Pregnanacy, OHIP and private insurance

[nadinewasfi]

Hi,

I wanted someone s feedback on the following:

-Im a returning Canadian , i understand when i go apply for the OHIP , i will be reapplying and will have to wait 3 months before it is activated. I also understand that i have to be in the country for atleast 5 months out of the first 6 months immdeiately after applying for OHIP. If i am already in my 6th month of pregnancy by the time i return to Canada, and i only apply for the OHIP then, i will only get the OHIP 3 months later meaning i will be in my 8th month of pregnancy . If i deliver in the 9 th month and not earlier, i will only have been in Canada for 4 months and not for 153 days yet. Will the OHIP be valid to use for the pregnancy even though i had only applied 4 months earlier for it ? I mean i wouldne have compelted the 153 days but i would ve received my OHIP since i wouldve spent 3 months . Or do i have to actually have spent the first 153 days in Canada before i give birth using my OHIP card?

-What is reommended private insurance company that can cover the 3 month wait for my OHIP that will include pregnancy and check ups and any emergencies. Are there insurance companies that can cover emergency delivery as well?

-Are there any private insurance companies that do cover the pregnancy , delivery and everything that comes with it? I understand that there are but you would need to apply for it atleast a 1.5 months before you decided to get pregnant.



Appreciate your advice
Thanks
Nadine

 

[scylla]

You'll be covered again once you spend three months straight in Canada. So as long as you return at least three months before you give birth - your birth will be covered.

The only private insurance I know of that covers the cost of the birth is very expensive and you must also purchase it (i.e. become a policy holder) before you are actually pregnant (i.e. at least 10 months before you give birth). So you wouldn't qualify.

As for the costs of your pre-delivery care, I believe you're better off paying for these out of your own pocket. Any insurance policy that covers them will likely cost more than the costs of these appointments / tests themselves since insurance companies are in the business of making money and won't give out policies where they end up losing money overall.

 

[nadinewasfi]

Hi Scylla,

Thanks for your reply!
I didnt quite understand your first point. Do you mean that even though i would not have covered the first 153 days upon my arrival to Canada i can use my OHIP once the 3month wait is over and then continue the rest of the 153 days ?
Or does the agreement say that i have to have stayed 153 days in Ontario prior to using OHIP ? This contradicts the policy of waiting 3 months before using OHIP,because if i apply to OHIP when i first arrive, my 3 month wait will start from that day and so i wouldnt have covered 153 days by then,which is why i wanted to know can i use OHIP after 3 months from my arrival to Canada and then complete the 153 days ?
Hope i didnt confuse you!
Thanks

 

[nadinewasfi]

Hi Scylla

Also regarding point 3 - about getting insured for 3 months before delivery and until OHIP gets delivered, i am not aware of the expenses of regular check ups or the case any pregnency emergency if iw ere to pay out of my pocket. Are you implying it s actually cheaper to pay out of my pocket as opposed to getting insured for pregnancy related check up s and emergencies?
Is this only applicable for pregnancy related tests, and check ups ? Or are you refereing to all medical care in general?

Would you advise to get insurance for general medical care 3 months before OHIP gets delivered or would that too be too expensive versus what youw ould pay out of your pocket for check ups. There is ofcourse the unexpected events of surgeries or what not not factored into this.

Thanks

 

[scylla]

Hi Scylla,

Thanks for your reply!
I didnt quite understand your first point. Do you mean that even though i would not have covered the first 153 days upon my arrival to Canada i can use my OHIP once the 3month wait is over and then continue the rest of the 153 days ?
Or does the agreement say that i have to have stayed 153 days in Ontario prior to using OHIP ? This contradicts the policy of waiting 3 months before using OHIP,because if i apply to OHIP when i first arrive, my 3 month wait will start from that day and so i wouldnt have covered 153 days by then,which is why i wanted to know can i use OHIP after 3 months from my arrival to Canada and then complete the 153 days ?
Hope i didnt confuse you!
Thanks

See the information on this page of the OHIP web site and the examples they provide that are relevant to you. The requirement you have to meet is 3 months if residency:

http://www.health.gov.on.ca/en/public/publications/ohip/ohip_waiting_pd.aspx

 

[nadinewasfi]

ok Thanks Scylla for your help

 

[Rob_TO]

I didnt quite understand your first point. Do you mean that even though i would not have covered the first 153 days upon my arrival to Canada i can use my OHIP once the 3month wait is over and then continue the rest of the 153 days ?

You are covered under OHIP exactly 3 months (approx 90 days) after you arrive back in Canada. However if you then use OHIP, you must remain in Ontario for the 153 days total afterwards. For example if you came for 3 months, got OHIP and delivered your baby with OHIP, then immediately left Ontario... they could turn around and bill you for the entire amount.

Also regarding point 3 - about getting insured for 3 months before delivery and until OHIP gets delivered, i am not aware of the expenses of regular check ups or the case any pregnency emergency if iw ere to pay out of my pocket. Are you implying it s actually cheaper to pay out of my pocket as opposed to getting insured for pregnancy related check up s and emergencies?
Is this only applicable for pregnancy related tests, and check ups ? Or are you refereing to all medical care in general?

