can i get private health insurance in canada?
April 24, 2008 7:25 AM   Subscribe

are there any private health insurance options available in canada? im australian and i want to have a baby there. also, is it possible to have a baby without involving a hospital, ie through midwives?

my husband and i are going to live in canada for a couple of years. i have a 2 year working holiday visa and he will be telecommuting. we are australian. we will have travel insurance to cover us for the first year or so. i will probably work fairly casually in a childcare type job, i dont know if that will cover me for health insurance.

but the thing is, we want to have a baby while we're there. i dont think any travel insurance agencies will insure for pregnancy/birth costs. what other options are there? what is the deal with the midwifery system? we plan to live in toronto.

any information hugely appreciated.
posted by beccyjoe to Health & Fitness (20 answers total)
Ontario does license midwives for home births, yes. Association of Ontario Midwives. Do be warned that there's a bit of a shortage; you pretty much need to get one the second you find out you're pregnant.
posted by kmennie at 7:27 AM on April 24, 2008

Why do you think your travel insurance will need to cover pregnancy/birth costs? You will be fully eligible for free health care from OHIP after three months in Ontario:

Or are you likely to give birth in the first three months?
posted by standbythree at 7:47 AM on April 24, 2008

Actually, re-reading your post, I wonder if you maybe don't realise that all Canadian residents (including people on work visas, as long as the visa is for longer than 7 months) are entitled to free health care, including hospital stays. This doesn't depend on your job, or even on whether you have a job. All it requires is that you live there. In Ontario, there is a three month waiting period before coverage begins - some other provinces cover you from day one.

You can get extra coverage via your employer but this is for things like prescription drug costs (outside of hospital), dental work, etc.

But basically you won't encounter any costs from having a baby as a Canadian resident - even a temporary one.
posted by standbythree at 7:51 AM on April 24, 2008 [1 favorite]

But basically you won't encounter any costs from having a baby as a Canadian resident - even a temporary one.

I think this should probably read:

But basically you won't encounter any medical costs from having a baby as a Canadian resident - even a temporary one.

Speaking as a Canadian who has children, there are most definitely costs to having children, even if we don't have to pay the doctors and hospitals. Medical costs are a possibility, however, if you request procedures that aren't medically necessary (i.e. circumcision).

There is also some confusion about the idea of "free" health care in Canada - some provinces do charge health care premiums (Alberta, for example, although they've recently announced that they're getting rid of this tax in 2009), and across the country the health care system is paid for through tax revenues. If you are paying taxes, then you're paying for health care coverage.

As to your question about private health insurance - yes, it is available. From the link that standbythree provided:

"If you are not covered by another the health insurance of another province/territory, it is important to buy private health insurance to cover you until you receive your Ontario health coverage.

For more information :
Contact a private insurance company directly or call the Canadian Life and Health Insurance Association Inc. at 1 800-268-8099. In Toronto, call 416-777-2344."

posted by gwenzel at 8:15 AM on April 24, 2008

The midwife system in Ontario is pretty flexible, and typically partnered with hospitals. My wife and I went through the Midwives Collective of Toronto which gave us the option of home birth or hospital birth (we chose the later) with all the pre- and post- delivery home visits and care that midwives are known for.

It was so nice being able to leave the hospital the same day the baby arrived, rather than the typical 3 day stay for mothers under a doctor's care.

Everything was fully covered by the Health system, but you do have to make a choice between an OBYGN and midwife at about the second trimester.
posted by Paid In Full at 8:38 AM on April 24, 2008

Actually, given what the OP describes (husband is telecommuting to a job out of the country? and she is on a working holiday visa), I don't think she's eligible for OHIP. If he is not working for a Canadian company he is a visitor, and if she is on a holiday visa (even if it's working) she is a visitor as well I think. If he is working for a Canadian company then he will get OHIP and you will also, for being his spouse.

