Travelling Within Canada and Beyond: What Your Provincial Health Insurance Covers

Whether you’re taking a cross-Canada road trip or you’re a snowbird looking to flock down south for the winter, it’s a common assumption that your provincial health insurance covers all your medical needs.

In reality, the type and amount of coverage vary by province or territory. So, before you leave your home province, even for a short or extended period, be sure to understand which medical services are covered and which aren’t.

Read on to find out what health coverage you receive while travelling within and outside of Canada. Plus, we’ll explain what’s not covered under your provincial or territorial health plan and why having supplemental travel insurance can be essential to protecting your well-being.

What your provincial health insurance covers when travelling within Canada

No matter if you’re hiking up the Rocky Mountains or driving along the Cabot Trail, Canadians receive some basic medical coverage while they’re travelling within Canada. The federal government designed the Canada Health Act, which sets out the standard of care for all provinces and territories. That means you can visit a family doctor or a hospital anywhere in Canada (except for Quebec), since the government health insurance plan (GHIP) is publicly funded.

Essentially, it’s a reciprocal medical billing agreement whereby, when you visit another province or territory and present your valid health card to receive a covered medical service, you likely won’t have to pay any out-of-pocket costs.

Be aware that Quebec isn’t part of the reciprocal program. So, visitors to Quebec who see a physician or go to a hospital will need to pay up front for medical treatment. They can submit a claim afterward through their provincial or territorial public health insurance plan for reimbursement.

Keep in mind that each province and territory sets its own guidelines for which medical services are covered. Also, medical coverage is limited, and reimbursement is based on the home province’s rate and in Canadian funds. So, you’ll need to pay for any additional charges above what your provincial or territorial health care plan reimburses you for. For example, if you visit another province and they charge $500 for a medical service, but your home province only covers $400, you’ll be on the hook for the $100 difference.

Uninsured medical services, such as cosmetic procedures, private duty nursing services, or prescription drugs, aren’t usually covered. As a result, the patient will need to pay out of pocket.

What your provincial health insurance covers when travelling outside of Canada

Your provincial or territorial health insurance plan may provide emergency medical services when you’re outside of the country. However, even if they do, if the country you’re visiting charges more than your provincial coverage, you’ll have to pay the difference.

To ensure you have sufficient coverage, additional travel medical insurance is an affordable way to protect you and your family while travelling.

Read more: What you need to know about international travel medical insurance.

Out-of-province medical coverage across Canada

Read on to understand the breakdown of the type of out-of-province medical coverage you’d be eligible for across Canada.

Alberta Health Care Insurance Plan (AHCIP)

AHCIP provides coverage for insured physicians and hospital services in other provinces and territories. Generally, when you present your AHCIP card to a medical or hospital service provider in another province to receive insured services, you don’t have to pay any fees.

If you visit a physician in Quebec, you may have to pay up front. However, you can submit a receipt to AHCIP for reimbursement. If you use a private facility in another province or territory, you’re responsible for covering the facility fees, including laboratory services, MRIs, and accommodation.

There is limited coverage for physician and hospital costs outside of Canada. For expenses incurred outside the country, AHCIP may cover up to $100/day for inpatient hospital services and up to $50/day for outpatient services.

Travellers are responsible for paying the health service provider first and can then submit a claim to the AHCIP office for reimbursement of eligible out-of-country health expenses. You’ll be responsible for paying the difference between the amount charged and the amount AHCIP reimburses.

British Columbia Medical Service Plan (MSP)

British Columbia’s Medical Service Plan will help pay for unexpected medical services outside of the province if MSP normally insures them. You will need to present your valid B.C. Services Card to receive treatment. Typically, the physician will bill directly to their provincial plan. Reimbursement for physician services will be processed in Canadian funds, and any excess costs are your responsibility. When travelling to Quebec or outside of Canada, you will likely pay out of pocket for medical services and then receive reimbursement from MSP.

MSP does not provide any coverage for treatment provided by a non-physician health care practitioner (such as a 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. If you receive elective (non-emergency) medical care outside of the country, then you’ll need pre-approval from a B.C. specialist to receive partial coverage for your medical services. Experimental or developmental treatment is not eligible for coverage.

