out of country OHIP coverage cancellation

Out Of Country OHIP Coverage Cancellation May Raise Costs For Employers

The Ontario government is moving forward with the cancellation of out of country OHIP coverage. Health Minister, Christine Elliot argues that the plan coverage is too low to be helpful to travelers who already largely depend on private travel insurance. Changes are expected to come into effect as of October 1st, 2019.

Out of country OHIP currently covers

  • Out of country inpatient services to a maximum of $400 per day and $200 per day for a less amount of care.
  • They also pay a maximum of $50 per day for emergency outpatient services and doctor services.
  • According to Ontario.ca, if you plan to be outside Canada for more than seven months in any 12 month period, you can keep your OHIP coverage for up to two years (must apply for this in advance).
    • Provided you have a valid health card, make Ontario your primary home, will be in Ontario for at least 153 days a year in each of the two years immediately before you leave the country.

What does this mean for employers of group benefit plans?

Under the new plan, those traveling outside the country will be encouraged to pursue their insurance coverage, and this could increase claims for employers.

In 2017, employers shelled out more than $360 million in Ontario for travel health claims for both employer-sponsored and individual plans.

Some insurers will need to update their existing contracts due to this change and to update employees on new policies and procedures, specifically what changes are being made and how that will impact the claims process. 

What isn’t covered under benefit plans for out of country claims?

Depending on the insurer, some plans only cover unexpected medical emergencies resulting from an “acute episode” meaning a medical condition that was not treated before leaving Canada. Unstable pre-existing conditions are usually not covered.

Some contracts exclude coverage for high-risk activities, participating in sports activities where there is remuneration or that requires that a waiver be signed to participate (i.e., scuba diving, rock climbing, off-track snow sports).

There are stipulations for some out of country emergency policies. To renew your coverage, one insurer for a personal health insurance policy requires specfically that you must return to home province for twenty days, if over the age of sixty-five, or twenty-four hours if under the age of sixty-five.

Pregnant women traveling outside of their home province, need to reference their specific benefits booklet. Some policies exclude coverage for childbirth while traveling after a specified number of weeks.

However, most policies contact a clause that if there was any indication that the delivery was going to take place or travel was not okayed by a doctor before the women leaving the country, the claim will not be paid.

If you have any questions about what your plan currently covers or need to update your existing contracts, please get in touch today!

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