El Guapo, on Monday, February 9th, 2009, 12:18 AM, said:
I don't get why she has to be flown back to Canada. Does her insurance only pay for medical coverage in their country?I am with Kaiser, but if I can't get to a Kaiser facility, it will be covered no matter where I go.
Our Provincial Health Plan only covers limited things out of country and only pays what they would pay here in Canada which is usually a fraction of what US Hospitals will charge.That's why all Canadians should buy travel health insurance when they are out of country. The problem is that travel insurance won't cover pre-existing conditions and it sounds like they might be considering her heart issues as pre-existing while things related to the stroke aren't so the travel insurance company is covering things for the stroke.http://www.health.go...hip/travel.html
Travelling Outside Canada This fact sheet provides basic information for health care providers and the public and should not be construed as legal advice. The authoritative source for OHIP eligibility is the Health Insurance Act and Reg. 552 thereunder.For the purpose of this fact sheet, OHIP defines the following terms :An “insured” person refers to an individual who is entitled to receive OHIP funded services under the Health Insurance Act and associated regulations.An “eligible” person refers to a person who is a resident of Ontario who has applied for and qualified for Ontario health insurance under the terms of the Health Insurance Act and associated regulations.“Coverage” is defined as the insurance provided by the Ontario Health Insurance Plan (OHIP) to eligible residents of Ontario."What does it mean to be “eligible for continuous OHIP eligibility”?It means that while you are away and upon your return to Canada, there will be no interruption to your eligibility status with OHIP. When I travel outside of Canada will OHIP pay the same medical expenses that are covered in Ontario?No. If you are a resident of Ontario and you are insured under OHIP, you are entitled to very limited funding for a limited range of medical services when you are travelling outside of Canada. For this reason, you are strongly advised to purchase additional health insurance every time you leave Canada. What does OHIP cover while I’m out of the country?OHIP will pay very limited amounts for physician services and hospital/health facility services if certain conditions are satisfied (refer to section below “What is not covered by OHIP?). Under Ontario’s Health Insurance Act and regulations, physician services are subject to different conditions than hospital services.OHIP will pay only for insured, emergency out-of-country health services that are rendered to an insured person. To qualify as an ‘emergency’ there are a number of criteria that must be satisfied. These criteria are set by regulation and all conditions listed below must be met:the treatment must be medically necessary, and the treatment must be performed at a licensed hospital or licensed health facility, and the treatment must be rendered in relation to an illness, disease, condition or injury that : is acute and unexpected, and arose outside of Canada, and requires immediate treatment. These conditions are intended and designed to provide a very limited amount of funding for the medical treatment of insured residents of Ontario if they incur an injury or develop a disease while they are outside of Canada. If the illness, disease, condition or injury arises before you leave Canada, or if it is not acute or unexpected, no payment can be made.What is not covered by OHIP?OHIP does not cover :treatment that is not medically necessary. health services that are rendered at a facility that is not a licensed hospital or licensed health facility. treatment that is generally accepted, in Ontario, as being experimental or for research or for part of a study. treatment rendered for an illness, disease condition or injury that arose inside Canada. ambulance services or transportation costs. other services specifically set out in the regulations and uninsured or otherwise not listed as insured. How much will OHIP pay?The amount that OHIP pays is set by regulation. The amount paid for out-of-country health services is very limited and usually will not be sufficient to cover the full cost of the services rendered. OHIP covers only very limited amounts for both health facility and physician services. You are strongly advised to purchase additional health insurance every time you leave Canada to cover any expenses in excess of the limited funding provided by OHIP.OHIP will not pay more than the service would have cost in Ontario.For physician services, OHIP will pay the actual cost billed by the out-of-country physician(s) or the cost of the same physician service(s) in Ontario, whichever is less. Physician services in Ontario are usually rendered at a significantly lower cost than at those billed out-of-country health facilities. Please note that out-of-country health facilities and physicians usually bill on an individual basis. For health facility services, OHIP will pay $50 Canadian (CDN) per day. For inpatient services, OHIP will pay $200 CDN per day. If the services are inpatient services rendered in an operating room, coronary care unit, intensive care unit, neonatal or pediatric special care unit, then OHIP will pay at the higher rate of $400 CDN per day for hospital services. For outpatient dialysis services, OHIP will pay $210 CDN per day. The “per day” rates listed above cover all hospital inpatient services including, but not limited to, accommodation, meals, prescription drugs, surgically implanted devices and nursing services.Note : OHIP does not pay for ambulance services, transportation costs, or out-of-hospital food/accommodation/drugs or prescriptions. Should I obtain additional insurance coverage for my absence from Canada?Yes. The ministry strongly recommends you do, whether you are absent from Canada for a few minutes or for an extended time. OHIP does not insure or pay for all out-of-country medical services. Also, the amount of funding provided by OHIP will not usually cover the full cost of any health services that you do obtain outside of Canada. You should therefore, obtain supplementary health insurance from a private insurance company to provide you with additional coverage during your absence. To obtain private insurance contact a private insurance company or call the Canadian Life and Health Insurance Association Inc. at 1 800 268-8099; in Toronto call (416) 777-2344.How long can I be absent from Canada and still maintain my OHIP?You may be outside of Canada for a period of 212 days in any 12 month period and still maintain your OHIP coverage.How long do I have to stay in Ontario immediately after I apply for coverage?If you have moved to Ontario from outside Canada, or if you have moved from another Canadian province or territory and were not insured by that province or territory’s health plan, you must be present for 153 days in the first 183 days immediately following the date you establish residency in Ontario (i.e., you cannot be absent for more than 30 days during the first 6 months of residency in Ontario).What if I’m going to be absent from Canada for a long period of time?If you are out of the country for more than 212 days in any 12-month period, you may still be eligible for continuous Ontario Health Insurance Plan eligibility if you are away for one of the following reasons :study outside of Canada work outside of Canada missionary work outside of Canada vacation or other reason outside of Canada To be eligible for continuous OHIP eligibility during one of these extended absences you must first have been physically present in Ontario for at least 153 days in the 12-month period, for 2 consecutive years before the absence (refer to section above “What does it mean to be “eligible for continuous OHIP eligibility?).