Manitoba Health, Seniors and Long-Term Care 

Manitobans who travel within Canada are still covered by Manitoba Health, Seniors and Long-Term Care 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 Canada are covered by the province for services at established daily rates, but are responsible for some costs. Physician services are covered at the same rates paid to Manitoba doctors.

If you’re approved to see a specialist or to receive hospital care outside Manitoba but within Canada, the other province will send the bill directly to Manitoba Health, Seniors and Long-Term Care. In most cases, you do not have to pay out-of-pocket expenses.

Also, if you visit the United States for referred medical care that’s been approved, then your doctor bill will be covered at the Manitoba rate, and you’ll receive up to 75 per cent coverage for insured hospital services.

New Brunswick Medicare

New Brunswick Medicare will cover insured physician or hospital services in all provinces and territories, except for Quebec, upon presentation of a Medicare card. If you’re having genetic screening or experimental procedures from a physician from another province or territory, you may submit a claim, but there’s no guarantee that you’ll be reimbursed.

If you’re seeing a physician in Quebec, the physician may bill you directly or New Brunswick Medicare. If you’re eligible for reimbursement, it’ll be based on the New Brunswick rate, which may be less than the physician’s rate.

When travelling outside of Canada, the plan will cover emergency hospital and physician services, and medical services for which you received prior approval, at a maximum of $100/day for inpatient services and $50/day for outpatient services.

Newfoundland and Labrador Medical Care Plan (MCP)

The province provides limited coverage for travellers under the Medical Care Plan (MCP) and the Hospital Insurance Plan.

MCP covers only insured medical services within Canada, except for Quebec. Generally, you’ll be covered for a visit to the doctor or hospital, surgical procedures, maternity care, radiology interpretive services, and select medically necessary surgical-dental procedures performed in a hospital.

If you receive insured medical treatment in Quebec, you’ll first pay out of pocket and then submit a claim for reimbursement through MCP.

The provincial plan typically doesn’t cover ambulance services, whether in Canada or abroad. When travelling outside of Canada, the Hospital Insurance Plan will cover up to $350/day for a stay in a community or regional hospital, or up to $465/day for a stay in a tertiary or specialized hospital. For outpatient services, the coverage is up to $62/day. For hemodialysis, the maximum coverage is $330/day. Individuals who leave the province for more than 30 days will need an out-of-province coverage certificate.

Nova Scotia Medical Services Insurance (MSI)

MSI will provide coverage to Nova Scotia residents for medically necessary expenses incurred anywhere in the country, upon presentation of a valid health card, except for 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 per day, plus 50 per cent of ancillary fees incurred during an in-patient stay. When seeing a doctor due to an accident or sudden illness, the service is covered at Nova Scotia rates.

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.

Nunavut Health Care Plan

For residents of Nunavut, the province provides coverage for physician services and hospital visits in Canada. The coverage may include treatment of an illness or injury, obstetrical care, and surgery. If you’re visiting a hospital, your stay and meals at the ward level, necessary nursing services, and diagnostic procedures are generally covered. However, dental services, optometric services, or physical examinations aren’t covered.

If you’re leaving the country, the Nunavut Health Care Plan will cover limited costs for emergency health services at the province’s physician fee schedule and hospital reciprocal rates. Ground and air ambulance services are not covered.

NWT Health Care Plan

Residents of the Northwest Territories have coverage for medically necessary services from a physician or hospital in Canada. However, ground ambulance services or medevacs aren’t covered.

If you’re travelling outside of Canada, you can get coverage for medically necessary services, such as in the event of a sudden illness or emergency. The coverage amount is based on NWT rates and in Canadian funds.

If you plan to be away for more than 90 days, then you’ll need to submit a Temporary Absence Form. This rule applies to students enrolled in post-secondary studies, high-performance athletes, and snowbirds.

Ontario Health Insurance Plan (OHIP)

OHIP will cover physician and public hospital services outside of the province upon presentation of a valid health card. For example, it could be a visit to a walk-in clinic or to the ER if you need diagnostic services. Ambulance services, prescription drugs, or fees charged by private hospitals or facilities are not covered.

