If a patient leaves Canada specifically to obtain medical or hospital care, a medical specialist in B.C. must write to the province’s health care program (called MSP, or “Medical Services Plan”) and provide information regarding the medical necessity for the referral outside of Canada. The specialist needs to provide information about what other treatment options have been explored elsewhere in B.C. and/or Canada. Treatment which is considered to be experimental or still in the developmental (research) stage is not eligible for coverage. Also, if the patient does not obtain MSP approval for elective out-of-country medical care, all costs for services received outside Canada will be the patient’s personal responsibility. Travel and accommodation costs are also not eligible for coverage. This is explicitly detailed on the B.C. Government’s website ‒ click here 

More information about patients obtaining medical care outside of British Columbia is available ‒ click here

The Alberta Health Care Insurance Plan (AHCIP) provides coverage for insured physician and hospital services elsewhere in Canada.

Alberta has reciprocal agreements with all provinces and territories (except Quebec) for insured physician services. An Albertan can visit a physician in almost every province or territory, and in most cases, they will not have to pay up front for insured services. Alberta also has reciprocal agreements with all provinces and territories for insured hospital services. A patient can get insured health services at any publicly funded or general hospital in Canada. In most instances, the bill will go straight to the AHCIP.

Furthermore, if a patient chooses to have treatment at a private facility in another province or territory, they are responsible to pay the cost of physician services over the amount covered by the AHCIP. They will also be responsible to pay the facility fees, including laboratory services, MRIs and accommodation. To learn more ‒ click here

Of note, AHCIP coverage is severely limited when it comes to obtaining health care outside of Canada. The government’s website specifically indicates that “hospital services provided in a private health facility will not be reimbursed.” This includes elective treatment and surgery, transportation, ambulance services, prescription medication, medical and surgical appliances, and clinical trials. To learn more ‒ click here

Saskatchewan health coverage covers most medically necessary services (hospital and physician) provided in a publicly funded facility in Canada. However, it only provides limited emergency medical care coverage outside of Canada.

Saskatchewan Health provides limited coverage for emergency medical care from approved hospitals outside Canada if the same services would be covered in the province. Saskatchewan Health will pay up to $100 CAD per day for inpatient services, and up to $50 CAD for an outpatient hospital visit.

However, if a specialist refers a patient outside Canada to receive treatment not available in Saskatchewan or other provinces, Saskatchewan health coverage may cover the full cost of the treatment. Of note, prior approval by the government is required. The specialist must ask for prior approval from the Medical Services Branch of Saskatchewan Health or from the Saskatchewan Cancer Agency. If the treatment is approved, the government will pay the full cost of treatment at a rate that the Saskatchewan Ministry of Health considers fair and reasonable after taking into account the location where the insured service is provided. To learn more ‒ click here

Manitoba has agreements with all Canadian provinces (except Quebec) to allow physicians to bill a provincial health plan, although some physicians may choose to bill directly.

Manitoba Health will also pay for emergency doctors’ services outside of Canada at a rate equal to what a Manitoba doctor would receive for a similar service.

Emergency hospital care abroad is paid on an average daily rate established by Manitoba Health. The patient may be charged more than the amount paid by Manitoba Health for services provided outside Canada. The difference above the covered amount may be substantial and is the responsibility of the patient.

When a patient needs medical treatment or care that cannot be provided in Manitoba, the province may cover some of the costs of this care abroad, based on a specific approval process. The patient may be eligible for help with costs related to getting medical care in another province or country when an appropriate physician recommends that they need a necessary, specific medical service, and that treatment is not available in Manitoba.

If the prescribed treatment is not available in Manitoba, the specialist must write a letter to Manitoba Health, and provide certain information about the case. Manitoba Health will review the letter from the specialist, and seek an opinion from a medical consultant if necessary. After reviewing the case, Manitoba Health will write back to the specialist to approve or deny coverage for out-of-province treatment.

Of note, Manitoba Health will pay for care or treatment in the United States only if all Canadian medical resources have been exhausted. In some cases, documentation (e.g, proof) that the patient has seen other Canadian specialists may be required before the request for referral outside the country will be considered.

For medical and hospital services provided in the U.S., Manitoba Health will cover doctor bills at the same rate a Manitoba doctor would receive for similar services, and hospital bills up to 75 per cent of insured hospital services. If the costs for medical and hospital services exceed these coverage limits, it will be the responsibility of the patient to pay the difference, unless the patient qualifies for special assistance based on financial hardship. To learn more ‒ click here

Similarly to Manitoba, Ontario will offer support for patients to receive treatment abroad if they are recommended to do so by a physician.

If a physician determines that a patient requires out-of-country hospital or medical treatment, the physician must submit a Prior Approval Application to the Ontario Ministry of Health for consideration. With limited exceptions, applications must include written confirmation from a specialist that the regulatory conditions for funding are satisfied.

The requested services must be performed at a hospital or licensed health facility, not experimental or for research purposes, and either not performed in Ontario by an identical or equivalent procedure, or performed in Ontario but the insured person must receive the services outside Canada to avoid a delay that would result in death or medically significant irreversible tissue damage.