Would you advise to get insurance for general medical care 3 months before OHIP gets delivered or would that too be too expensive versus what youw ould pay out of your pocket for check ups. There is ofcourse the unexpected events of surgeries or what not not factored into this.

You will not find insurance to cover any pregnancy related costs. If you need to get regular checkups during the pregnancy you should prepare to pay those doctor visits and any tests (i.e. ultrasound, blood work, etc) out of pocket. You can try to retain the services of a midwife group as they are a free service and will do all your checkups for free... but since they are in high demand it's very unlikely you'll get one.

You should also have private medical insurance in case of accidents/emergencies for the 3 months waiting time. A minimal $10K policy should cost in the $50 and up per month range. Check some companies/rates here: https://www.kanetix.ca/travel-visitors-to-canada
Just note these travel policies will NOT cover any costs related to your pregnancy, but is still important to have since many others things can happen that may require a doctor/hospital visit, and it's very important an expectant mom stays healthy in general. Ask lots of questions to the insurance companies to find out exactly how the pregnancy affects potential insurance claims.

 

[nadinewasfi]

Thanks a lot Rob for this information.

 

[muumi]

In clarification, I think you need to know that midwives are not a "free" service. Like doctors, they are paid by OHIP - but not at as high a rate. When OHIP did not pay midwives, full prenatal care plus the birth cost around $3000 - that was in 1990. This included basic tests performed in the office, but not ultrasounds.

 

[Steevy]

Hi,

I wanted someone s feedback on the following:

-Im a returning Canadian , i understand when i go apply for the OHIP , i will be reapplying and will have to wait 3 months before it is activated. I also understand that i have to be in the country for atleast 5 months out of the first 6 months immdeiately after applying for OHIP. If i am already in my 6th month of pregnancy by the time i return to Canada, and i only apply for the OHIP then, i will only get the OHIP 3 months later meaning i will be in my 8th month of pregnancy . If i deliver in the 9 th month and not earlier, i will only have been in Canada for 4 months and not for 153 days yet. Will the OHIP be valid to use for the pregnancy even though i had only applied 4 months earlier for it ? I mean i wouldne have compelted the 153 days but i would ve received my OHIP since i wouldve spent 3 months . Or do i have to actually have spent the first 153 days in Canada before i give birth using my OHIP card?

-What is reommended private insurance company that can cover the 3 month wait for my OHIP that will include pregnancy and check ups and any emergencies. Are there insurance companies that can cover emergency delivery as well?

-Are there any private insurance companies that do cover the pregnancy , delivery and everything that comes with it? I understand that there are but you would need to apply for it atleast a 1.5 months before you decided to get pregnant.



Appreciate your advice
Thanks
Nadine

Unfortunately, since you are already pregnant, no private insurance company will cover check ups or delivery, but only pregnancy related emergencies including abdominal pain, miscarriage, bleeding, etc.

There is a good plan that will cover you for such emergencies for up to 31st week of your pregnancy period and then you will have your delivery covered by OHIP.

Just Click Here to take a look at the plan and chat with a representative.

OHIP might also be available to you a little earlier if you try to speak with someone and explain your situation. As far as I know, Quebec health care has this sort of exception.

In your case as you already pregnant, I would

 

[manas_shekar]

Hello,
Me and my Wife are in a very similar situation.
Both of us will be travelling to Ontario in October on my WP (My Wife will be travelling as a dependent) during her 5th month of pregnancy.
we will be staying there at least for 2 years.

1. Will she be eligible for OHIP as a spouse with me being on a WP?
2. Considering that we apply for OHIP after arrival, and we get it in her 8th month, I understand that the birth of the baby will be covered. Please confirm?
3. Company has a group insurance tie-up and i am checking with them too for coverage of standard expenses from 5th-8th month of pregnancy. how much will these costs be approximately?

are there any other points that i need to worry about before arriving to Canada?

Thanks in advance.

 

[Steevy]

1. Yes, she is eligible to be covered by OHIP according to the Ontario Health website. It reads: "you are the spouse, or dependent child (under 22 years old or 22 years and over if dependent due to a mental or physical disability) of an OHIP-eligible member of the clergy or OHIP-eligible foreign worker"

2. Yes, OHIP covers pregnancy related costs including delivery.

3. You may as well check out an individual private insurance plan for Visitors to Canada and be covered until she becomes eligible for OHIP.

THIS plan covers pregnancy related emergencies including abdominal pain, bleeding, miscarriage, etc. up to the 31st week of pregnancy. You may also chat live with a representative.

Hope it clarifies the situation.

 

[manas_shekar]

Thanks Steevy. This definitely helps!
I am still checking with the group insurance plan of my company.

after that, i will check with the above mentioned private insurance plan.



Thanks again!

 

[Rob_TO]

3. Company has a group insurance tie-up and i am checking with them too for coverage of standard expenses from 5th-8th month of pregnancy. how much will these costs be approximately?

Note that in Ontario many employer group insurance providers (like Sunlife, Manulife, etc) require that an employee have OHIP coverage before you are eligible to be covered by the group plan. So during the 3 month waiting period you may not be eligible for ANY coverage from your group plan either.

Each company is different so need to call them directly to ask.

 

[manas_shekar]

I just checked with my company about the group insurance plan - and it covers everything without any pre-conditions or exclusions until OHIP kicks in.
this is great news ;D