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OHIP Eliminates Out-of-Country Medical Payments

The money “saved” could go to good use in Ontario hospitals

The Ontario government has announced that OHIP will not pay for out-of-country medical care as of October 1, 2019.

This change will have minimal impact on travellers and could have a positive impact on Ontario residents seeking medical care within the province. The reason is that OHIP reimbursed very little of out-of-country medical costs and spent millions of dollars in administrative costs. Last year, OHIP paid $9 million for 88,000 claim reimbursements and the administration costs to do this were $2.4 million.

The contribution by OHIP towards out-of-country medical costs has been about 6% of the total claim. Ontario residents have been responsible for 94% of the average bill and sometimes even more. For example, if someone had a heart attack and required surgery and intensive care, their first-day cost would be at least $40,000 (CDN) and OHIP would only reimburse $400 for the first day and $400 per day for all of the subsequent days. For someone requiring emergency out-patient care or doctor services, OHIP would only reimburse $50 per day.

The OHIP announcement will have a small effect on travel insurance rates. Insurance companies will now have to pay the 6% of the invoice that OHIP used to pay. If insurance companies maintain national rates, they will factor in the added cost and non-Ontario residents will pay a little more as well. Rates should increase 4-5%. Some insurance companies have stated that, with the elimination of their administrative fees, rates are likely to go up less than 4%.

Think About It ...

The OHIP announcement means OHIP will no longer spend $11.4 million on out-of-country reimbursements. Wouldn’t it be nice if OHIP hired 47 more doctors (earning $200,000 per year) to reduce wait times in hospital emergency rooms?


Dan Donnelly is President of Travel Insurance Office Inc. and a founding member of the Travel Health Insurance Association.


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