Travel Insurance - Detailed Information

Did you know that when travelling outside of Canada OHIP will not pay the same medical expenses that are covered in Ontario? If you are a resident of Ontario and you are insured under OHIP, you are entitled to very limited funding for a certain range of medical services when you are travelling outside of Canada. For this reason, you are strongly advised to purchase additional health insurance every time you leave Canada and ensure that the supplementary insurance you have purchased provides adequate coverage.

Why?

OHIP will pay very limited amounts for physician services and hospital/health facility services, and only if certain conditions are met. Under Ontario's Health Insurance Act and regulations, physician services are subject to different conditions than hospital services.

OHIP will pay only for insured, emergency out-of-country health services that are rendered to an insured person. To qualify as an 'emergency' there are a number of criteria that must be satisfied. These criteria are set by regulation and include the conditions listed below that must be met :

  • the treatment must be medically necessary, and
  • the treatment must be performed at a licensed hospital or licensed health facility, and
  • the treatment must be rendered in relation to an illness, disease, condition or injury that :
    • is acute and unexpected, and
    • arose outside of Canada, and
    • requires immediate treatment.

These provisions are intended and designed to provide a very limited amount of funding for the medical treatment of insured residents of Ontario if they incur an unexpected illness, disease, condition or injury while they are outside of Canada. If the illness, disease, condition or injury arises before you leave Canada, or if it is not acute or unexpected, no payment can be made.

OHIP does not cover:

  • treatment that is medically unnecessary>
  • health services that are rendered at a facility that is not a licensed hospital or licensed health facility
  • treatment that is generally accepted by the medical profession in Ontario, as being experimental, or for research or for part of a study
  • treatment rendered for an illness, disease condition or injury that arose inside Canada
  • ambulance services or transportation costs
  • other services specifically set out in the regulations as uninsured or otherwise not listed as insured

Types of Travel Policies:

  • Multi-trip Worldwide
  • Multi-trip within Canada
  • Single Trip Worldwide
  • Single Trip within Canada
  • Single Trip Worldwide excluding USA
  • Student Medical Plan

Pre-Existing Coverage:

59 Years of Age or Younger: No Stability period for trips 35 days or less*, 90 day stability period for trips greater than 35 days.

60-74 Years of Age: 180 day stability period for all trip lengths.

75-89 Years of Age: 365 day stability period for all trip lengths.

*Conditions and or symptoms that have worsened on the date of departure, or at any time within the seven days prior to the date of departure, other than minor ailments, will not be covered.

Family rates are available for individuals up to 59 years of age. Please read policy wordings for full coverage details or discuss with your broker.

Student Medical Plan

Students travelling to other countries for studies will need to have a plan to cover unexpected medical costs while abroad. Below is a summary of coverage offered by this plan:

  • Maximum limit for coverage is $2 Million.
  • Insurance company pays emergency fees directly to the hospital or doctor of your choice.
  • You must be undergoing treatment for a medically necessary and for an acute, sudden and unexpected sickness or accident.
  • Covers hospital confinement. Ambulance services, X-rays, and services of a physician. Prescriptions are covered to a max of $10 000 of a 30 day supply. There is coverage for rental of medical appliances. Private duty nursing has a maximum $15000 when prescribed by attending physician only in lieu of hospitalization.
  • $600 for chiropractor, physiotherapist, acupuncture, etc services. (Referral from physician required.)
  • Emergency air transportation.
  • Annual physician visit.
  • Non emergency treatment is covered to a maximum of $3000 - it has to be for treatment that is a direct result of the initial emergency medical treatment.
  • Maternity - $25000 for pre-natal care.
  • Impacted wisdom teeth $150 per tooth for extraction when medically necessary.
  • Emergency Dental - $5000 maximum for an accident requiring the repair of natural teeth.
  • Expenses for dental pain other than that caused by an accident $600.
  • Repatriation - in the event of your death, maximum $15000 for preparation and return of your body.
  • Maximum $5000 for burial or cremation.
  • $5000 maximum for the transportation costs of one family member to go to identify your body.
  • $1000 for out patient care from a psychiatrist or psychologist.
  • $10 000 for inpatient hospitalization for psychiatric or psychological reasons.
  • $5000 maximum to fly a family member in to be with you while you are in hospital if a physician deems it necessary.
  • $150 per day to max $1500 for meals and accommodation for that family member.
  • One visit for eye exam.
  • $200 for glasses or contact lenses, hearing aids as required by an accident.
  • $20 an hour to a maximum $400 for costs of qualified private tutoring in the event you are hospitalized for 30 days or more.
  • $10 000 max for death or dismemberment as a result of an accident during a covered trip.

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