HEALTH INSURANCE – Are YOU Covered in Canada?

ARE YOU VISITING OR LIVING IN CANADA WITHOUT HEALTH COVERAGE OR TRAVEL INSURANCE?

Does your situation fall into one of the following categories?
• You are a visitor to Canada.
• You are in Canada on a residency, working, or student visa.
• You are a resident of Canada waiting to become a legally landed immigrant.
• You are a foreigner married to a Canadian Citizen.
• You are a Canadian Citizen moving back to Canada with a child born outside Canada.
• You are a Canadian Citizen who has spent more than six months out of Canada.
• You are a Canadian Citizen moving from province to province.

If your situation falls in one of the above categories, the information to follow will be of significant interest to you.

Whether you are planning a visit to Canada or living in the country temporarily or permanently, there are some very important facts you need to know about Canada’s medical system to insure you and your family have adequate health coverage.

Despite misconceptions, Canada does not have free health care. If you or a family member should need medical assistance, the costs could be substantial if you do not have medical coverage. If you qualify, you would normally obtain health coverage with the provincial medical plan in the province you are residing. For those of you who do not qualify for provincial medical coverage, I cannot express enough the importance of purchasing travel insurance.

In my work in the health care field, I come across patients daily that have not bothered for whatever reason to obtain medical coverage. Usually they just do not know what questions to ask, or where to find the information they need. As a result, they have incurred medical bills in the tens of thousands of dollars. This creates a great financial burden for the patient, the patient’s family, and on the Canadian health care system. My hope here is to help you avoid such a financially disastrous situation for you and your family. After all, it’s stressful enough when you or someone you love has to seek medical attention.

The Canadian Health Care System

Every province, each having its own yet similar regulations, governs Canada’s Health Care system. The provincial medical plan program under provincial guidelines administers coverage.
Canadian citizens and legally landed immigrants eligible for provincial coverage in their province of residency, pay for that coverage through income taxes and in some provinces by monthly premiums. When valid, provincial coverage will pay for doctor visits, lab and radiology tests, and hospital stays. The plan does not cover prescriptions, some medical procedures, and supplies.

So how is eligibility for provincial coverage determined?

In order to qualify for provincial coverage in Canada, you must meet the following criteria:
- You must be a legal Canadian Citizen, a legally landed immigrant, or a refugee.
- You must also meet the residency criteria of the province you are residing in. This will vary by province but usually depends on you living in the province for at least three months.

Provincial coverage is mandatory in some provinces in Canada. Whether coverage is mandatory or not, provincial coverage will provide full or partial premium subsidy if you are a legal Canadian Citizen and your yearly income for the prior year was less than approximately $28,000. You will have to provide a copy of your previous income tax assessment as proof of income.

Do not confuse the term “residency” with valid citizenship when it comes to provincial eligibility. Just because a person is residing in Canada does not mean they qualify for coverage. A person must be a legal Canadian Citizen; a legally landed immigrant; a legal refugee; or have a residency, working, or student visa to qualify for MSP. They must also have been living in the said province for a length of time as required by the plan of that province. In most cases, this would be a minimum of three months counting the first month as a full month.

Canadian Citizens Moving from Province to Province

In most cases, your medical coverage in one province will expire three months after you have moved to the new province. When you arrive in the new province, you should register with the province’s provincial medical plan right away. In most provinces, you will have a three-month waiting period, which during that time; your medical coverage from the province you moved from should continue to be active. Some provinces do not require this waiting period so you will need to contact the Medical Services Plan in the province to where you are moving to confirm the waiting period criteria.

Canadian Citizens spending more than six months out of Canada

This is a very common situation for Canadian Snowbirds who leave Canada for several months at a time for warmer weather and sunnier skies. When they return to Canada, they often believe their medical coverage is still active. However, once they have left the country for (183 days) six months and one day the provincial plan will cancel their coverage automatically.

They have the option of contacting the provicial plan to apply for a term certificate prior to exiting Canada. If not done, they must reapply for provincial coverage upon their return. Depending on the province they are returning to, they may be required to wait the three-month period before their coverage will become active again. This waiting period is a crucial time as this is when they usually do not think to obtain temporary medical insurance. Obtaining travel insurance will provide coverage during the waiting period.

