What will the cost of using an Ontario health care card in Quebec be?

February 8, 2009 12:19 PM

A question about using an Ontario health care card in Quebec.

I live in Montreal, and have for nine months. However, I still have just my Ontario health care card. I need to go to the emergency room and possibly have some x-rays done (sidewalks grumble grumble).

What will the charges be?
Can I get them reimbursed from Ontario, considering that I have not lived there for nine months?
If I go to get my Quebec card in the morning will I be issued something temporary until it arrives in the mail?

posted by jon_kill to law & government (8 comments total)

To be eligible for Ontario health benefits you must be physically present in Ontario for a minimum of 153 days in any 12 month period. I know they grant waivers for people who are out of the province for more than that (like Snowbirds who spend winter in Florida), but I think you have to prove that your main residence is in Ontario.

You should talk to someone at the hospital... they may defer the fees until your card arrives, or give you a period of time to prove your insured status.
posted by kaudio at 12:38 PM on February 8

Relevant info on getting Quebec health insurance when moving there from another province.

For as long as you remain covered by the health insurance plan of your province of origin, you must present your health insurance card of that province when receiving healthcare from a doctor in Québec. The health insurance plan of your province will cover the cost. However, if the doctor does not accept that card, you will have to pay the doctor's fee and then apply for a refund to the organization administering the health insurance plan of your province of origin.

I'm guessing that if you haven't informed OHIP that you no longer live in Ontario and you have a valid OHIP card, you can hope that as per the quote above, the hospital you visit will accept the OHIP card and Ontario will cover the cost. For all intents and purposes, you're still considered an Ontario resident as per the health card. You should then immediately apply for a Quebec card, which you'll get in 3 months.
posted by meerkatty at 12:46 PM on February 8

Oh man, this really sucks. If you try and use your OHIP card to cover your treatment, you'll more than likely have to fill out one of these Out of Province/Country forms to get bills paid, because Quebec does not have a reciprocal billing agreement with any other province in Canada. The form asks you for an address of residence, which should be an Ontario address in order to fulfill the "permanent resident" requirement for OHIP coverage, and it also asks you whether or not you've been absent from Ontario for 212 days out of the last 12 months.

If, as meerkatty points out, the hospital simply accepts your OHIP card, then you might be fine. However, in my time living as an out-of-province person in Montreal (I was a student), things never worked that way: no hospital ever simply accepted my Alberta health care card, and there was always some red tape wrangling to be done. I have no idea how they'd treat an Ontario card, but the extra steps that are needed when Quebec and other provinces communicate over medical billing procedures might up the odds that your lapsed OHIP status would be discovered.

I'd do as kaudio suggests, and talk to someone at the Regie. Here's their 24-hour Health Insurance hotline number:

In Montreal: 514 864-3411
Toll-free: 1 800 561-9749

Good luck, don't let this stop you from going to an emergency room, and I hope you're ok.
posted by Hellgirl at 3:39 PM on February 8

Expect to pay for the whole thing and have it reimbursed later by either OHIP or (more likely) by the Régie if you come clean with switching your province of residence.
posted by furtive at 4:09 PM on February 8

Quebec does not have a reciprocal billing agreement with any other province in Canada.

This is AFAIK a clear violation of the "portability" requirement of the Canada Health Act. I'd go to the doctor with my OHIP (or AHP or whatever) card just to bring a case against these bastards. Quebec has, by far, the most privatized system in Canada, so they are de facto two-tier, and then they pull this shit as well?

Fight the good fight for us all, OP.
posted by ethnomethodologist at 4:43 PM on February 8

I'll pgo to get my card in the morning, and see if they won't issue me something that says it's in the mail. I remember when I got my Ontario card they did that. Thanks everyone!
posted by jon_kill at 5:36 PM on February 8

You are considered a resident of the last province that you lived in for 12 consecutive months, not being a student. For example, my girlfriend is still a resident of Manitoba although she hasn't lived there for 8 years, as she's been in University that entire time. She's never had any problems using her Manitoba health card in either Alberta or Ontario though. What I'm trying to say is that you may not be eligible for a Quebec health care card as you've only been there for 9 months. Just go in with your Ontario card and see what happens, I can't imagine it will be much of a hassle; I live in Ottawa and people cross the border all the time and use whatever services are more convenient regardless of province, I wouldn't worry too much about it.
posted by mizike at 7:38 PM on February 8

Do go and apply for your Quebec health card tomorrow if you have time (but be prepared to wait). Legally, you are covered under the Quebec plan after three months of residence (well, actually on the 1st day of the third month after you arrive). Having the card allows you the convenience of not having to pay up front for treatment, but you should still be covered, even though you don't have a card. In my experience, the most likely outcome is that you will have to pay out of pocket for treatment, but will be given a form that you can send in to be reimbursed (I had to do the same once when I lost my Quebec health card). It can't hurt to ask if you can get something to show it is in the mail though.

From the RAMQ site: If you don't present your Health Insurance card or your card is expired, you must pay for the healthcare services you receive and then apply to the Régie de l'assurance maladie for a reimbursement. To do so, obtain the form entitled Demande de remboursement à la personne assurée, available from your doctor, and send it to the Régie as soon as possible, not later than one year after the service date. The Régie will reimburse you only if you were eligible for the Health Insurance Plan when you received the services.

I would not try to claim to be an Ontario resident (or hand over your OHIP card) if you have moved to Quebec. Your OHIP card is not going to prevent you from having to pay up front anyways.

Of course, if you are a student, the situation can be quite different.

What I'm trying to say is that you may not be eligible for a Quebec health care card as you've only been there for 9 months. Just go in with your Ontario card and see what happens, I can't imagine it will be much of a hassle; I live in Ottawa and people cross the border all the time and use whatever services are more convenient regardless of province, I wouldn't worry too much about it.

You certainly are eligible (unless you are only living in Quebec temporarily, e.g. as a student). I've lived on both sides of the border in Ottawa/Gatineau and had some experience with this issue. It certainly is not true that you can visit a doctor on whichever side of the border you like and expect not to have to pay out of pocket.
posted by ssg at 8:48 PM on February 8