Expenses incurred for non-medical services such as travel, accommodation and meals (except where included as part of insured hospital services) are NOT covered by OHIP. To learn more ‒ click here

The Régie de l’assurance maladie du Quebec (RAMQ) will provide for certain health care services abroad that are covered by the RAMQ if the patient has a valid health insurance card. However, in most cases, RAMQ will only reimburse part of the cost. The proportion of services received abroad that are covered depends on several factors: the duration of the patient’s trip outside Quebec, destination, etc. In general, to remain eligible for health insurance, a patient must not be absent from Quebec for 183 days or more, consecutive or not, in a given calendar year (January 1st to December 31st).

The professional services covered by the RAMQ abroad are those rendered by doctors, dentists and optometrists, as long as the same services are covered in Quebec. RAMQ issues reimbursements for professional services at amounts not exceeding Quebec rates, even if the patient paid more.

The hospital services covered are those insured under the Hospital Insurance Plan, specifically, services received during a hospital stay or at a hospital outpatient clinic. These services include nursing care, diagnostic procedures, accommodation in a ward (a room with 3 or more beds), and prescription drugs administered during hospitalization. However, RAMQ will only reimburse the cost of hospital services received as a result of a sudden illness or an accident.

Certain services received outside Quebec are not covered by the Health Insurance Plan. These include:

• Any medical services not covered by Quebec Services rendered by a health professional other than a doctor, a dentist or an optometrist
• The cost of a private or semi-private hospital room
• Emergency transportation, by ground or air
• The cost of bringing a person back to Quebec
• Drugs purchased outside Quebec, even if prescribed by a physician
  
  

To learn more ‒ click here

For out-of-country services, New Brunswick Medicare only covers:

• Emergency hospital services;
• Emergency physician services at New Brunswick rates; and
• Services for which a patient has received prior approval.

An “emergency” is related to a specific incident that occurs while outside Canada where a delay in the provision of treatment would threaten life, such as (but not limited to) fractures, sutures, strokes and cardiac arrests. Emergency services do not include services related to a pre-existing condition which requires ongoing monitoring, or follow-up visits resulting from an out-of-country emergency.

However, New Brunswick Medicare covers out-of-country services not available in Canada on a prior approval basis only. This involves having a written request submitted to New Brunswick Medicare by a New Brunswick specialist who identifies a specific, medically necessary and scientifically acceptable service unavailable in New Brunswick or elsewhere in Canada.

Furthermore, as per the New Brunswick Medicare website, “Residents may choose to seek non-emergency out-of-country services, however, those who receive such services will assume responsibility for the total cost.” To learn more ‒ click here

Medical services for an emergency or sudden illness within Canada are covered for Island residents with a valid PEI Health Card. However, pre-approval by Health PEI is required for a non-emergency medical or hospital service, either in Canada or abroad.

A PEI physician or nurse practitioner will request approval for a patient’s out-of-province health service. Typically, the service will be approved only if the treatment is not available in the province. If treatment options within Canada have been exhausted and are not available, an out-of-country request can be submitted and assessed for approval. If approval is granted, all charges for insured services may be covered.

Nova Scotians who are referred by their health care provider for a medically necessary insured service outside Nova Scotia may be eligible for financial assistance. However, not all medical services are covered by Medical Services Insurance (MSI), and a patient cannot self-refer.

It is the patient’s physician’s responsibility to ensure that a referral is completed by an appropriate physician specialist in order to obtain pre-approval from MSI first. All referrals are reviewed by the MSI Medical Consultant on behalf of the Department of Health and Wellness under the Health Services Insurance Act.

The out-of-province treatment must be done in an accredited medical facility that is approved by MSI. If the patient wishes to be considered for financial assistance from MSI, they must not receive, or make payment or financial arrangement, for any medical service outside Nova Scotia until they have received pre-approval by MSI. Without pre-approval, the patient will be responsible for all costs of care, travel, and accommodation. The patient will also be responsible for any costs not covered by MSI.

All pre-approved medically necessary services that are provided on an in-patient or out-patient basis will be insured at 100%. Upon approval, the patient will also be advised by the Department of Health and Wellness, in writing, if they are eligible for financial assistance with travel and accommodation, and how to submit claims for reimbursement. To learn more ‒ click here

Claims for certain medical services obtained outside Canada, that are available in Newfoundland and Labrador, are paid at Newfoundland and Labrador Medical Care Plan (MCP) rates, which are the rates paid to Newfoundland and Labrador physicians. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.

Insured medical services obtained outside of Canada which are not available in Newfoundland and Labrador ‒ but are available in another province ‒ are payable at the rates established by the medical care plan in that province. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.

However, if a patient is planning to have insured medical treatment which is not available in all of Canada, and they wish to claim reimbursement of the related medical costs through the MCP, the patient must ask their physician to request prior approval from MCP before obtaining such treatment in another country. In doing so, they will be made aware in advance of the rate at which their medical bills will be reimbursed.

If the patient is granted prior approval based on the unavailability of the services in Canada, the Medical Care Plan will provide coverage for medically necessary physician services. Payment will be in the currency of the country where the services are received provided the rates are deemed to be fair and reasonable as determined by the Newfoundland and Labrador Department of Health and Community Services. Prior approval is mandatory to receive payment at rates higher than those published in the MCP or other provincial physician fee schedules. If a patient opts to travel outside the country for medical service/treatment and prior approval has not been granted, the fees for services rendered will be the responsibility of the patient. To learn more ‒ click here