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Ministry Programs

Ontario Health Insurance Plan

OHIP Out of Country Services

Prior Approval: Questions & Answers

• Ontario has a shortage of family physicians. What can a patient do if they don't have a family physician [and they are seeking out-of-country medical services]?
• Is my Ontario health card valid outside of my Local Health Integration Network (LHIN)?
• Why is PSA testing not covered by OHIP?
• How do Ontarians know what the wait time is for treatment in Ontario?
• When reviewing a patient's application for OOC prior approval, the ministry should also take into consideration the person's quality of life. Is that currently factored in when processing the application?
• Where can I get travel insurance that doesn't have exclusions for pre-existing medical conditions?
• Why is my ODB coverage not valid in another province? Why can't seniors bring receipts back to Ontario and get reimbursement?
• Why do some patients get approved for funding of OOC cancer treatment but other patients get denied?
• How long does it take for experimental treatment to become accepted treatment in Ontario?
• Can I get laser treatment for a port wine stain in Ontario?
• 1-30 days to review? Is this some kind of joke? When there is an emergency, there is no time to wait for approval

Ontario has a shortage of family physicians.  What can a patient do if they don’t have a family physician [and they are seeking out-of-country medical services]?

Any licensed Ontario physician can complete and submit a prior approval application to the ministry on your behalf.  This includes physicians who work in walk-in clinics and hospital emergency departments. 

If you are looking to find a physician who may be accepting new patients in your area, it may be helpful to visit the College of Physicians and Surgeons of Ontario website.

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Is my Ontario health card valid outside of my Local Health Integration Network (LHIN)?

Yes, your Ontario valid health card entitles you to receive insured health services anywhere throughout Ontario. 

Physicians are not required to complete an Out of Country prior approval application for patients who require insured health services in Ontario.

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Why is PSA testing not covered by OHIP?

PSA testing is a lab service and is therefore the responsibility of the ministry’s Laboratories Branch.  Information regarding this service is, however, available on the ministry’s website

Information provided on this site advises :

• When a man has been diagnosed with prostate cancer and is receiving treatment, or is being followed after treatment for the disease, the PSA test is available at no charge to the patient through the hospital laboratory service. *
• When a doctor suspects prostate cancer because of a man's history and/or the results of his physical examination (including digital rectal examination), PSA testing is available at no charge to the patient through the hospital laboratory service. *
• In men without symptoms (screening), PSA testing is not paid for by the provincial health plan. A man can have the PSA test if he is willing to pay for the test himself. However, it is hoped he will make this decision only after discussion with his doctor.

* Men must attend a hospital to have the specimen drawn to avoid a charge.

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How do Ontarians know what the wait time is for treatment in Ontario?

The wait times for certain procedures in Ontario can be found on the ministry website.

You may also call the ministry INFOline at 1-888-779-7767 or send an e-mail inquiry to transforminghealth@moh.gov.on.ca.

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When reviewing a patient’s application for OOC prior approval, the ministry should also take into consideration the person’s quality of life. Is that currently factored in when processing the application?

The diagnosis/medical problem and the treatment being requested are considered within the context of each individual patient’s circumstances. Ministry staff carefully review the submitted documentation and if indicated, contact the referring Ontario physician and other Ontario physicians who have been involved in the patient’s care. The ministry’s decision, however, must meet the criteria established by Ontario law.

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Where can I get travel insurance that doesn’t have exclusions for pre-existing medical conditions?

The ministry is not in a position to recommend one private insurance plan over another.

If you would like information about obtaining private travel insurance you may contact the Canadian Life and Health Insurance Association who can provide a list of available travel and private insurance plans.  Contact information for this organization is provided below :

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Why is my ODB coverage not valid in another province?  Why can’t seniors bring receipts back to Ontario and get reimbursement?

The Drug Program Branch has a clear policy regarding this.  Prescriptions must be written by an Ontario prescriber, dispensed by an Ontario pharmacy and provided to an Ontario resident.  If you would like further information or clarification, please write to the Drug Program Branch at :

MOHLTC
Ontario Public Drug Programs Branch
Queen's Park
Toronto, Ontario M7A 1R3

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Why do some patients get approved for funding of OOC cancer treatment but other patients get denied?

Each application for out of country prior approval is adjudicated independently and is based on each patient’s individual circumstances and the information provided by the referring Ontario physician. The severity of the patient’s condition, the presence of additional medical problems, and the opinions of Ontario experts are all considered when reviewing an application. The ministry’s decision, however, must meet the criteria established by Ontario law.

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How long does it take for experimental treatment to become accepted treatment in Ontario?

With ongoing advancements in health technology and treatment it is expected that Ontario will continue to see changes in the services that are generally accepted in province. The amount of time it takes before a treatment or service is accepted in Ontario varies considerably. Unfortunately, it is not possible to predict with certainty what treatment(s) will be introduced in the province or when.

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Can I get laser treatment for a port wine stain in Ontario?

Yes, pulse dye laser treatment for port wine stain on the face or neck is an insured service in Ontario.  Removal of port wine stains from other parts of the body may be an insured service, but requires prior ministry approval first.  Your physician should be able to provide information regarding where this service is performed in

Ontario and can apply to the ministry for prior approval of removal of port wine stain from areas of the body other than the face or neck.

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Additional Remarks :

1-30 days to review?  Is this some kind of joke?  When there is an emergency, there is no time to wait for approval.

The OOC Unit has a process in place to expedite “urgent” requests for medical services out-of-country – these applications can be processed in less than one hour if all the medical documentation is submitted with the application.  The 1-30 day turnaround time relates only to prior approval applications and was provided as an estimate only.  In the majority of cases, the ministry processes these applications in an average of 8 days or less. 

Patients in need of emergency treatment are transferred immediately to an OOC facility if necessary, without delay through Criticall (from the referring Ontario hospital).

Please note, Ministry staff in the OOC Unit is available to assist patients and physicians with this application process.  If you would like to speak to staff in the Unit, please call the 1-888-359-8807.