What Canadian Travellers Need to Know About Provincial Health Insurance Coverage Limits!

Think your provincial health insurance will cover you when travelling outside Canada? Think again. Learn the ins and outs of provincial health insurance limits for Canadian travellers.

Provincial Health Care Coverage Limits for Snowbirds

Many Canadian are under the false impression that their provincial health care plans will cover most or all of their medical expenses if they require emergency medical attention while travelling.

Unfortunately, the reality couldn’t be farther from the truth. The fact is, your provincial health plan only covers a tiny fraction of medical treatment expenses you incur while outside Canada and often won’t cover all expenses for medical treatment you receive outside your home province within Canada.

While it’s important for all travellers to be aware of these limitations, it's particularly so for snowbird and senior travellers who often spend longer periods of time outside Canada and may be more likely to experience medical issues.

That’s why we’ve created the following guide to the ins-and-outs of provincial health care plans for Canadian travellers, including what provincial plans cover, the importance of maintaining your provincial coverage and why supplemental coverage is essential, particularly if you’re travelling outside Canada.

What do provincial health care plans cover for Canadian travellers?

If you’re under the impression that your provincial health insurance plan will cover you for medical costs while travelling outside your home province, think again.

Travelling outside Canada

When travelling outside Canada, there are three important limitations you need to be aware of:

  1. Your provincial plan will only cover a small fraction of medical treatment expense you incur while outside Canada, leaving you on the hook to cover the balance of these expenses.
  2. Your provincial plan will only cover expenses for emergency medical treatment that is medically necessary and not related to a pre-existing medical condition.
  3. Your provincial plan may exclude coverage for certain medical treatments and services altogether, such as prescription drugs, ambulance services, emergency dental and transportation back to your home province (exclusions vary from province to province).

For example, Ontario’s Ontario Health Insurance Plan (OHIP) will only cover the following amounts for out-of-country medical treatment:

  • Emergency Room Visit (Outpatient) - up to $50 CAD per day
  • Emergency Room Visit (Inpatient) - $200 - $400 per day
  • Doctor Visit - The OHIP rate that would be paid to an Ontario doctor for the same service.

(You can find a summary of coverage limits for each province below)

To put this in context, consider the following costs of receiving medical treatment in the United States:

  • a typical hospital stay in the U.S. can cost $10,000 USD per day and be as high as $25,000 USD or more, depending on the severity of the emergency and the treatment you receive.
  • a typical doctor’s visit in the U.S. can cost $200 to $1,600 USD and can be as high as $2,500 USD or more, depending on the medical facility and the treatment you receive.

Using the OHIP example above, an Ontario resident would only be covered for approximately 2% – 4% of typical emergency medical treatment costs received in the U.S.!

What about travelling to countries other than the U.S.?

You may be surprised to learn that while medical treatment costs for travellers may be lower in other countries, they are often much higher than you would expect and can sometimes even be comparable to costs in the U.S.

In addition, while medical expenses may be lower in countries other than in the U.S., the cost to repatriate you back to Canada via air ambulance will be much higher.

If you’re travelling outside Canada, whether it’s in the U.S. or another country, obtaining supplemental travel medical insurance is a must. Otherwise, you risk being on the hook personally for tens of thousands or even hundreds of thousands of dollars in medical expenses.

Provincial Health Plan Coverage Limits for Out of Country Medical Care

Province / Territory

Emergency Room Coverage Limits While Travelling Outside Canada*

 

Outpatient Visit

Inpatient Visit

Alberta

  • Up to $50 CAD per day
  • $100 CAD per day

British Columbia

  • Up to $75 CAD per day
  • $75 CAD per day

Manitoba

  • Up to $100 CAD per day
  • Same rate as the provincial rate sheet

New Brunswick

  • Up to $50 CAD per day
  • $100 CAD per day

Newfoundland

  • Same rate as the provincial rate sheet
  • Same rate as the provincial rate sheet

Nova Scotia

  • None declared
  • $525.00 CAD + 50% of ancillary fees incurred while an inpatient

Ontario

  • Up to $50 CAD per day
  • $200 - $400 CAD per day

Prince Edward Island

  • Same rate as the provincial rate sheet
  • Same rate as the provincial rate sheet

Quebec

  • Up to $50 CAD per day
  • $100 CAD per day

Saskatchewan

  • Up to $50 CAD per day
  • $100 CAD per day

Yukon Territory

  • Same rate as the provincial rate sheet
  • Same rate as the provincial rate sheet

*As of November 15, 2018. Please note that this is only a summary of provincial plan limits and these limits may change from time to time without notice. Contact your provincial health care plan provider for complete out of country coverage limits and details.

What about travelling within Canada?

