Canada Healthcare System

Canada’s Healthcare System

Canada’s national health insurance program, often referred to as “Medicare”, is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis. Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage.

Roles and responsibilities for Canada’s health care system are shared between the federal and provincial-territorial governments. Provincial and territorial governments are responsible for the management, organization and delivery of health services for their residents, learn more about each province below.

Provincial Healthcare Plans and Travel Policies

To maintain eligibility for Medical Services Plan (MSP) coverage, an individual must continue to meet the residency requirements.

Residents who will be absent from B.C. for six months or more in a calendar year, need to contact Health Insurance BC to confirm continued eligibility and discuss options for continued MSP coverage that may be available during an absence.

In some circumstances, while temporarily outside the province for work or vacation, individuals may retain eligibility for coverage during an ‘extended absence’ of up to 24 consecutive months, once in a 60 month (five year) period. To qualify, the individual must:

  • be a Canadian citizen or a person lawfully admitted to Canada for permanent residence;
  • make his or her home in British Columbia;
  • be physically present in Canada for six of the 12 months immediately preceding departure;
  • not have been granted an extended absence in the previous 60 months (five years);
  • not have taken advantage of the seven month absence in a calendar year, available to vacationers, during the year the extended absence begins or during the calendar year prior to the start of the extended absence; and
  • not have returned to the province for more than 30 consecutive days during their extended absence.

If an individual returns to B.C. for over 30 consecutive days during an extended absence, their absence is no longer considered to be consecutive and any subsequent absence would be considered a new absence. The individual will need to contact Health Insurance BC to determine their eligibility for benefits during their new absence.

Residents who leave B.C. temporarily without suspended coverage will continue to be billed for premiums. Although it is recommended that residents maintain their provincial health care coverage, certain individuals may qualify to suspend their coverage during a temporary absence. If a request to suspend coverage is received prior to departure, the person’s coverage is suspended at the end of the month of departure. If the request is received after the month of departure, suspension is effective at the end of the month notification is received. Coverage is renewed the first day of the month in which the person returns, provided that they remained an eligible resident during their absence.

If an individual stays outside B.C. longer than the period for which they were eligible for coverage, they will be required to fulfill a wait period upon re-establishing residence in the province before coverage can be renewed.

Residents should be aware that their provincial coverage may not pay for all the health care costs incurred outside the province, and the difference can be substantial. For example, B.C. pays $75 (CDN) a day for emergency in-patient hospital care, while the average cost in the U.S. often exceeds $1,000 (US) a day, and can be as high as $10,000 (US) a day in intensive care. For this reason, residents are strongly advised to purchase additional health insurance from a private insurer before leaving the province, whether they are going to another part of Canada or outside the country – even if they plan to be away for only a day.

If you are physically present in Alberta for at least 183 days in a 12 month period, you remain eligible for continued AHCIP coverage.

Alberta Health covers only limited physician and hospital costs outside of Canada. It is strongly recommended that Albertans obtain private supplementary insurance when outside the province or outside Canada, as costs for services can be much higher than in Alberta.

The rate for in-patient hospital services is $100 (Canadian) per day, not including the day of discharge. The rate for outpatient services is $50 (Canadian) per day, with a limit of one visit per day. These hospital services rates are the maximum that is reimbursed for all services provided to a patient, such as room and board, nursing, laboratory and x-ray services, medical supplies and prescription drugs.

Insured hospital services must be provided by a general or auxiliary hospital. Hospital services provided in a private health facility are not eligible for reimbursement. The AHCIP does not cover food, lodging or other travel expenses.

Alberta Health covers only limited physician and hospital costs outside of Canada. It is strongly recommended that Albertans obtain private supplementary insurance when outside the province or outside Canada, as costs for services can be much higher than in Alberta.

If you are a Canadian citizen or a permanent resident/landed immigrant and you make your home in Saskatchewan, and you are ordinarily present in the province for at least six months of each year, you are eligible for Saskatchewan health coverage.

Costs for hospital services outside of Canada may be much higher than in Saskatchewan. You will be responsible for paying the difference between the full amount charged and the amount Saskatchewan Health covers. We recommend you to obtain additional health insurance when travelling outside the country.

You are required to notify Health Registries when you will be on an extended absence of more than six months.

You should report your absence from Saskatchewan for the following situations:

  • Attending full-time studies at an accredited educational institute, and intend to return upon completion of your studies. You must provide your graduation date and confirmation of full-time enrollment;
  • Away for the purpose of vacation, visit, business engagement or employment for up to 12 months;
  • Away on an employment contract outside of Canada for a maximum of 24 months.