This situation would also apply to anyone who leaves Canada for more than six months to work for an employer in another country. The provincial plan does provide special coverage in cases such as these but you must contact them to get it. If you take employment outside Canada and have plans to return, you may have to provide them with a copy of your work contract that indicates the length of your work term. They may extend your coverage for up to 24 months. Make sure you notify them if your family will be joining you. If you need this particular coverage, make sure you know what the provincial medical plan is willing to cover.

Anyone who had left Canada for this extended period will usually have to provide proof to the provincial plan he or she has been back in Canada for more than three months. Proof would normally include utility bills and rent receipts.

Canadian Citizen moving back to Canada with a child born outside Canada

Just because a child born outside Canada has one parent, who is a Canadian citizen does not automatically qualify the child for medical benefits. The parent must apply for citizenship for the child with proof of the parent's own citizenship. The parent must also provide proof that he or she has been living in the province for the three-month period. Once the child receives citizenship, the three-month waiting period will still apply in certain provinces before the child will qualify for medical coverage. You should obtain travel insurance for the child until the waiting period has expired.

The same situation does not apply to a child born to a mother of Canadian Citizenship, living in Canada permanently and transferred to an out-of-country hospital for special maternity care. In this case, the child has coverage for three months under the mother’s Provincial Health Number providing her own provincial coverage is active. The mother should immediately register the baby as a Canadian Citizen and apply for the child’s own provincial health number (PHN). Three months after birth, the child’s coverage under the mother will become invalid so this is where registering the child at birth and applying for his/her own PHN number will eliminate delays in the child having coverage.

Visitors to Canada

In most cases, visitors from overseas will have purchased travel insurance before their trip. However, there are some cases when a visitor does not have medical coverage. This is common with skiers who have decided to extend their stay after their travel insurance has lapsed.

There are also those visitors who come over the USA/Canada border for a short visit, a seasonal stay at their summer or winter cottage, or for a day or weekend of shopping. These types of visitors are probably the most vulnerable to unexpected medical costs because they do not think they need to protect themselves with health coverage. After all, they may just be crossing the border for a day or so, why will they need insurance? I recommend you obtain travel insurance even if visiting Canada only for a couple hours, or several days.

A foreigner married to a Canadian Citizen

Just because you have married a Canadian Citizen, does not mean you automatically qualify for provincial medical coverage. You must qualify for provincial coverage just like any other person living in Canada.

Until you receive your legally landed immigration documents, you are considered a visitor by MSP and not eligible for coverage. You will have to fulfill the three-month waiting period after you receive your immigration papers. You must obtain travel insurance to protect yourself from any medical surprises during your waiting period.

Residents of Canada waiting to become legally landed immigrants

Many in this position do not know what to do. They realize they do not have any kind of medical coverage but they do not know what alternatives are available to them, so they do nothing. Then the medical crises hits but by then it is too late. Not only are the patient and the family members dealing with the stress of the medical emergency but now they also have the extra financial burden. As I stated earlier, someone waiting to obtain his or her landed immigrant status will not be eligible for provincial medical coverage until three months after the date stamped on the immigration documents. It could take months or even years before you obtain your legal immigration status. Purchase travel insurance to protect yourself in the meantime. Another way to deal with this is to obtain a residency, work, or student visa. However, you will still have to fulfill the three-month waiting period after your receive your visa.

Anyone in Canada on a Residency, working, or student visa

If you plan to come to Canada or are already here on a working, student, or residency visa there are some key factors you need to know.

Working Visa (Permit) – If you receive a work visa that is valid for at least 12 months, you may be eligible for medical coverage as of the date the visa was issued. If the visa is for less than 12 months, you will not be eligible for provincial medical coverage until you obtain an extension that allows you to stay in a province for at least 12 months. Once you get the extension, you will be eligible for coverage as of the date of the extension.

Student Visa (Permit) – To obtain medical coverage while on a student visa, your term of study must be for a period of at least 183 days (six months plus one day). Depending on the province you will be studying in, you may have to fulfill the three-month waiting period before you will be eligible for medical coverage.

Residency Visa (Permit) – A visitor residing in Canada on a Residency Visa in most cases is not eligible for provincial medical coverage; however, there are exceptions. Contact the medical services plan of the province you will be residing in to confirm whether you will be able to obtain coverage or not.