A common misconception among Canadian travellers is that their provincial health insurance plan will fully cover them if they require medical treatment when travelling in another province within Canada. However, this is only partially true.

While your provincial plan will cover most emergency medical expenses in another province, certain treatments and services may be excluded from coverage, such as ambulance services, prescription drugs, transportation back to your home province, returning your vehicle to your home province and medical services that are not covered under your home province’s plan. Coverage details and exclusions for treatment in other provinces within Canada vary from province to province.

While the financial risk of not having supplemental travel medical insurance is much lower when travelling within Canada than when travelling to another country, it’s still a smart move to obtain private travel insurance, as gaps in your provincial coverage could leave you with thousands of dollars in out of pocket medical costs and other expenses.

Make sure you don’t lose your provincial health care coverage!

Most travellers aren’t aware that spending too much time outside your home province can result in you losing your provincial health care coverage, which can have serious implications for your travel medical insurance coverage.

That’s because travel medical insurance policies require you to have valid provincial health insurance coverage both at the time you purchase your policy and any time you make a claim.

If you don’t have provincial health insurance coverage in place, you travel insurance provider can void your policy and deny your claims, even for medical treatment you receive outside Canada that wouldn’t otherwise be covered by your provincial plan.

Alternatively, some providers will cap your coverage limits if you don’t have provincial health insurance. For example, your policy may have a coverage limit of $10 million, but if you don’t have provincial coverage, this amount may be reduced to $50,000 or less.

Accordingly, snowbirds and other travellers who spend significant periods of time outside their home province must take steps to maintain their provincial coverage by complying with the eligibility requirements outlined by your home province.

Provincial rules for maintaining your health care coverage

If you are already covered by your province’s health insurance plan, be aware that you are required to spend a minimum number of days in your home province to maintain your coverage. These requirements vary from province to province and failure to meet your province’s minimum threshold can result in losing your coverage.

Below is province by province summary of the minimum amount of time individuals with provincial health care coverage must spend in their home province to maintain their insurance:

Province / Territory

Minimum Requirements to Maintain Provincial Health Care Coverage**

Alberta

  • You must be physically present in Alberta for at least 183 days in any 12 month period.
  • You may remain eligible for AHCIP coverage if, on a recurring basis, you are absent from Alberta for up to 212 days in a 12-month period for the purpose of vacation (i.e. snowbirds). Contact the AHCIP for eligibility details.

British Columbia

  • You must be physically present in British Columbia for at least 6 months in each calendar year.
  • However, eligible B.C. residents who are outside B.C. for vacation purposes only, are allowed a total absence of up to 7 months in a calendar year.

Manitoba

  • You can spend no more than 212 days outside Manitoba in any 12 month period. It is recommended you notify Manitoba Health, Seniors and Active Living for departures longer than 90 days.

New Brunswick

  • You can spend no more than 212 days outside New Brunswick in any 12 month period.

Newfoundland

  • A certificate must be obtained from MCP if leaving the province for more than 30 days. Certificates are valid for 8 – 12 months.
  • Must meet certain residency requirements prior to each certificate

Nova Scotia

  •  You must be present in Nova Scotia for at least 183 days in a calendar year.

Northwest Territories

  •  You must be physically present in the NWT at least 153 days during each calendar year

Nunavut

  • Nunavut must be your “primary place of residence”

Ontario

  • You can spend no more than 212 days outside Ontario in any 12 month period if you have lived in Ontario for more than 6 months.
  • You can spend no more than 30 days outside Ontario if you have lived in Ontario for less than 6 months.

Prince Edward Island

  • You must spend 6 months plus a day in Prince Edward Island every year

Quebec

  •  You must be present in Quebec for at least 183 days per year per calendar year.
  • Absences of 21 consecutive days or less and days of return or departure are not included in the calculation

Saskatchewan

  • You must normally live in the province for at least 5 months a year.

Yukon Territory

  • Must be physically present in Yukon and not absent for more than 6 months
  • If you will be away for 3 months or more, you must fill out a Temporary Absence form

**As of November 15, 2018. Please note that this is only a summary of the minimum amount of time you must spend in your home province to maintain your provincial health insurance coverage and these requirements may change from time to time without notice. Contact your provincial health care plan provider for current requirements.

Extending your provincial coverage when exceeding the travel limit

If you plan on spending more time outside your home province than your provincial health care plan allows, most provinces will permit you to apply to have your plan extended, essentially allowing you to be away longer without losing your coverage.

However, the application process, criteria and limits for extending your provincial health care coverage vary by province, so be sure to check with your province’s health ministry for details.

Disclaimer: The material provided in the Snowbird Advisor Insurance Learning Centre is for informational purposes only and does NOT constitute insurance, legal, financial or other advice, and should not be relied on as such. If you require such advice, you should speak with a qualified professional to assist you.