To update Health Registries about your extended absence, go online (recommended) or complete the Notification of Extended Absence Form.

Following an extended absence from the province, you need to contact Health Registries to ensure your Saskatchewan health services card is still active and you are eligible for benefits. To update Health Registries about your return, go online (recommended) or complete the Notification of Extended Absence Form.

To ensure that you remain eligible for Manitoba Health, Healthy Living and Seniors coverage during your extended absence, report any expected absence of 90 days or more in a 12-month period to Manitoba Health, Healthy Living and Seniors prior to your departure. Additionally, to ensure that you are eligible for out-of-country benefits while abroad, you must apply for a Term Registration Certificate.

Manitoba Health, Healthy Living and Seniors recommends that you explore private insurance options along with your Manitoba Health, Healthy Living and Seniors coverage to ensure that you have sufficient coverage for all of your health care needs while out of the country.

You are responsible for some of the costs of emergency hospital or medical care when you travel outside of Canada. That’s why it’s always a good idea to buy travel health insurance before you leave. Health care services in other countries, particularly the United States, can be significantly more expensive than here in Manitoba.

If you are admitted on an emergency basis to a hospital outside of Canada, Manitoba Health, Healthy Living and Seniors will pay for the services you need based on established daily rates. If you are seen in a hospital outpatient or emergency department, coverage is limited to a maximum of $100 CDN per visit. Physician services are covered at the same rates paid to Manitoba doctors.

You may be temporarily outside of Canada for a total of 212 days in any 12 month period and still maintain your OHIP coverage as long as your primary place of residence is still in Ontario. However, the ministry does have extended absence provisions which are outlined below.

The ministry strongly recommends that 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. It is also recommended that you understand the terms and conditions of the additional insurance coverage you have purchased and the implications of any pre-existing health conditions on your insurance coverage. To obtain private insurance contact a private insurance company of your choice.

If you are a resident of Ontario and you are insured under OHIP, you are entitled to very limited funding for a certain 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 and ensure that the supplementary insurance you have purchased provides adequate coverage.

When travelling or when outside Québec temporarily, persons holding a valid Health Insurance Card can receive healthcare services covered by the Québec Health Insurance Plan. However, in most cases, the Régie de l’assurance maladie reimburses only part of the cost.

In order for these services to be covered, persons spending time outside Québec must fulfill certain conditions regarding the duration of their trip or temporary stay.

When spending time outside Québec, it’s a good idea to take out private insurance before leaving. Generally speaking, the Régie does not reimburse the full cost of healthcare services received outside Québec and certain services are not covered by the Health Insurance Plan at all. If you receive healthcare outside Québec but don’t have private insurance, you are responsible for the portion of the cost not reimbursed by the Régie.

It is important that in all instances of temporary leave (one month or more), you notify New Brunswick Medicare in order to maintain your Medicare eligibility and to ensure there is no delay in payment should you require and receive physician and/or hospital services during your absence.

Permanent New Brunswick residents who plan to be temporarily absent from New Brunswick for a vacation or visit may remain insured during their absence, provided they live in New Brunswick for at least five months (153 days – consecutive or not) during a 12 month period. Approval may be granted for an extension of up to 12 months only once per 3 years from the time of return. If exceeding 12 months, NB resident must reapply for Medicare upon return.

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 fractures, sutures 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. These visits should be sought in Canada.

New Brunswick Medicare pays:

  • $50.00 a day for out-patient emergency services, and
  • $100.00 a day for in-patient services resulting from an emergency admission.

These amounts are in Canadian funds and include most laboratory, radiological or interpretation fees billed separately from the hospital claim.

Out-of-country emergency physicians’ fees are paid in Canadian funds at a rate equal to what a New Brunswick physician would receive for a similar service.

The costs of most out-of-country physician and hospital services are considerably higher than rates paid by New Brunswick Medicare and the difference between the two is your responsibility. That is why out-of-country travelers are strongly advised to obtain additional insurance from private insurers to cover the portion of charges not paid by New Brunswick Medicare.

Once deemed a resident for MSI coverage and ordinarily present (physically present in Nova Scotia for 183 days in every calendar year), you may retain coverage while temporarily absent for up to one year, provided you intend to return permanently to Nova Scotia.

If you are traveling outside Canada for a short period of time MSI will provide coverage for emergency medical services only.
1. Out-of-country in-patient hospitalization as the result of an accident or sudden illness while temporarily absent from Canada, is covered in Canadian funds. The current rate for emergency in-patient services is $525CDN. Per day plus 50% of ancillary fees incurred while an in-patient. Physician Services, as the result of an accident or sudden illness during a temporary absence from Canada are covered in Canadian funds at Nova Scotia rates.

