Leon Help me..regarding health coverage suspended and PR expiring before 720 day

[Leon]

Hi Again

In the letter received from OHIP, they said "you health card and eligibility have been cancelled". They gave us the option to request review of this decision to OHIP eligibiltiy review committee. Please address following:
1. They have not talked about payback of services used. Are they going to look into my parents case again for payback.
2. Can we rather go to Ontario service center and apply from begining? Are they going tp process our request or they will say that my parents wont be able to apply from here as long ?
3. Should we go to review committee and tell them that they had been quebec for some time. This way can they tell us to apply from begieining here?
Thanks!

You have a problem with OHIP so you have to take it up with OHIP. Nobody here can fix this problem for you. I have already told you what I think you should do. If you prefer to do something else, then it's up to you.

1. They might
2. You must clear this up with OHIP. Nobody else can help you.
3. You must tell them the whole story. Give them details of where your parents have been living and dates. They will figure out when your parents should have been covered and when not and hopefully you will eventually get out of this mess. Keep in mind that it was you/your parents obligation to inform themselves of the terms of OHIP and inform OHIP if they were moving away and they didn't. You need to apologize of not informing yourself about the rules and explain to them that you were not trying to commit fraud.

Think about how this looks from OHIP point of view. People register for OHIP, they are in and out of Canada, completely ignoring the 153 days/6 months and later 183 days/12 months rules. Not informing when they are moving out of province etc. Eventually when OHIP finds out about this and sends them a letter asking them to clarify, they ignore the letter. Later they show up and apply for OHIP again and say they were living in Quebec. If you were OHIP, would you want to cover these people?

 

[on-hold]

In my experience, the Canadian government is extremely decent about misuse of services; they want to be paid back, and then leave it at that. When my wife and I moved around in a complex manner we kept receiving child benefits for some months after we left Canada (we'd been told before leaving that we would remain residents for 4 months, and didn't bother looking into it), and we got some GST (I think) refund too. Later on we got a letter requesting about 1600 dollars back. We paid it back, no big deal -- when we moved back to Canada, we remained eligible for all these programs.

This is also one of the problems of government health insurance that includes no user fee whatsoever -- it seems free. In actual fact, your parents have used a fair chunk of money, no different than if they saw it lying on a government counter and took it; some people would insist on paying it back.

 

[Msafiri]

ranjitbuttar,

so now you need to know:

1. Can they apply for OHIP now and will they get it or because they ignored the suspension letter no they won't get coverage?

My take is that if they are resident in Ontario and provide the required documentation in the OHIP application they will get coverage 3 months from the date they submit a complete application. They will probably have a flag on file for the secondary requirement of 152 days post the 3 month period. They may also get a short validity health card forcing them to renew say in 2 years. In the interim it depends if Quebec health card will work in Ontario till OHIP comes through- presumably you are having problems with this being accepted and hence going for OHIP. Hiding the Quebec coverage was pointless.

2. Will OHIP make them pay for 'non eligible services' regardless of if they get or do not get OHIP?

OHIP can chase the debt either way. Likely this debt is not statute barred so they can come for it any time in the future. Either as advised tell them about the non eligibility and get the bill - work out a payment plan or live in the dark stressing out if and when they will come for their (actually taxpayer) money.

Going to the review committee now to appeal is moot you refused this option before I don't see how you can go them 1+ year later for a second chance...deal with them if the new application is denied which if the paperwork is correct will not be an issue.

 

[ranjitbuttar]

I dont think its permanently revoked as even the letter says "eligibility cancelled". I went to a lawyer today and he said theres no way your parents can be denied health insurance. At most they can make you wait for 90 days. But in order for him to write anything or handle the case he would charge me 200 $ /hour...and he thinks this case for all communications would be around 1000$, which is more than what we prob. need to payback if OHIP asks so...
Today we went to services ontario as well just to see what the front man says about our file. he said file is locked and you need to talk with kingston guys.
Yesterday i spent many hours and read much material on this. Looks like once they are suspicious of someone ineligible they would ask OPP to take matter in their hands and review. Further case can go to court and they can ask for payback.
But we are still confused..if we prove that we have been in ontario for atleast 5 months,...they have to give my parents insurance as long as they are PR..
in the letter they said health cards have been cancelled due to inadequate documents and we have the option to go to review committee...if we dont do and lets say after 3-5 months when we have proofs for my parents staying here for around 5-7 months..can they still deny health coverage

 

[Leon]

in the letter they said health cards have been cancelled due to inadequate documents and we have the option to go to review committee...if we dont do and lets say after 3-5 months when we have proofs for my parents staying here for around 5-7 months..can they still deny health coverage

I think it has already been discussed that you need to clear things with OHIP or if you prefer, go to a lawyer and sue them. I don't think anybody on here can really help you further.

If you are unsuccessful clearing things up with OHIP, you can try the Ontario ombudsman: http://www.ombudsman.on.ca/Investigations/Investigation-Results.aspx?topic=Health but I do not think there is any point going there unless you try to clear things up first.

It was your mistake that lead to problems with OHIP in the first place so first you need to set things straight with them. After that, if they still refuse coverage, then you can go to the ombudsman.