Toronto

Ford government proposes scrapping OHIP's out-of-country medical coverage

The Ford government is proposing to end the Ontario Health Insurance Plan's limited coverage of emergency out-of-country medical costs.

Ontario's medicare plan covers just 5 per cent of typical traveller's urgent health costs

The province published the proposal to end OHIP's out-of-country medical coverage on its website on Wednesday. (Thaiview/Shutterstock)

The Ford government is proposing to end the Ontario Health Insurance Plan's limited coverage of emergency out-of-country medical costs, a move the Opposition says will hurt snowbirds and frequent travellers.

The province published the proposal on its website on Wednesday and is giving Ontarians until next Tuesday to respond. 

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.

The government is justifying the plan by saying OHIP covers just five per cent of the cost of a typical medical emergency for Ontarians travelling outside Canada, so purchasing travel insurance is already a necessity. It says the move is part of an effort 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 OHIP program] may be giving people a false sense of security that they have coverage when the coverage is very, very limited."

According to the 2018 auditor general report, the province pays $9 million a year in emergency out-of-country medical claims. 

OHIP reimburses $200 a day for an unexpected hospital stay in another country, and a maximum of $400 per day in an intensive care unit or surgical ward. In the U.S., hospitals typically charge 10 to 15 times those amounts.  

Concerns premiums will rise

The government says the change will have no impact on 99.5 per cent of Ontarians and will not affect health care coverage for Ontario residents travelling in other parts of Canada.

"OHIP data suggests, of those 40,000 Ontarians who do travel outside of Canada each year and require health services, over 90 per cent obtain private travel health insurance," says the posting. 

"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% of reimbursement for eligible costs." 

In a statement Wednesday, The Canadian Snowbird Association, which says it consists of 110,000 members, called the proposal "unprecedented" saying it would increase premiums for private travel medical insurance coverage — something it says will "burden" not only snowbirds who travel south during the winter, but also cross-border shoppers and Ontarians planning vacations.

The statement added that every province and territory in Canada reimburses residents who need emergency medical assistance while travelling outside the country. 

"We urge the Ontario government to maintain OHIP's Out-of-Country Travellers Program, which has helped countless travellers faced with unexpected medical emergencies while abroad," Karen Huestis, president of the Canadian Snowbird Association, said in the statement.

"We estimate that this proposal will increase travel medical insurance premiums in the province by 7.5 per cent." 

NDP slams lack of consultation 

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.

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. 

With files from The Canadian Press