Every year, many Canadians learn that they were not fully covered by their Provincial Health Insurance Plan. After the fact, they find that they should have purchased emergency health coverage from a third party - whether they are travelling somewhere in Canada or out of Canada. An accident can happen to anyone, even during a very short business or recreational trip. Extra insurance should be purchased before you leave your home Province.
            For example, an outpatient visit to a U.S. emergency room may cost thousands of dollars pert day for the duration of your care, however some provinces will only reimburse up to a total of $50.00 CDN per day for this service regardless of the severity of the situation. Two nights in a U. S. hospital can cost over $10,000. If a patient needs surgery, air evacuation and other assistance, the health care bill could cost hundreds of thousands of dollars.
            Each Province sets the rates that they will pay for an illness that occurs in a different province, based on the local rates in the insured’s home province. Government Health Insurance does not cover several emergency situations such as ambulance (either land or air), private and semi-private rooms, the return of your vehicle, transporting a family member to be at your bedside, or returning you to your home province.

You are strongly advised to purchase
additional health insurance every time you leave Canada
to cover any expenses in excess of the limited funding
provided by Provincial Insurance Plans.

            Canada's publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health insurance plans. Known to Canadians as "Medicare", the system provides access to universal, comprehensive coverage for medically necessary hospital and physician services. Medicare provides health care services paid for by money collected from taxes.
            Most physicians in Canadian provinces and territories (except Quebec) will bill their own provincial health plan for services provided if you present your valid provincial health card. The provinces recover the funding monthly between each other.
            Emergency health services are those given in connection with an acute, unexpected condition, illness, disease or injury that arises outside Canada and requires immediate treatment. You are strongly advised to purchase additional health insurance every time you leave Canada to cover any expenses in excess of the limited funding provided by Provincial Insurance Plans.  In 1990, I suffered a heart attack in Nashville, Tennessee and was covered by OHIP, my Superannuation Group Policy, and by Blue Cross trip insurance. The ten day stay and angioplasty in the Nashville Memorial Hospital could have bankrupted us without the excellent insurance coverage. During that time we spoke to many Americans who had to sell their home to pay their medical expenses.
            Standards of hygiene may be different in other countries. Food, water, and ice cubes in your drink may be contaminated. The climate or environmental conditions may favour disease organisms which do not occur in Canada. One of our friends suffered an infection of parasites on a one-day trip across the Mexican border. Years later, he still requires treatment for this condition.
            Do not assume that coverage provided by your credit cards is automatically included or that the card alone provides adequate coverage. Some companies charge an additional premium for travel coverage. Others require that you pay for your travel arrangements using that card. Verify the conditions, limitations, and requirements before departure.
            Most insurance systems will insist that you travel home once you are stabilized so that you may be treated at a lower cost in a hospital in Canada.
            On November 29, 2006, Canadian Snowbirds Association President Gerry Brissenden met with the Honourable Tony Clement, Minister of Health, and the Honourable John Baird, in Ottawa. Follow this meeting, the Minister of Health wrote individually to each Provincial and Territorial Minister of Health concerning compliance with the Canada Health Act.
            Under the portability criterion of the Act (section 11), insured Canadian residents who are temporarily absent from their home province and outside Canada must continue to be covered for insured health services during their absence. Where the insured services are provided outside Canada, payment is to be made on the basis of the amount that would have been paid by the province for similar services rendered in the province, commonly referred to as the "home province" rate. This allows individuals to travel or be absent from their home province or territory, within a prescribed duration, while retaining their health insurance coverage. Canada's new government is committed to the Act. Each provincial and territorial government is responsible for ensuring that the five principles of the Act – portability, universality, public administration, comprehensiveness, and accessibility – are respected.
            Provincial Insurance Plans will not pay more than the service would have cost in your home province. Some provincial health plans do not allow the same amount per day when you are out of the country as they do if you are still in your home province.
            In Ontario, the government administers the Ontario Health Insurance Plan, called OHIP, which pays for health care services received by Ontario residents with a valid health card. The amount paid for out-of-country health services is very limited and usually will not be sufficient to cover the full cost of the services rendered.