Be aware if you want private health insurance in Canada you must apply for it within (5 or 10) days of officially arriving in Canada. You should call companies in Canada BEFORE you leave Australia to figure out what you'll need to do. I moved here as a visitor (which it sounds like you both will be, however I don't have all the details, so do check that all out thoroughly) and could not buy private insurance because I didn't call to ask about it until a few months after I got here - every insurance company we called told us the same thing, they would not cover me because I didn't apply right away on arrival - so I had to go without insurance here until I got permanent residency 3.5 years later. I would assume if you're paying for private insurance here in Canada it will cover pregnancy/birth but you should ask the different companies when you call exactly what they will cover.

Now midwifery, on the other hand - if you're an Ontario resident, and that means simply you are living in Ontario even as a "visitor", which you will be, NOT that you have a permanent resident card - you have access to free midwifery care. You must call and ask for a midwife at your local midwifery group as soon as you know you're pregnant or you may not be able to get one, they are in demand and book up fast. Midwives only take on low-risk cases as well, if you are a high risk case you will have to go to an OB/GYN (and pay for it). You can have a homebirth or a hospital birth - if the midwives feel there are complications at home they want to monitor in the hospital you will go to the hospital. If you have a homebirth, it is free. If you need/want to go to hospital, it cost us around 1K out-of-pocket for a vaginal birth, no complications, and including epidural (~$200 of that). You will also have to pay for ultrasounds (about $100 per) out-of-pocket, you will have at least one midway through the pregnancy, and perhaps one early on to establish a due date. If you get private insurance again that is probably covered.

You may get a little bit of extra insurance through your job but that extra insurance will only cover what OHIP doesn't - so you might get a hospital room upgrade or something. If you don't have OHIP or private insurance, the extra through your job isn't going to help in the way of pregnancy/birth.

Feel free to ask/email me if you have further questions.
posted by Melinika at 9:20 AM on April 24, 2008

Once you become eligible for OHIP coverage, get yourself a family doctor and tell her/him that you're planning on getting pregnant. The doctor will probably hook you up with some free maternity vitamins/folic acid supplements.

My brother claims that you'll be able to get all the maternity vitamins you need for free but I don't know if that was because of OHIP, his health plan (he's a student) or his low income (again, student).

You probably will want a private health plan because there are many things that OHIP does not cover in most cases (such as prescriptions and dental care). One private insurer is Blue Cross, my wife got insurance with them when she moved to Canada, but as she never went to a doctor or anything I can't say if they're actually any good or not.
posted by any portmanteau in a storm at 9:23 AM on April 24, 2008

Actually, given what the OP describes (husband is telecommuting to a job out of the country? and she is on a working holiday visa), I don't think she's eligible for OHIP.

If you are not a tourist and you are in Canada for more than three months you are required to be enrolled in the healthcare program of your province.
posted by KokuRyu at 10:09 AM on April 24, 2008

Actually, given what the OP describes (husband is telecommuting to a job out of the country? and she is on a working holiday visa)

There is no such thing as a "working holiday visa" in Canada. The Working Holiday Program provides a "letter of introduction" which you give to the immigration officer on arrival in Canada. On the basis of this the immigration officer grants you a regular work permit (initially for 12 months).

This work permit, being for more than six months, is 100% eligible for OHIP coverage.

The husband's situation may be more complex, but it's probably safe to assume that he won't be getting pregnant in Canada!
posted by standbythree at 10:12 AM on April 24, 2008

OHIP eligibility

You are eligible for the Ontario Health Insurance Plan (OHIP) if :
you are a foreign worker who holds a valid work permit or employment authorization which names a Canadian employer situated in Ontario and your prospective occupation, and is valid for at least six months

For more information
Call the ministry INFOline at 1-800-664-8988
(Toll-free in Ontario only)
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm

I think you'd be covered, but if you can call the number then they should be able to tell you for sure one way or the other.
posted by any portmanteau in a storm at 11:23 AM on April 24, 2008

I am an American working here in Ontario on a NAFTA permit, which means that I am not officially a resident. I have OHIP though -- in my situation, I had to live in Ontario for three months before OHIP kicked in; before that, I was on a plan sponsored by my university.

