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Ontario government proposes ending OHIP coverage for travel outside Canada

Last Updated Apr 24, 2019 at 5:02 pm EDT

The Ontario government is proposing to end OHIP coverage for Canadians travelling outside of the country.

The parliamentary assistant to Health Minister Christine Elliott said Wednesday that the government is reviewing OHIP’s Out-of-Country Travellers Program as part of efforts to address the province’s $11.7 billion deficit.

“We don’t have an unlimited amount of money, obviously,” said Progressive Conservative legislator Robin Martin. “We want to maximize value we get for people and we think that this is not an effective use of our resources.”

The program currently covers out-of-country inpatient services to a maximum of $400 per day for a higher level of care, such as intensive care, as well up to $50 per day for emergency outpatient services, and doctor services.

Martin said the program offers limited travel insurance coverage – paying out as little as five cents on the dollar in some instances – and encouraged people to purchase additional travel insurance when they go abroad.

“Ontarians who decide to travel outside of Canada may continue to seek the best, most comprehensive coverage from travel insurance companies who already cover 94 per cent of reimbursement for eligible costs related to emergency care services out of country,” the proposal reads.

The province spends $2.8 million to administer approximately $9 million in claim payments through the program every year.

The Tories posted the proposed change on the province’s regulatory website Wednesday, offering the public six days to comment on it. The change would come into effect Oct. 1 if the government decides to proceed with it.

NDP legislator Marit Stiles called the cut “disturbing” and accused the government of attempting to sneak the change past Ontario residents without proper consultation.

“Without actually having a conversation with the folks who will be affected, who travel overseas or to the south during the winter months … I don’t know how this government can be making this decision at all,” she said. “I don’t really care how big or small it is.”

In her 2018 report, Auditor General Bonnie Lysyk said the Ministry of Health processed an average of 88,000 out-of-country claims per year over a five year period and paid an average of $127 per claim.

The majority of claims paid out in 2017-2018 – 83 per cent – were made for services in the United States, the report also notes.

Lysyk also uses an example to illustrate the quandary uninsured travellers can find themselves in even during simple border crossings.

She highlighted the case of “Mary” an Ontario resident who travelled to Buffalo for a weekend of shopping and was involved in a car accident during her trip. The woman returned to the province with a $10,000 hospital bill and $3,000 in doctor’s fees. After making a claim to OHIP, she was reimbursed $1,400, leaving her $11,600 out of pocket.

Lysyk also noted the high administrative costs of the program, but she said they arise because staff must check varying physician services fee rates and process claims manually. She recommended that the government seek ways to reduce administrative costs by adopting a single reimbursement rate for all health services obtained out-of-country.

She also recommended the government bolster efforts to inform Ontarians of the limit on reimbursement rates under the program and on the need to purchase private health insurance before travelling.