Answering your questions about the elimination of the Ontario Out-of-Country Travellers Program

In November 2019, we provided you with an update on Ontario’s decision to cancel its Out-of-Country Travellers Program, as of Jan. 1, 2020. With the program’s elimination, we have received questions about the effect of this decision for members in terms of their health-care coverage. Below, we provide some insight into the impact this decision will have on members and the work we have been doing to advocate for retirees on this issue.

• What changes have taken place? Are there any exceptions? 
• Why was out-of-country coverage eliminated?
• How will this affect members’ coverage under the Public Service Health Care Plan (PSHCP) and/or Johnson MEDOC?
• How has or is Federal Retirees advocating on this issue? Is Federal Retirees doing anything to fight this change?
   

1. What changes have taken place? Are there any exceptions?

Effective Jan. 1, 2020, the Ontario government has eliminated the Out-of-Country Travellers Program. This means that Ontarians travelling outside of Canada who require emergency health and doctor services will no longer be covered under the Ontario Health Insurance Plan (OHIP) and will need to rely entirely on private travel insurance to cover any health-care costs while travelling.

For members covered under the Public Service Health Care Plan (PSHCP), the Plan provides some coverage for the first 40 days of travel outside Canada. Those with MEDOC travel insurance also have coverage for certain health-care expenses incurred while travelling outside Canada. Even with this coverage, it is important for individuals to understand what their insurance plan covers and to assess whether the coverage provided is adequate for their needs.

You can find more information about this change on the Ontario government website.

An exception to the above has been made for Ontarians who require dialysis care. They will continue to receive support for dialysis care while travelling outside of Canada through a new service launched by the Ontario government called the Out-of-Country Hemodialysis Reimbursement Program. This program began Jan.1, 2020 and coincides with the elimination of the Out-of-Country Travellers Program. It will continue to provide provincial coverage of C$210 per treatment.

You can find more information about the Out-of-Country Hemodialysis Reimbursement Program on the Ontario government website.
 

2. Why was out-of-country coverage eliminated?

The Ontario government cites the Auditor General’s 2018 report which highlighted long-standing issues with the Out-of-Country Travellers Program, specifically concerns with the administrative inefficiencies and costs of the program, as the basis for eliminating the program. The government was spending $2.8-million to administrate roughly $9-million in claims annually.

In eliminating this coverage, the Ontario government stated that the funding provided by the province “does little in the way of providing meaningful travel coverage or value to taxpayers, especially when private insurance plans are readily available and offer the level of coverage everyone should have when travelling.” With the high cost of health-care services abroad, the daily maximum provided through OHIP equated to relatively low coverage for Ontarians (up to C$50 per day for emergency outpatient services and up to C$400 per day for inpatient care). As well, approximately 95% of reimbursements for eligible costs related to emergency services outside Canada were being covered by travel insurance companies. Since many Ontarians travelling abroad have coverage through employer plans and/or purchase their own private plans, the Ontario government believes that the cost of the program outweighed the benefits received by Ontarians.
 

3. How will this affect members’ coverage under the Public Service Health Care Plan (PSHCP) and/or Johnson MEDOC?

Currently, there are no changes to either the Public Service Health Care Plan (PSHCP) or Johnson MEDOC travel insurance as a result of Ontario eliminating its out-of-country coverage. As a member of the PSHCP and/or if you have purchased MEDOC travel insurance through Johnson, you are covered under private insurance as per the terms of your plan. The only difference now is that the Ontario government will no longer be paying part of the costs related to health-care services received outside of the country.

We, along with many insurance industry experts, are still unsure if and how the elimination of out-of-country coverage may impact either plan in the future. For the PSHCP, we will need to wait and see if the elimination of out-of-country coverage will impact the pensioner contribution rates. Pensioner contribution rates reflect the previous year’s pensioner plan costs and population, and rates are adjusted by the estimated percentage increase in benefit cost for the following year. If the portion of the plan costs attributable to pensioners increases for any reason, including as a result of the elimination of Ontario’s out-of-country coverage, this may result in an increase in contribution rates. “Since cost is of particular importance to our members as they pay 50% of plan costs for pensioners, Federal Retirees is monitoring this issue closely,” notes Federal Retirees president, Jean-Guy Soulière.

For Johnson MEDOC insurance, it will likely be a few years before we are able to fully understand the impact that this change will have on the insurance industry and on premiums for insured individuals. This is because loss experience, a measure used by insurance companies to establish premiums, needs to be blended over a period of time, which is typically three years.
 

4. How has or is Federal Retirees advocating on this issue? Is Federal Retirees doing anything to fight this change?

Federal Retirees advocated against this change when it was announced in May 2019, sending letters to Ontario’s health minister as well as Canada’s health minister. We also launched an email campaign to both the federal health minister and the Ontario health minister to allow members in Ontario to share their concerns regarding these changes. Read about Federal Retirees’ views on this move and our past advocacy on this issue.

In terms of next steps, Federal Retirees will raise this issue when we meet with the federal Health Minister in the coming months. “Last year, when we sent a letter on this issue to the minister of health at the time, we were encouraged to hear that she shared our concerns with the elimination of the Out-of-Country Travellers Program and that she had expressed these concerns to her provincial counterpart in Ontario,” says Soulière. “With the federal election last year, we now have a new Minister of Health and we will be raising this when we meet with her. We are optimistic that she will share our concerns about the cancellation of this program and look forward to working with her on this issue.”

As well, the Canadian Snowbird Association recently launched a court challenge against Ontario’s elimination of out-of-country coverage, arguing that ending coverage is contrary to the portability criteria under the Canada Health Act. The principle of portability requires provinces and territories to continue coverage for insured health services should an urgent or emergent issue arise while an individual is away on vacation or business. At this time, Federal Retirees is assessing if and how we will move forward with any possible legal action.

If you have any questions, please email us at advocacyteam@federalretirees.ca.