I imagine it will be similar for you.
posted by the dief at 12:50 PM on April 24, 2008

Response by poster: hi, beccyjoe (original poster) here.

THANKS SO MUCH for all the information. you've all been so helpful. i had tried talking to the consulate and emailing an OHIP website for advice but didnt get anywhere.

to elaborate:

-my husband is a programmer and will be working online for a company in sydney. therefore not paying taxes to the canadian govt and therefore not eligible for health insurance- i assumed. unless what some of you say is true - that any resident in ontario is eligible after 3 months. if that is the case then our problems are solved.

but does this mean i only have to be LIVING there for three months or working for three months? we plan to travel for the first while so i dont know when we'll settle and ill get a job. probably after about 3months...

however if, as Melinika says, we have to apply for private insurance as soon as we arrive and even enquire before we leave, this goes against the assertion that as residents we will be eligible after three months. anyone have any ideas about that? is it different for different people?

so im a little confused. what i have, as standbythree pointed out, is not a working holiday visa but a letter of introduction for a working holiday program. it is not called a "temporary work visa" so i didnt think that gave me status as a "temporary resident", but rather a visitor.

any clarification would be great. again, thanks all of you for the information!

(also- im not pregnant yet. wanted to find out about this stuff first.)
posted by beccyjoe at 3:45 PM on April 24, 2008

Even if your husband is working for an Australian company, he still needs a Working Holiday Visa, or will have to leave the country every 3 months, and will probably be questioned on his first return into Canada. You cannot live in Canada on a tourist visa.

As an Aussie in BC, i needed travel insurance for my first 3 months, then i was covered under BC Health (Same idea as OHIP, but different terms and conditions i'm sure) - just think of it as a different medicare for each province. This coverage is basic health insurance, and costs me $50ish per month. It is compulsory for every resident of BC.

You should double check that you would be covered for pregnancy under BC Health (or OHIP, etc), as you will have a slightly different policy to normal BC residents. This is because you will have a temporary Social Insurance Number (starts with a 9, every govt service will know you are a temporary resident).

Further, if you have a reasonable job, you may have Extended Benefits as part of your package, which gives you extra benefits such as dental, massage etc. I have this (and my $50 monthly BC Health care cost) covered for me by my employer. The benefits change, depending on the provider your employer uses. You can pay for Extended benefits yourself, but it is reasonably expensive and has less benefits than if your employer organised it (from what i have heard).

Lastly, if you want to work in child care, under the working holiday, you need to get a medical exam and go through a slightly different process than the normal WHP. Check the website for more info.

Good luck, mefimail me if you need more info.
posted by chromatist at 4:41 PM on April 24, 2008

This comment will be quite long, apologies in advance.

OHIP doesn't cost anything - as in, you don't have to pay a fee, like in BC (obviously it isn't free, it is paid by our taxes, etc.). (UHIP, which is the University Health Insurance Plan, is compulsory, but it only applies if you're a student from outside Ontario at an Ontario university, I believe.) OHIP is provincial insurance, covering the residents of the province of Ontario for free; private insurance is a different beast, and one you pay for. Anyway.

Your husband will not qualify for OHIP; moreover, he can't just come into Canada on a tourist visa and telecommute to Australia for two years. Visitor's visas only last six months; if he wants to remain in Canada legally he'll have to ask for an extension every time it runs out. They can deny him the extensions if they choose. So call CIC and ask if this is legal (telecommuting for two years and temporary residency on a visitor's visa while working but not for a Canadian company, while your spouse is on a working holiday program) and viable (getting extensions for two years under those circumstances). You should probably also check if he can come through the working holiday program too since it will last for two years (and obviously you should check if he can keep his Australia job and telecommute while on a working holiday program).

