrist
  • Optometrist
  • Physician Assistant
  • Nurse Practitioner
  • Ambulance services – air or ground
  • Mental health services not provided in a general hospital
  • Publicly funded services such as:
    • Home care
    • Behavioral disorders
    • Addiction treatment;
  • Prescription medication
  • Prosthetics, Medical surgical appliances
  • Experimental or research procedures – e.g. clinical trials.
  • Go here and click on the high-lighted link saying: Out-of-Country Health Services Claim form. Download the pdf form print it and fill it out.
  • If there is a third-party request for reimbursement you need to download and fill out the Insurance Claim Consent and Authorization form at the link just below.
  • You must submit your claim within 365 days of the date of medical services received abroad.
  • Submit photocopies of all itemized payments and proof of payments like receipts.
  • Make sure you provide the following information for hospital services:
    • Facility name and address for any hospital services
    • Date of admission at hospital
    • Date of discharge at hospital
    • CPT billing codes and diagnosis
    • Nature of treatment, procedure, or surgery performed
    • Type and number of any lab, radiological, or diagnostic tests
    • Amount being claimed for hospital services and proof of payment.
  • Make sure you provide the following information for physician services:
    • Name & speciality of physician
    • CPT billing codes and diagnosis
    • Type of treatment, procedure, or surgery performed
    • Date(s) insured person treated
    • Amount claimed as well as proof of payment.
  • All documents must be on official letterhead of facility or physician
  • All supporting documents must be translated into English with a copy of the original statement included
  • For services provided in the USA, include either a UB04 hospital claim form and/or CMS 1500 physician claim form.

Mail your completed form to:

Alberta Health
Attention: Out-of-Province/ Out-of-Country claims
PO Box 1360, Station Main
Edmonton, Alberta
T5J 2N3

 

Funding of Health Services Not Available in Alberta/Canada

If you wish to seek medical services abroad that you feel are unavailable in Alberta, you must:

  • Have an application submitted on your behalf by an Alberta physician or dentist to the Out-of-Country Health Services Committee.
  • The committee has to approve funding for your application. The fact that you apply does NOT guarantee you funding.
  • Services NOT eligible for funding include:
    • Meals
    • Accommodation or lodging costs
    • Travel medical insurance
    • Take-home drugs
    • Medical equipment or supplies
    • Experimental or applied research
    • Publicly funded services provided in Alberta by Alberta Health Services
    • Mental health services
    • Behavioral disorders
    • Addiction treatment.

Remember that an Alberta physician or dentist (normally your doctor or dentist in Alberta) must submit an application on your behalf. The process for your doctor or dentist is as follows:

  • Download the Out-of-Country Health Services application form here by scrolling down to the middle of the page and clicking on the high-lighted link.
  • Complete the application form and make sure it – or the referral letter – includes the following information:
    • Health services or treatment needed
    • Expected duration of the initial services and the dates when they will be provided
    • Number and frequency of any follow-up visits
    • Address of Out-of-country facility where the health services will be provided
    • Name and speciality of out-of-country physician who will provide or coordinate the services
    • Any arrangements made for follow-up care in Alberta or elsewhere in Canada
  • Include the reason for seeking Out-of-country health services and include at least one of the following:
    • Documentation that the relevant health services in Alberta or elsewhere in Canada have been fully utilized, or/and
    • Documentation that the relevant health service in Alberta or elsewhere in Canada is not available, or/and
    • An explanation why services available in Alberta or elsewhere in Canada are not being utilized
  • Include a summary of the patient’s health relevant to the service being sought abroad.
  • Submit any relevant electronic health records directly to the committee as they do NOT have access to them.
  • Finally, the doctor or dentist submitting the application on the patient’s behalf should send the application package to the following address:

    Chair, Out-of-Country Health Services Committee
    PO Box 1360 Station Main
    Edmonton, Alberta
    T5J 2N3
     
    Contact:
    780-415-8744
    780-415-0963 (fax)

 

As you can see, in each of Canada’s 3 main anglophone provinces, you should always consider taking out travel insurance that covers ambulance, hospital, and physician services abroad, as you will NOT be reimbursed for the full amount by the AHCIP, OHIP, or BC Medical Services.


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