2. The following services are not payable under the MSI program.

  • Facility and Hospital Out-Patient charges
  • X-Ray, diagnostic tests and laboratory charges from Out-Patient, Emergency or Private Facility
  • Pharmacare and Childrens Dental Programs
  • Routine Vision Analysis

The balance of an account after payment by the Department may be quite large. It is strongly recommended that any resident traveling out of province purchase a Travel Health Plan for the period of absences to cover these balances and other insured services.

Ambulance Services rendered outside Nova Scotia are not subsidized and are therefore the patients responsibility.

All claims must be received by the department /MSI for payment within six months of the date of the discharge from the hospital to be eligible for payment. No claims received after the lapse of six months will be considered.

Eligible PEI residents temporarily absent from the province are covered for emergency or sudden illness only.

The period of coverage will vary according to the circumstances surrounding your temporary absence. For example, persons absent each year for winter vacations and similar situations involving regular absences, must reside in PEI for at least six months plus a day each year. It is strongly recommended that you notify Health PEI of any absences exceeding one month.

Under some circumstances, coverage for emergency or sudden illness may be extended up to one year. Such circumstances could include missionary work, sabbatical leave, etc.

You are advised to contact Health PEI for information on coverage if you are planning a lengthy absence from the province.

Students who are in full-time attendance at a university or other recognized educational institution are covered for emergency and sudden illness. Students must notify Health PEI when leaving the province and update their student status on a yearly basis.

Where an individual or family maintains an out-of-province dwelling at which the individual or family spends more than six months per year (Health Services Payment Act Regulation), that individual or family is not eligible for insured services under the PEI Hospital and Medical Plan.

For PEI residents travelling outside-of-Canada, insured services for emergency or sudden illness will be paid at PEI rates only, in Canadian funds. The PEI resident will be responsible for paying the difference between the full amount charged and the amount paid by Health PEI. The difference may be considerable and for this reason, extra health insurance is advised when travelling outside Canada.

Medical Care Plan (MCP) will provide coverage under the Medical Care Plan (MCP) to beneficiaries who temporarily leave Newfoundland and Labrador. Coverage under the Hospital Insurance Plan will also be provided, however, the Department of Health and Community Services can provide more information on the services insured outside Newfoundland and Labrador. Coverage under the Dental Health Plan is not available outside Newfoundland and Labrador.

To ensure that coverage remains intact while outside Newfoundland and Labrador, an Out-of-Province Coverage Certificate should be obtained from Medical Care Plan (MCP). This provides a maximum of twelve months’ out-of-province coverage to eligible beneficiaries, with the following qualifications:

  • Beneficiaries leaving for vacation purposes may receive an initial Out-of-Province Coverage Certificate for up to twelve months’ coverage. The normal four month residency requirement must be met immediately following their return to Newfoundland and Labrador. Further Out-of-Province Coverage Certificate’s will only be issued to provide up to eight months’ coverage.
  • Beneficiaries leaving for work purposes (temporarily absent workers) may receive an Out-of-Province Coverage Certificate for up to twelve months’ coverage. Beneficiaries who are working outside of the country may renew their Out-of-Province Coverage Certificate each year to provide up to three years’ out-of-province coverage. A letter from the employer, on letterhead, stating the dates of employment is required.
  • Beneficiaries leaving for study purposes may receive an Out-of-Province Coverage Certificate for up to twelve months’ coverage. This is renewable each year if a newly completed form and updated proof of enrolment in an educational institution is received. Approval is conditional upon the beneficiary’s intention to return to Newfoundland and Labrador upon completion of the program of study.
All permanent residents of the NWT are eligible for coverage. “Permanent resident” means a person who is legally entitled to remain in Canada and who makes his or her home in (and is ordinarily present in) the NWT for at least six months plus a day (183 days) of the year.

If you will be outside of the NWT for more than 3 months for any reason (going to school, medical, work or just travelling), you need to complete the temporary absence form to make sure that you are still covered.

Please inform us on any change in your status as this is important in receiving health services. Make sure that your health care registration information is current.

If you require medical care while traveling outside of Canada, your NWT Health Insurance may only cover a portion of your health care costs. Services received outside of Canada will be reimbursed at NWT rates. You are responsible for any additional costs.

It is recommended that you get travel insurance when travelling outside of the NWT to cover you for the duration of your trip.