Ontario Health Insurance Plan
OHIP Out of Province (OOP) Services - Travellers Medical Coverage
To obtain Out-of-Province (but within Canada) medical services, an insured Ontario resident must show his/her valid Ontario health card prior to insured service(s) being rendered.Please note that if an Ontario resident does not present his/her health card, the facility (e.g., hospital) and/or the physician can bill the Ontario resident directly for the service(s) being rendered.
Medical services are those given in connection with a condition, illness, disease or injury that arises outside of Ontario but within Canada and requires immediate treatment.
Generally speaking, to be continuously eligible for OHIP, a person must make their primary place of residence in Ontario and must be physically present in Ontario for 153 days in any given 12-month period. However, a resident can travel temporarily outside of Ontario and within Canada and continue to receive OHIP coverage (with some restrictions).
If an insured resident of Ontario takes-up permanent residence in another province/territory, they must notify the Ontario Ministry of Health and Long-Term Care. They must also contact the ministry of their new home province to register for health care in their new province/territory of residence.
Insured residents of Ontario who travel or work outside Ontario but within Canada are eligible for continuous OHIP coverage for up to 12-months if they meet the OHIP eligibility requirements.
Insured Ontario residents who travel outside Ontario but within Canada for academic purposes and are in full time attendance at an academic institution will maintain continuous OHIP for the duration of their studies if they meet all of the OHIP eligibility requirements.
Typically this coverage (while out-of-province but within Canada) is for insured physician and hospital services only. Therefore, when travelling outside of Ontario but within Canada, the ministry recommends that you obtain private supplementary health insurance for non-physician/non-hospital services.
Physician's Services - Physicians in all provinces or territories have the option of billing the Ministry of Health and Long Term-Care directly or billing the Ontario resident for the insured services being provided.
Insured Ontarians should show their Ontario health card and ask the physician whether the physician fees will be billed directly to Ontario.
If the patient is billed directly for the physician’s component of the health services provided, the patient may seek reimbursement by submitting the original receipt(s) to the ministry. Read the next question (If Ontario residents have to pay for health care in another province/territory within Canada, can they be reimbursed?) to learn more. The insured physician services will be paid in accordance with the rates listed in the Ontario Schedule of Benefits for Physician Services, (the same rates paid to Ontario physicians), or at the amount billed, whichever is less. For details, see http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html.
Please ensure that you keep copies of all receipts for future reference.
Public Hospital Services - When insured services are provided in a publicly funded hospital that participates in reciprocal billing there are no charges to the patient with regard to hospital/facility costs.
Standard hospital services that are covered under the reciprocal billing agreements include:
- preferred accommodation if medically required;
- nursing services;
- insured laboratory, radiological and other diagnostic procedures, together with the necessary interpretations;
- insured drugs, biological and related preparations when administered in the hospital;
- use of operating room, case room and anaesthetic facilities, including necessary equipment and supplies;
- medical and surgical equipment and supplies;
- use of radiotherapy facilities;
- use of physiotherapy facilities; and, services provided by persons who receive remuneration from the hospital.
- Private Health Facility Services - with some specific exceptions, OHIP does not cover payments to private health facilities or hospitals outside Ontario but within Canada. This means that generally speaking, facility costs for any services received in any private clinic in Canada are not insured and are the responsibility of the patient.
It is the responsibility of the patient to enquire from the hospital/facility if they will accept his/her Ontario health card before the services are rendered. You can also verify with the Ministry whether the hospital/facility is publicly funded or a private facility by calling the toll-free telephone number 1-888-359-8807.
In the event that patients are required to pay for physician or hospital services that would be insured in Ontario, they may submit a claim for reimbursement to a claims processing office within 12 months of the services being rendered. The Ministry of Health and Long-Term Care claims processing office for out-of-province claims is:
- Ministry of Health and Long-Term Care
- Claims Processing
- 75 Albert Street
- 7th floor
- Ottawa ON K1P 5Y9
To make a claim to OHIP, submit a fully itemized bill that includes all the following:
- An original, detailed statement itemizing the fee for service; and,
- Proof of payment; and
- Your name and current address in Ontario; and,
- Your Ontario health card number including the version code if applicable; and,
- A completed Out of Province/Country Claims Submission form (0951-84).
Note: Before submitting original documents, residents should make photocopies for their records.
Note:It is the responsibility of the eligible Ontario resident to present their valid Ontario health card to the out of province physician or facility at the time of service. If the eligible Ontario resident cannot present their valid Ontario health card, they may be charged directly for the services provided out of province.
Ambulance services provided to Ontario residents outside of Ontario, but within Canada are not covered by OHIP. If you plan to travel outside of Ontario, it is strongly recommended that you obtain additional private medical insurance and fully understand what your policy covers.
For information about Ambulances, please refer to the ministry's Fact Sheet: OHIP: Ambulance Services Billing.