If you’re leaving Ontario to study, work, or visit another province or territory for more than seven months out of the year, be sure to contact ServiceOntario, as they may require proof of residency or a letter from your employer or educational institution.

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.

OHIP provides coverage for out-of-country emergency health services and prior-approved health services. OHIP will cover up to $50/day for emergency outpatient services. For emergency inpatient services, OHIP will cover $200 to $400 per day, depending on the type of care provided.

Health PEI

Prince Edward Island residents are covered for medical emergencies or sudden illness anywhere in Canada, at PEI rates. Costs incurred for non-emergency care received outside the province are insured only with 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 Health PEI will pay is the traveller’s responsibility.

Be sure to contact PEI Medicare if you plan to leave the province for more than one month to prevent delays in reimbursements.

La Régie de l’assurance maladie du Québec (RAMQ)

Quebec residents who hold a valid health insurance card can receive out-of-province health care services under the Québec Health Insurance Plan (RAMQ). In most cases, RAMQ reimburses only part of the cost.

If you seek professional services from a doctor, dentist, or optometrist, in or outside Canada, these are generally covered, but at the Québec rates.

For example, for a patient hospitalized in Ontario for a fracture, the hospital stay is covered, but the doctor’s professional services totalling $928, are reimbursed only $422. The patient is responsible for paying the $506 difference.

In terms of out-of-country expenses, you’ll have to pay the fee upfront and apply for reimbursement. RAMQ will cover up to $100/day for hospitalization services and up to $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 Health

Saskatchewan Health provides coverage for physician and hospital care across Canada upon presentation of a valid health card. Travellers to Quebec will need to pay for physician services and then submit a bill to Saskatchewan Health for reimbursement at SK rates. Community-based health services such as mental health, alcohol and drug, rehabilitation, or therapy services aren’t covered.

If you purchased a prescription drug elsewhere in Canada, you can submit the receipt to the Saskatchewan Drug Plan and Extended Benefits Branch. If the drug is covered in Saskatchewan, then you could receive reimbursement.

For out-of-country care, Saskatchewan Health will provide limited coverage from approved hospitals at SK rates, and only if the same services would be covered in-province. Saskatchewan Health may cover up to $100/day for inpatient hospital services and up to $50/day for outpatient services.

Yukon Health Care Insurance Plan (YHCIP)

YHCIP provides basic coverage for hospital and physician services at Yukon rates, from publicly funded hospitals inside or outside Canada.

YHCIP does not provide coverage for air or ground ambulance services or any related services, such as hospital transfer, travel escorts, or return transportation charges, regardless of where the expenses are incurred.

You may be eligible for medical travel coverage if your medically necessary service isn’t available in your community. You could receive mileage reimbursement for in-territory travel at 30 cents per kilometre for non-emergency insured health services. If you have approval for medical travel, you could claim a travel subsidy. 

Why you need travel insurance within Canada

Before you pack your bags and explore the Great White North, it’s important to review the out-of-province benefits that you’re eligible for. Remember, each province and territory sets its own terms for insured health services. 

Obtaining travel health insurance within Canada can give you peace of mind that you’re protected from unexpected events. For example, should you be involved in an accident, you may require full emergency coverage. Travel insurance could cover ambulance services, a medical evaluation by a physician, or emergency dental treatment.

If you ever need to cancel a last-minute trip due to an unexpected health issue or the death of a loved one, you may be reimbursed for financial losses incurred. Additionally, you can rely on the 24/7 worldwide medical emergency assistance that’s available to you during your trip.

Securing travel protection when you leave the country

You’ve got your passport, and you’re ready to travel abroad. You may want assurance that you’re protected if your trip doesn’t go as planned.

There are different levels of coverage available that can fit your budget and needs. You can choose from emergency medical, trip cancellation and interruption, baggage and personal effects, and travel accident coverage.

Many travellers may not realize that international medical services can come at a hefty price tag. With RBC travel insurance packages, you can find a cost-effective solution that will ensure you get the necessary coverage when you’re travelling outside of Canada.

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