Does Your Provincial Health Plan Cover Surgery Abroad?
Canadian provincial health plans pay for planned surgery outside Canada only in a narrow set of cases: the province has given written approval before the treatment, and the treatment is not available in the province or in Canada, or waiting would cause serious, permanent harm. Each province runs its own process. This article sets out the rules all provinces share, the differences in Ontario, British Columbia, Alberta and Quebec, and what happens if a problem appears abroad or after returning home.
What rules do all provinces share?
The doctor applies, not the patient. The province decides based on the medical documents the doctor submits.
Approval comes before treatment. A patient who has planned treatment abroad without approval pays the full cost. The only exception is an emergency, such as an immediate risk to life.
The treatment must be accepted practice in the province. Experimental treatments and procedures that are part of a research study are not covered.
A long wait is not enough on its own. The test is whether waiting would cause permanent harm. Waiting in line for a treatment the province already offers, such as a knee replacement or bariatric surgery, is generally not a reason for approval abroad.
Even with approval, flights, hotels and meals are not covered. The plan pays only for the approved medical services.
Ontario (OHIP)
The Ontario doctor applies electronically using form on00314. The application includes written confirmation from a specialist that the funding criteria are met. Ontario's test is whether an identical or equivalent treatment is performed in Ontario. The decision goes to the doctor, with a copy to the patient. A refusal can be reviewed by the ministry, or appealed to the Health Services Appeal and Review Board within 30 days of the decision.
For a sudden, unexpected illness abroad, OHIP pays limited amounts: up to 400 CAD a day for an operating room or intensive care, 200 CAD a day for lower levels of inpatient care, and 50 CAD a day for emergency outpatient care. Doctors' fees are paid up to the Ontario rate.
British Columbia (MSP)
The application comes from a BC specialist who is actively involved in the patient's care and has expert knowledge of the proposed treatment. BC looks at a wider area: appropriate care must be unavailable in Canada, or a delay must risk serious, irreversible harm. The treatment must be one MSP would cover if it were done in BC, provided by a licensed physician at an accredited hospital.
Alberta (AHCIP)
An Alberta physician or dentist applies. Patients cannot apply on their own. Alberta requires that the treatment is not available in Canada and that all appropriate Canadian options have been exhausted. Applications are reviewed by the Out-of-Country Health Services Committee.
Quebec (RAMQ)
Two physicians sign the request form together. RAMQ authorizes treatment abroad when the specialized services required are not available in Quebec. A medical service that is not covered in Quebec is not covered outside Quebec either.
For a sudden illness or an accident abroad, RAMQ pays up to 100 CAD a day for hospitalization and up to 50 CAD a day for care in a hospital outpatient clinic.
Other provinces and territories publish their own rules on their health ministry websites.
What happens if a complication appears abroad?
The Government of Canada warns that a provincial or territorial plan may not cover the costs if complications develop in the country where the procedure was performed. The emergency amounts above cover only a small part of a foreign hospital bill. Ontario and Quebec also do not pay to bring a patient home from a hospital abroad.
Travel insurance usually does not close this gap. According to the Government of Canada, most travel insurance policies do not cover planned medical procedures in another country. These policies are written for unexpected illness or injury during a trip.
The product designed for this gap is complication insurance: a short-term policy tied to one procedure and purchased before treatment. The policy document sets out what is covered, where and for how long. How the policy available through Maple Med Global works is explained on the complication insurance page.
Who provides care after returning to Canada?
For medically necessary care, the family doctor and, when needed, the emergency department step in. The Canadian Medical Protective Association writes that an existing doctor-patient relationship generally continues when a patient receives care abroad, and that physicians should keep caring for these patients according to accepted standards of practice in Canada. The College of Physicians and Surgeons of Nova Scotia states in its standard that physicians have an obligation to treat patients with whom they have an existing relationship, and that this may include managing complications from treatment received elsewhere. A study from Alberta found that complications in patients who had bariatric surgery abroad were treated by Alberta surgeons in the public system.
One distinction matters. Treating a problem such as an infection, bleeding or a wound that will not heal is medical care. A second operation done only to change how a result looks is cosmetic surgery. OHIP, for example, does not cover cosmetic surgery.
What helps a Canadian doctor give fast, accurate care is information. The Government of Canada recommends that patients:
get copies of all records, including X-rays and scans, before leaving the country
review test results, the procedure performed and medications with a health care provider in Canada after returning
tell every health care provider they see for at least 12 months after returning that they had treatment outside Canada
seek care right away for fever, redness or swelling at the surgical site
Maple Med Global obtains from the hospital the treatment file that the patient adds to the Canadian health system through their family doctor, and delivers it to the patient.
Can the cost of surgery abroad be claimed on taxes?
Partly. According to the Canada Revenue Agency (CRA), medical services received outside Canada are eligible for the federal medical expense tax credit. The provider must be authorized to practise in the country where the service is given.
Purely cosmetic procedures do not qualify. CRA's examples include liposuction, filler injections, chin, cheek or lip augmentation, and teeth whitening. Procedures with a medical or reconstructive purpose are not excluded, for example breast reconstruction after a mastectomy, or removal of excess skin after rapid weight loss because of a risk of infection.
Travel costs qualify only under certain conditions. Similar treatment must be unavailable near home, and the patient must travel at least 40 km for transportation costs, or at least 80 km for other travel expenses. Costs for a companion require a doctor's written certification that the patient cannot travel alone.
Timing and records: expenses paid in any 12-month period ending in the tax year can be claimed. Receipts must show who was paid and should be kept in case CRA asks for them.
The credit is non-refundable and applies to expenses above an income-based threshold. An accountant can confirm how it applies to a specific situation.
Frequently asked questions
Can a province approve cosmetic surgery abroad?
No. These programs cover treatments that the provincial plan insures. OHIP does not cover cosmetic surgery, and RAMQ does not cover a service abroad that it does not cover in Quebec.
What if the records from the hospital abroad are not in English or French?
The Government of Canada notes that records may need translation into English or French to review them with a provider in Canada. For taxes, keeping translations of receipts that are not in English or French also helps.
Does complication insurance pay for the surgery itself?
No. Complication insurance responds to the cost of treating a complication arising from a covered procedure. The fee for the surgery is part of the treatment quote.
General information, not medical, legal, tax or insurance advice. Coverage decisions are made by provincial health plans, policy terms are set by the insurer, and clinical decisions are made by the treating physicians.
Sources
Government of Ontario, OHIP coverage while outside Canada, ontario.ca/page/ohip-coverage-while-outside-canada
Government of Ontario, Out-of-country OHIP covered services for physicians, ontario.ca/page/out-country-ohip-covered-services-physicians
Government of Ontario, What OHIP covers, ontario.ca/page/what-ohip-covers
Government of British Columbia, Medical Services Outside of Canada, gov.bc.ca
Government of Alberta, Out-of-country health services funding eligibility and appeals, alberta.ca
Régie de l'assurance maladie du Québec, Know which services are covered outside Québec, ramq.gouv.qc.ca
Government of Canada, Travelling outside Canada to receive medical care, travel.gc.ca
Canada Revenue Agency, Eligible medical expenses you can claim on your tax return, and Income Tax Folio S1-F1-C1, Medical Expense Tax Credit, canada.ca
Canadian Medical Protective Association, When Canadian patients travel abroad for care (2023), cmpa-acpm.ca
College of Physicians and Surgeons of Nova Scotia, Care of Patients Who Have Received Treatment Outside Canada, cpsns.ns.ca
Kim DH, Sheppard CE, de Gara CJ, Karmali S, Birch DW. Canadian Journal of Surgery, 2016;59(1):59-61
