I live outside Canada , 5-6 months out of the year hence am not a burden on the provincial system in Ontario.
That being said I do sometimes need to see a doctor outside Canada due to a condition that can’t wait 5 months to be attended in Canada , example bladder infection.
Can this doctor visit be covered by Ohip and if so how do I make a claim?
Hello,
Thank you for sharing your situation and question with us.
We can appreciate that you would be interested in this type of information.
You can find some detailed information regarding this type of situation on the Ministry of Health and Long-Term Care website.
Here is an excerpt,
When I travel outside of Canada, will OHIP pay the same medical expenses that are covered in Ontario?
No. If you are a resident of Ontario and you are insured under OHIP, you are entitled to very limited funding certain range 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
and
What does OHIP cover while I’m out of the country?
OHIP will pay very limited amounts for physician services and hospital/health facility services, and only if certain conditions are satisfied (refer to section below “What is not covered by OHIP? ”). 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
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.
What is not covered by OHIP?
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.
I hope this information is helpful. Please let us know if you have further questions and if there is any follow up to your question/situation.
=====Settlement.Org Content and Information/Referral Specialist, CIRSSettlement.Org