            As an Ontario citizen you may be outside of Canada for a period of 212 days in any 12 month period and still maintain OHIP coverage. You may be covered for an extended period of time outside of Canada for study (the duration of full-time academic enrolment). If you work for a Canadian company and your job requires you to leave Ontario, you may be covered by OHIP for a period of up to five years. It is strongly recommended that you obtain additional private medical insurance and fully understand what your policy covers. If you are working as a missionary, OHIP will provide coverage for the unlimited duration of the missionary activities. You may apply for to OHIP for coverage of an extended vacation up to a two year period once in a lifetime. To be eligible you must have been physically present in Ontario for at least 153 days in the 12 month period for two consecutive years before the absence.
            Just remember that if you stay for extended periods of time each year in the United States, you must file an 8840 IRS Closer Connection form with the USA to prove that you have permanent home and other connections to Canada. Add the total number of days in the USA this year to 1/3 of the total days last year, then 1/6 of the days the year before. If this number is less than 183 days, then the 8840 form is optional. If the total is 183 or more, then you must submit the 8840 form.
            There are many providers of Out-of-Province Insurance to Canadian travelers whether you are traveling in your RV or going to the sunny South by car or plane. (See our website for a list of providers)
            Medipac Out-of-Province Insurance is available to members of the Canadian Snowbirds Association. Coverage can be available for single trips of durations up to 212 days or plans for multiple trips of a shorter duration.  Since my wife and I travel for short periods several times a year we are covered by a policy that offers 62 days for each trip. As long as we are committed to helping publish a magazine, we cannot have the luxury of six months in a warm Southern climate.
            In each Province, Blue Cross offers Out-of-Canada emergency medical care that even includes travel assistance services. This service includes emergency response in most major languages and arranging transportation home, if medically permissible. As well, it assists in locating an appropriate physician, clinic or hospital, monitors your medical treatment and keeps your family informed. It will also provide information and co-ordinate payment to the hospital and physician. It includes an in-house, worldwide, 24-hour emergency hotline with multilingual operators, as well as physicians or nurses on staff. It covers doctor’s visits and prescription medicines, pays for foreign hospitalization and related medical costs. It also provides up front and direct payment of bills and cash advances abroad, so you don’t have to be out of pocket. It will cover emergency transportation, such as ambulance services, and provides for medical evacuation to Canada or the nearest location with appropriate medical care.
            Manulife Emergency Medical Benefits offers out-of-province insurance to RVers up to 84 years of age for multi-trip plans but has no age limit for single trip plans. They can provide up to $5 million in emergency medical coverage, ambulance transportation, emergency dental treatment, expenses related to death, return home if recommended by attending physician, visit to bedside if traveling alone, and the return of children in the care of the insured, expenses for meals and hotel, and the return of your vehicle.
            At the time of application for insurance and during the whole Period of coverage, all Covered persons must be covered under their Government health plan of their province/territory of residence.
            Many Group Insurance policies offer a limited period of out-of-province insurance that can be topped up to a maximum of 212 days for RVers who plan to spend half the year in the USA. You can reduce your premiums for insurance if you take some of the risk yourself. Deductibles range from $99, $1000, $5000, to $10,000. The higher the deductible, the lower the premium. When you travel, your health insurance should offer a minimum of $1,000,000 coverage. You should also check to find out what pre-existing conditions are covered.
            In general, the older you get, the more likely you are to have a hospital visit. The longer the time you are away, there is more chance that you might get sick before you travel home. - So premiums get more expensive. 
            Always notify your insurance company if your health, medication, or dosage changes – you MUST notify your insurance company prior to travelling to ensure your coverage is still valid. Notify your travel insurance provider of your travel dates when your plans are finalized, and ensure your policy is paid in full before you leave. Purchase travel medical insurance before you leave your home province or territory.
            Read your entire insurance policy and pay special attention to any limitations of coverage or exclusions for pre-existing medical conditions – if you do not understand something, ask!
            For a full report on travel insurance and other pertinent information visit the Canadian Snowbird Association web site at http://www.snowbirds.org/html/pdf/TravellersReportCard2006/pdf

Emergency in-patient maximum fees paid outside of Canada by the Provincial Health Plans

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