The basic requirement for being covered for healthcare services within your province is that you be a resident of your province. The residence requirements are that you reside there a minimum of 183 days per year.
When you are traveling, are you still covered by your province’s coverage?
The Canada Health Act in s. 11 talks about out of province coverage in the portability section.
Services that are necessary for the person to stay healthy, or medically necessary services by hospitals and physicians, are covered to people who are “eligible residents” when their out of province stay is temporary.
Generally, inside Canada when in you are visiting a province or territory other than your own, hospitals or doctors will accept your health card due to bilateral billing agreements.
There may be a requirement from another province/territory to pay them upfront and then seek reimbursement from your own provincial healthcare plan.
As provincial or territorial coverage can vary from one province/territory to the next, procedures that are covered in your province/territory may not be covered in another.
For example, if your home province/territory covers ambulance service but you are visiting a province/territory that does not, you will have to pay out of pocket for the service. Though your province may cover additional benefits, they cannot be taken out of the province.
It may be a good idea to set up private insurance for health services that may not be covered.
What if I travel outside of Canada?
If you travel outside Canada and you get sick, the province/territory of your residence necessitates that whatever health care services you receive in another country be at the rate of what the province/territory pays for such services. It’s a very good idea therefore that you buy private health insurance for the entire time that you will be outside of the country.
What if I’m seeking medical treatment outside of Canada?
You need to be aware that if you choose to have surgery outside of Canada, your surgery will not just be paid by your provincial/territorial healthcare plan.
Usually the province/territory health insurance plan requires you to seek their approval for the treatment. If you don’t, you may well be stuck with the bill for the treatment.
If you are going to have treatment outside of Canada you may want to seek advice from a lawyer.
When does my healthcare coverage kick back in after I have been outside of the country for an extended period?
Generally, there is a three-month period waiting period for your healthcare plan for you to be covered again. You may want to contact your provincial/territorial health ministry though for further information.
If you are facing issues with traveling and your health, you may want to consult a healthcare lawyer.
Canada Health Act – Frequently Asked Questions
OHIP Out of Province Services Ontario