OHIP coverage outside Ontario

Find out what OHIP covers when you’re in another Canadian province or territory temporarily.

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Check your health card before you go

You should bring your health card with you if you’re planning to travel within Canada, but first, make sure it’s still valid.

A valid Ontario health card has:

• not expired
• your correct personal information on it (such as your name, birthdate)
• your current address that’s on file with ServiceOntario

If you’ve moved, you can update your address online with ServiceOntario.

If your name has changed since receiving your current health card, you will need to visit ServiceOntario and bring a form and specific documents.

What is covered when you are in other provinces

When you show your valid Ontario health card in another Canadian province or territory, you will be covered for some of the same services you’re covered for in Ontario including:

• physician services (such as a visit to a walk-in clinic)
• services provided in a public hospital (such as emergency, diagnostic or laboratory services)

Any service or treatment you receive in another Canadian province or territory must be medically necessary for it to be covered by OHIP .

What is not covered when you are in other provinces

Services that are not covered by OHIP in another Canadian province or territory include:

• services not covered in Ontario (such as cosmetic surgery)
• ambulance services (including transport and paramedic)
• prescription drugs and other drugs given outside a hospital
• home-care services
• fees charged by private hospitals or facilities
• diagnostic or laboratory services outside of a public hospital
• long-term care or residential services
• assistive devices (such as prosthetics)

We recommend that you buy private health insurance before leaving Ontario to cover any uninsured services you may need.

Outside Ontario for more than seven months

If you’re going to visit, work or study in another Canadian province or territory for more than 7 out of 12 months, you need to confirm your coverage before you leave. Call ServiceOntario to determine what you may need to do.

During frequent work travel

If your job requires frequent travel to other parts of Canada, your OHIP coverage will continue if you qualify as a mobile worker.

To qualify as a mobile worker, bring proof to the nearest ServiceOntario centre that you:

• travel frequently for more than 212 days in any 12-month period for work
  • proof from your employer is required (letter on letterhead confirming the travel for example)
  • proof of residency is required (such as your most recent income tax assessment, utility bill, mortgage, rental or lease agreement)

  During full-time studies

  To keep your OHIP coverage while studying fulltime in another province or territory in Canada, you must bring proof to the nearest ServiceOntario centre that you:

  • have lived in Ontario for at least 5 months in the 12-month period immediately before leaving
    • proof of residency required (such as your most recent income tax assessment, valid Ontario driver’s licence, utility bill)

    Get pre-approval for planned procedures

    You will need written approval for some services to be covered by OHIP before they are provided outside of Ontario (such as a breast reduction or panniculectomy). The Schedule of Benefits for Physician Services outlines which services require prior approval. Speak with your health care provider for more information.

    If prior approval is required, either your Ontario physician or your out-of-province physician can submit a Request for Prior Approval Application for Full Payment of Insured Out-of-Province Health Services (in another province/territory) form.

    How to get reimbursed

    You may be charged for medically needed services or treatment you receive in another Canadian province or territory if:

    • you don’t show your valid Ontario health card
    • a doctor charges you even if you show your health card (they have the right to do this)

    If this happens, you can submit a claim to OHIP within 12 months of the date you received the service or treatment to get your money back.

    We assess claims and reimburse you according to Ontario’s physician rates.

    Follow these steps to submit an OHIP claim for reimbursement:

    1. Fill out the Out of Province/Country Claims Submission form.
    2. Attach an original (not photocopied) statement from the person who provided treatment that:
       • describes the service
       • itemizes the fee
       • names the patient who had the service
    3. Include proof of payment.
    4. Make copies of the completed form, statement and proof of payment for yourself.
    5. Mail your claim to:
       OHIP Claims Office
       347 Preston Street, 4 th Floor
       Ottawa, ON K1S 3J4

    Moving in Canada

    If you’re moving permanently to another province or territory in Canada, OHIP will cover you for the same services as when you are going away temporarily until the last day of the second full month after you leave Ontario.

    Remember to apply for coverage in your new province or territory.

    Contact or visit the nearest ServiceOntario centre with any questions.