Now, what you'll need to find out is if someone on a working holiday program is eligible for OHIP, and you're going to need to call them to find out if you are. My gut reaction is "no", because WHP Canada says: "There is no reciprocal medical insurance agreement between Canada and Australia. It is your responsibility to ensure that you have the adequate health insurance for your trip." If it were as simple as getting provincial health insurance, wouldn't they say so? And many (most? all?) places that hire people on working holiday require them to have travel insurance as a condition of employment, implying you're not eligible for the provincial insurance. A "working holiday" is more about the "holiday" part than the "working" part, meaning you are primarily a tourist, and travelling through the country, unlike (as someone mentioned above) a NAFTA permit in which you are primarily here to work, and staying put in one place. You're not eligible for OHIP if you are a "tourist, transient, or visitor" who is not making their "permanent and principal home" in Ontario. (OHIP FAQ) However, I can see how it could just as easily be "yes" since you'll be getting a work permit for longer than six months even if it isn't specific as to employer. I can't think why employers would require you to have travel insurance on top of that if that were so, though! Very confusing. You'll have to call OHIP and ask for certain.

Even if you are eligible for OHIP on this program, you won't be eligible until you are living (you don't have to be working, just living) in Ontario for three months. So you can go those three months on your travel insurance, you can go without insurance for three months, or you can get private health insurance for those three months; and if you want private health insurance you must apply for it on arrival to Canada (within days) or they will not sell it to you. If you want that last option, you better call before you even leave Australia to find out what they'll require of you and when to apply. If you're not eligible for OHIP and you want private health insurance for the duration of your stay, the same applies - you'll need to get it as soon as you get here.

Reiterating what I said in my previous comment: you can get a midwife without insurance/OHIP as long as you are living (again you don't have to be working, just living) in Ontario. Midwifery care is free with or without OHIP/insurance. Homebirth is free. Hospitals will not be free if you don't have OHIP/private health insurance. I told you about how much it cost me, out of pocket. If you are not eligible for OHIP your baby when it is born may not be either; it depends again on whether you are considered transient/tourist or not for OHIP's purposes. If your baby is not eligible for OHIP it will cost more. The extra insurance you will get through your job will not cover what OHIP/a full private insurance plan does, so it certainly won't cover pregnancy/birth.

I will absolutely advise you when you call CIC and ask about your husband, and when you call OHIP and ask about your program/eligibility, to call several times, and talk to several different people, and ask the same questions each time. I have found in dealing with any sort of Canadian bureaucracy that if your situation/question is "complicated" it confounds them - if you ask five different people you will get five different answers. Make sure you know what the deal is before you come over here! (I know this very much from personal experience.) In fact if you have trouble calling/emailing from Australia you're welcome to MeMail me and I will call and ask your (general) questions for you. After making these two long comments I find myself quite interested in knowing what is the final word on the eligibility of your proposed situation.
posted by Melinika at 8:21 PM on April 24, 2008

Why wouldn't your husband be paying taxes to the Canadian government? Taxation here is based on residency (not citizenship) and worldwide income is taxable.
posted by any portmanteau in a storm at 9:12 PM on April 24, 2008

@Melinka - I was under the impression that for the last few years (since 2004) we have been paying for OHIP? Is there not an Ontario Health premium that is deducted in addition to our regular provincial tax?

