How does OHIP know if you’re out of the country?
The Ontario Health Insurance Plan (OHIP) doesn’t know when you’re out of the country unless you notify them. OHIP eligibility relies on your residency status, which is closely tied to how much time you physically spend in Ontario. If you’re absent for extended periods without proper documentation or approval, you may lose your coverage. This is especially important for individuals who travel frequently, live part-time abroad or are temporarily working or studying outside the country.
You don’t need to let OHIP know you’ll be out of the country if the duration of your time away is less than 7 months. If you’re spending more time away, you can keep your OHIP coverage for up to 2 years by submitting proof of employment or education to ServiceOntario. You can keep your OHIP coverage when travelling across most of Canada, but you may need to pay for additional services in places like Quebec.
Does OHIP track when you leave Ontario?
No, OHIP doesn’t track your movement across borders in real-time. However, it is up to you to understand when and how to self-report if your absence is for an extended period of time. OHIP also relies on you to re-register your government documents and data from other agencies to monitor your activity and you’re expected to meet the minimum requirements to maintain your coverage. This means that you must be physically present in Ontario for at least 153 days within a 12-month period and show proof of residence at your nearest ServiceOntario office.
How much time can you spend outside of Ontario without losing OHIP?
If you are planning to leave Ontario, then it’s important to note that you can’t be gone for more than 212 days, or 7 months, within a 12-month period. They don’t need to be consecutive days, but that is the maximum amount of time that you can spend outside of Ontario without reporting your absence. There are some instances of temporary time away, like vacation and work, that may be allowed under special programs if reported in advance.
If you’re planning to spend an extended period outside of Canada, you may want to get additional private health insurance coverage like our Freedom to Choose™ health and dental insurance. Alternatively, you may want to look into getting Travel Assistance with your workplace benefits.
How does OHIP detect extended absences?
There are a few ways for OHIP to find out about extended absences:
- Re-registration and health card renewals required proof of residency.
- Data matching with agencies like the Canadian Border Service Agency (CBSA) can reveal travel patterns.
- Tax filings as a non-resident or claiming benefits in another jurisdiction can indicate that you’re no longer living in Ontario.
- Routine checks during OHIP renewals may reveal absences beyond the permitted limits.
These aren’t foolproof, but they do provide OHIP with enough information to question your eligibility if your residency status is unclear. It’s best to keep a personal record of your absences to make sure you’re not accidentally away from more time than is allowed.
What are you required to report?
If you’re planning to be away from Ontario for longer than 212 days (7 months) in a 12-month period, then you are required to report this to ServiceOntario. This includes those that are planning to be away for:
- Study abroad
- Work
- Charity or missionary work
Failing to report extended travel can result in OHIP coverage being suspended or terminated. If you’re planning to be away temporarily for the same reasons as listed above, then you should apply for Temporary Absence Coverage through ServiceOntario or consider getting Travel Assistance with your workplace benefits.
What happens if you’re found ineligible?
If OHIP decides that you no longer meet the residency requirements, your coverage may be cancelled. There are a few things to consider if you lose coverage:
- You’ll need to reapply for OHIP after returning to Ontario.
- There may be a 3-month waiting period before your coverage resumes.
- While you wait for coverage, you’ll be responsible to pay for medical expense out-of-pocket.
- You may be required to provide proof of return and re-establish residency, such as lease agreements, utility bills or employment records.
To avoid these complications, it’s best to stay informed about OHIP’s rules and report any extended absences in advance to ServiceOntario.
Are there special circumstances and exceptions?
OHIP may continue to cover you during extended absences. In those cases, coverage may continue under approved programs, including:
- Studying outside Canada: Students enrolled in full-time academic programs abroad may be eligible for up to 4 years of coverage.
- Working outside Canada: Employees temporarily assigned to work abroad may qualify for coverage for up to 2 years.
- Charitable work or missionary service: Recognized charitable or religious work may also be eligible for extended coverage.
These exceptions may require pre-approval and supporting documentation. It’s also important to note that coverage under these programs is typically limited to 2 years, but in special cases extensions may be granted.
How to protect your OHIP coverage while away?
If you’re planning to leave Ontario for an extended period, it’s important to take proactive steps to protect your OHIP coverage:
- Apply for OHIP coverage before you leave so that you know your absence is documented and approved.
- Keep records of your travel dates, residency documents and any communication with ServiceOntario.
- Make sure your health card is valid and renew it if required.
- File taxes as an Ontario resident and maintain a permanent address in the province.
These steps help to prove your residency in Ontario and ultimately maintain your OHIP eligibility.