As with the working or student visa, do not let your visa lapse. If this happens, you may have to reapply for your provincial coverage and fulfill the three-month waiting period once again. If this happens, you will need to purchase travel insurance while you wait for coverage.

Travel Insurance

I have mentioned several times throughout this report you must obtain travel insurance if you do not qualify for provincial medical coverage. Most visitors traveling to Canada will have purchased travel insurance before coming to Canada.

Those people who have extended their visit; are here on a short term visit; are residing in Canada on a residency visa, or waiting for their legal immigration papers will usually not be eligible for medical coverage. Those here on working or student visas, and Canadians returning after an extended stay outside Canada will need to fulfill the three-month waiting period. These people will need to obtain some type of health coverage for short or long-term protection.

Travel insurance is relatively easy to obtain. Many health insurance companies will sell you medical coverage in and out of Canada. If you are already in Canada, some companies that sell car insurance also sell travel insurance. The best advice I can give you is to check around for the best quote, as some can be very expensive. I have heard of some companies selling travel insurance for $1.00 to $ 1.60 a day depending on your age and health while others charge around $1200 yearly.

How much coverage should you get? You may think $100,000 is a lot but the truth is it can add up quickly if you end up in an Intensive Care Unit for a week or more and need surgery as well. The doctors and surgeons who will be treating you are self employed in Canada and will bill you for their medical services above-and-beyond the hospital fees. Keep in mind, many companies will not cover you for a pre-existing condition, or maternity but the odd company may for an additional fee. Again, check around for quotes.

American Medicare

As a final note for American visitors, it is imperative I point out that USA Medicare will not cover you while you are in Canada. The only time it will pay your medical expenses is if you require medical attention while you are traveling from one state in the continental USA to Alaska and vise versa. Always check with your health insurance provider before traveling to ensure they will cover you in the event of a health emergency.

Medical Debt and Canada Customs and Immigration

There are 50 million visitors to Canada each year with its health care system suffering a loss of more than a billion dollars yearly. The sore spot is the lost revenue could have gone back into health care for much needed improvements to hospitals, better medical equipment, and more doctors.

Canada is stepping up its action to collect on medical debt incurred by uninsured non-Canadians and uninsured Canadians alike.

Now, if you leave a debt behind in Canada, that information is available to Canadian agencies including Canada Customs and Immigration. If you make an application for any one of the visas, to become a legal immigrant, or to enter Canada as a visitor, Canada Customs and Immigration may refuse your application or your entry into Canada until you pay your debt. That is not something you want to find out when you depart from the plane or enter one of the border crossings somewhere in Canada and refused entry.

Provincial Contacts for Medical Coverage:

British Columbia:
1-800-663-7100
Vancouver: (604) 683-7151
Victoria: (250) 382-8406

Alberta:
780-427-1432 (Edmonton)
Toll-free in Alberta, dial 310-0000 then 780-427-1432.

Saskatchewan:
Phone: (306) 787-3475
Toll-Free: 1-800-667-7523

Manitoba:
Phone: (204) 786-7384
Toll free: 1-800-392-1207

Ontario:
1-800-664-8988 (Toll-free in Ontario only)
TTY 1-800-387-5559

Quebec:
Quebec: 418-646-4636
Montreal: 514-864-3411
Elsewhere in Quebec: 1-800-561-9749

Prince Edward Island:
Telephone: (902) 368.6130

New Brunswick:
Phone: 1-888-762-8600 (from within North America)
Or (506) 684-7901 (outside North America)

Nova Scotia:
Phone: (902) 496-7008
Toll free 1-800-563-8880

Newfoundland and Labrador:
Phone: (709) 292-4000

North West Territories:
Toll Free: 1-800-661-0830
Phone: (867) 777-7400

Nunavut:
Toll free: 1-888-252-9869

Yukon:
867-667-5209 or 1-800-661-0408 (toll free within Yukon),

Disclaimer: The information provided in this article is a guide only and does not replace your responsibility to verify your eligibility for coverage by contacting MSP in the province you will be or are currently residing in. While every effort is made to present up-to-date and accurate information, the author is not responsible for any omissions, outdated, or misleading information on this blog or any site connected or linked to this page.