To the OP: please get your husband to clarify his situation with the immigration folks. I had a friend do the "tourist telecommute" thing and he was turned down for his second extension and given two weeks to get out.
posted by Umhlangan at 5:15 AM on April 25, 2008

This is what I said above: OHIP doesn't cost anything - as in, you don't have to pay a fee, like in BC (obviously it isn't free, it is paid by our taxes, etc.). Here is more info on the Ontario Health Premium: Ontario Health Premium FAQ for employers. Quote: "Starting July 1, 2004, the premium is being deducted from pay and pensions of those with taxable earnings or pension income of $20,000 or more a year, as part of federal and Ontario income tax." "Unlike the old OHIP premium, the new health premium would be a tax on individuals under the Ontario Income Tax Act." BC Health Care works like: everyone gets a flat fee, which might then be subsidized based on income: link. I was trying to make the distinction without going into a long explanation since my comment was already long, and this particular information (comparing Ontario provincial insurance to BC provincial insurance) wasn't relevant to the question; I was just trying to convey to the OP that she didn't have to pay a fee every month once/if she was signed up under OHIP.
posted by Melinika at 7:05 AM on April 25, 2008

Response by poster: hey all, beccyjoe (OP) here again.

THANKS again everyone for the further information. you are all great.

some more stuff to clarify... re my husband and telecommuting. as australians we can stay for 6 months as visitors (tourists) so we figure we have six months to do that while he telecommutes. then when we are settled in toronto he plans to find a job there and get sponsored for a temporary work permit. since he is a programmer we dont think finding a job will be too hard. all he has to do is leave the country to apply for the new work permit. (i have asked the consulate if this is possible and they said it is).

we have thought this through a little...but there are so many things to consider and so much bureaucracy to deal with! --he wasnt eligible for the working holiday program as he is 31 and you have to be under 31 to qualify.

but thank you umhlangan for the warning about telecommuting. its good to know these things. when i spoke to the consulate they seemed to think it would be fine for him to telecommute indefinitely, provided he left the country every six months. we tried to find out a bit about what the deal is with telecommuting, but noone seemed to know much. we figured its sort of a new phenomenon so the rules havent really been worked out.

as for him paying taxes to the canadian govt, i dont know how this would work since he would get paid by an australian company into an australian bank account.

also, dont worry, we plan to be covered for a few months with travel insurance that we can extend from canada.

to chromatist who is an aussie in BC, were you on a working holiday program? because i did actually read the website that melinika quoted about australia and canada having no reciprocal health program. so its curious that in BC you got covered automatically after three months.

(and as for midwifery, i will definitely consider it but obviously want to have hospital options in case things go awry. are midwives really free?)

thanks again everyone for your help. this is my first question here and im SO impressed!
posted by beccyjoe at 1:24 AM on April 27, 2008

As far as taxes go, yeah the Canadian government wouldn't be taking money directly out of his paychecks. But he still may have to pay the government at the end of the year:

If he doesn't pay (and he owes the gov't money) then he may be subject to additional fines/penalties which could make things a hassle. You may need to talk to an accountant, or at least someone who knows more than myself (a random person on the internet).
posted by any portmanteau in a storm at 8:57 AM on April 28, 2008

Follow-up I have done so far at the OP's asking (I'm putting it in the thread as well so anyone that needs this info in the future can find the definitive answers here):

I have called OHIP and asked if the OP would be eligible in her situation/circumstances. OHIP says no. A working holiday program gives you an "open work permit", which does not specify employer, and an open work permit does not make you eligible for OHIP.

However, the hypothetical baby, having been born here, will be considered a Canadian citizen, and will be covered under OHIP. Should the OP in her circumstances have a baby here in Ontario, she will not be given a health card for the baby at the hospital as is standard, since the mother is a visitor. She will have to go to the Ministry of Health after the birth and apply for one for the baby.

I called the 1-800 number provided by gwenzel above (thank you, gwenzel!). The OP must apply for private insurance within a few days of arriving in Canada or the companies will not cover her. She will only be able to get emergency insurance - I was told none of the companies would offer comprehensive insurance that covers pregnancy/birth for a visitor/tourist. She will have to pay pregnancy/birth costs out of pocket unless her travel insurance covers her (which AFAIK travel insurance will not). The OP will have to call the same 1-800 number to get a list of companies in Ontario that offer private health insurance to compare pricing and so forth.
posted by Melinika at 1:59 PM on May 1, 2008

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