How to avoid a massive holiday health care bill when OHIP out-of-country coverage ends

TORONTO -- If you are an Ontario resident planning to travel outside of Canada over the holidays and will be out of the country after Jan. 1, make sure you have adequate travel health insurance coverage or risk dealing with a crippling medical bill should a medical emergency arise.

The Ontario government’s decision earlier this year to scrap its “inefficient” out-of-country health insurance coverage takes effect January 1, 2020. This means Ontarians who end up requiring major inpatient emergency care, for example, can no longer claim the $400-a-day maximum that OHIP currently provides and the $50-a-day maximum allowed for emergency outpatient services, such as an MRI or a CAT scan.

Ontario Health Minister Christine Elliott announced the decision in May following a public consultation, pointing to the inefficiency of the province spending $2.8 million administering $9 million claims each year.

The existing OHIP coverage is quite minimal given the cost of medical care abroad, said Robin Ingle, chief executive of travel insurance firm MSH Ingle International, especially in countries such as the United States, the most popular destination for Canadians.

“Today they cover about five per cent of your global health bill,” Ingle told CTV’s Your Morning, noting that the province used to cover some 80 per cent of a traveller’s out-of-country medical bill. The province was forced to change its coverage in 1991 due to the cost of the U.S. healthcare system.

A hospital stay in the U.S. could cost $5,000 a night, said Ingle. An MRI typically costs US$1,000 to US$5,000, an X-ray can range from US$150 to US$3,000.

Some locations might require a cash payment up front or refuse treatment altogether without proof you can pay or have adequate coverage.

“There was a recent example of a Canadian who was in Thailand, fell off a ladder, was stuck in the hospital because the family didn’t have travel insurance,” Ingle said Monday.

“The bill starts ramping up, and if you need an air evacuation, it’s not just the hospital bed cost. An air evacuation back to Canada from Thailand would be about US$150,000; from the Southern U.S., it would be about US$20,000.”

Ingle argued the new set-up will actually be better in the long run and expects other provinces will follow Ontario’s lead.

“As an insurer, for example, it’s a major hassle for us to actually get compensation back from the provincial government. So you might get a little bit of a rate increase now, but you will have it go down over time, because the processes will be simpler for the travel insurer,” he said.

Patients living with kidney failure will continue to have the same partial coverage for out-of-country dialysis care under a new program.

WHAT SHOULD YOU DO?

You can ask about travel insurance through your credit card company, your employer’s insurance provider, a broker, or a travel agent, for example. Shop and compare insurance plans, and make sure you understand any requirements, conditions, and exclusions. Ask questions, such as:

• What does it cover? Does it include hospitalization while abroad?

• Ask specifically for the kind of products that you will need.

• What is the deductible, if any?

• How comprehensive is the plan? Are there coverage limitations or exclusions for certain destinations?

• Is the coverage renewable while you are out of the country?

• Who pays the bills upfront?

Regardless of your destination, the federal government recommends that your insurance covers the following:

• Medical evacuation to Canada or the nearest place with appropriate care, as well as the cost of a medical escort.

• Your pre-existing condition and have it in writing. Find out how your insurer defines “pre-existing condition” and what the limitations and restrictions are, and make sure the agreement covers a compassion clause and change of health clause.

• Preparation of your remains and repatriation to Canada in case of death.

For more detailed recommendations and advice from the government, visit: https://travel.gc.ca/travelling/documents/travel-insurance and https://www.canada.ca/en/global-affairs/news/2019/01/advice-for-canadian-travellers-buy-travel-insurance.html.