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Canada - ENTravel Insurance
Understanding Your Out-of-Province Government Medical Coverage
By Maxine Betteridge-Moes • Published November 30, 2022 • 7 Min Read
Most Canadians are fortunate to have provincial medical coverage for hospital visits, outpatient services and prescription drug costs incurred in-province. But your provincial health care plan may not provide coverage for emergencies while outside your province.
Most Canadians are fortunate to have provincial medical coverage for hospital visits, outpatient services and prescription drug costs incurred in-province or in-country. All provinces and territories except Quebec have a billing agreement that provides coverage for insured hospital and physician services, but some plans have exceptions.
Want to know how much out-of-province medical coverage your province or territory provides?
For more in-depth and up to date information regarding out of province coverage visit your province’s approved health insurance website. Understanding the coverage you have before you travel is an important part of planning a trip.
Alberta
Plan: Alberta Health Care Insurance Plan (AHCIP)
Details: AHCIP provides coverage for insured physicians and hospital costs in other provinces across Canada. This means that in most cases when you present your AHCIP card to a medical or hospital service provider in another province, there is no cost to you. If you visit a physician in Quebec, you may have to pay up front, but can submit a receipt to AHCIP to be reimbursed. If you use a private facility you will have to pay facility fees including laboratory services, MRIs and accommodation.
There is limited coverage for physician and hospital costs outside of Canada. For expenses incurred out-of-country, AHCIP will cover a maximum of $100/day for hospital services, and a maximum of $50/day for outpatient services. Travelers are responsible for paying the health service provider first and then can submit a claim to the AHCIP office to request reimbursement for eligible out-of-country health expenses. The traveler is responsible for paying the difference between the amount charged and the amount AHCIP reimburses.
British Columbia
Plan: Medical Service Plan (MSP)
Details: British Columbia’s MSP will help pay for unexpected medical services outside of the province if they are normally insured by MSP. Reimbursement for physician services will be made in Canadian funds and any excess cost is the responsibility of the beneficiary. When travelling to Quebec or outside of Canada, you will probably be required to pay out of pocket for medical services and then get reimbursement after.
MSP does not provide any coverage for treatment provided by a non-physician health care practitioner (e.g., physician assistant, nurse practitioner, chiropractor or physical therapist), prescription drugs, medical supplies or ambulance services outside the province. The province will pay up to $75/day for emergency hospital services outside of Canada.
Manitoba
Plan: Manitoba Health, Seniors and Active Living (MHSAL)
Details: Manitobans who travel to another province are still covered by MHSAL if they present their Manitoba Health card to a hospital or other medical care centre.
Travellers admitted on an emergency basis to a hospital outside of Canada are covered by MHSAL for services, based on established daily rates but are responsible for some of the costs. Care received as a hospital outpatient or from an emergency room outside of Canada is covered up to $100/visit. Physician services are covered at the same rates paid to Manitoba doctors.
New Brunswick
Plan: Medicare
Details: New Brunswick Medicare will cover insured physician or hospital services in all provinces and territories, except for Quebec, upon presentation of a Medicare card.
The plan will cover only emergency out-of-country physician and hospital services with prior approval, at a maximum of $100/day for in-patient services and $50/day for outpatient services.
Newfoundland & Labrador
Plan: Medical Care Plan (MCP)
Details: Provides limited coverage for travellers under the Medical Care Plan (MCP) and the Hospital Insurance Plan. MCP covers only insured services and does not cover all charges related to hospitals and clinics or ambulance/air ambulance services inside or outside of Canada. Individuals who leave the province for more than 30 days will need an out-of-province coverage certificate.
Nova Scotia
Plan: Medical Services Insurance (MSI)
Details: MSI will provide coverage to Nova Scotia residents for medical expenses incurred anywhere in the country, upon presentation of a valid health card, except Quebec for physician services.
For out-of-country medical care, MSI will cover emergency medical services only, at Nova Scotia rates. The current rate for emergency in-patient services in-province is $525 a day, plus 50 percent of ancillary fees incurred during an in-patient stay. The program will not cover ambulance services, Pharmacare, children’s dental programs, routine vision analysis, or any out-patient charges, including X-ray, diagnostic tests and laboratory charges.
Ontario
Plan: Ontario Health Insurance Plan (OHIP)
Details: OHIP will cover physician and hospital services outside of the province upon presentation of a valid health card. Physicians outside of Ontario can choose to bill the province directly, in which case the patient doesn’t pay anything, or to bill the patient, who will be reimbursed upon submitting appropriate documents and invoices to OHIP.
As of October 1, 2019, OHIP no longer covers Ontario travellers facing emergency medical expenses outside of Canada.
Prince Edward Island
Plan: Health PEI
Details: Island residents are covered for medical emergencies or sudden illness anywhere in Canada, at PEI rates. Costs incurred for non-emergency care received outside of the province are not covered without prior approval from Health PEI.
When travelling outside of Canada, coverage is available for emergency or sudden illness up to a set amount. The difference between the medical fees charged and the amount that Health PEI will pay is the responsibility of the traveler.
Québec
Plan: Régie de l’assurance maladie Québec (RAMQ)
Details: Québec residents who hold a valid health insurance card can receive out-of-province health care services under the Québec Health Insurance Plan (RAMQ), but in most cases, RAMQ reimburses only part of the cost. For example, a patient seeking hospital services in Ontario totaling $928 will be reimbursed only $422. The patient is responsible for paying the difference.
For out-of-country expenses, RAMQ will cover a maximum of $100/day for hospital services and a maximum of $50/day for outpatient services. For hemodialysis and the required medication, RAMQ will cover up to $220/treatment, regardless of whether the cardholder is hospitalized.
Saskatchewan
Plan: Saskatchewan Health
Details: The province provides coverage for physician and hospital care across Canada upon presentation of a valid health card. Travelers to Quebec may have to pay for physician services then submit a bill to the Ministry of Health for reimbursement at Saskatchewan rates.
For out-of-country care, Saskatchewan Health will provide limited coverage from approved hospitals at Saskatchewan rates, and only if the same services would be covered in-province. Saskatchewan Health will cover a maximum of $100/day for hospital services and a maximum of $50/day for outpatient services.
Yukon
Plan: Yukon Health Care Insurance Plan (YHCIP)
Details: YHCIP provides basic coverage for hospital and physician services from publicly funded hospitals inside or outside of Canada, at Yukon rates. There are limitations within this coverage.
YHCIP does not provide coverage for air or ground ambulance services or any related services, such as hospital transfer, escorts or return transportation charges, regardless of where the expenses are incurred.
It’s important to note that non-physician (e.g., physician assistant, nurse practitioner) and non-hospital (e.g., chiropractic, dental care) services are not covered under most provincial plans.
For more in-depth and up to date information regarding out of province coverage visit your province’s approved health insurance website. Understanding the coverage you have before you travel is an important part of planning a trip.
When you are ready to get away, RBC Insurance will be there to help you with your travel insurance needs. Click to get a travel insurance quote.
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This article is intended as general information only and is not to be relied upon as constituting legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. Information presented is believed to be factual and up-to-date but we do not guarantee its accuracy and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the authors as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Royal Bank of Canada or any of its affiliates.
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