Prior approval from the Ministry of Health and Long-Term Care is required in order for you to receive funding for OHIP insured hospital and medical services out of country (OOC). Written approval must be received from the ministry before OOC health services are received.

• How to Apply for Out of Country Prior Approval
• Services Not Eligible for Out of Country Funding
• Workplace Safety and Insurance Board (WSIB)

Application forms must be submitted by your Ontario physician before any OOC hospital or medical services are rendered. If your physician determines that you require OOC hospital or medical treatment, your physician must submit a Prior Approval Application for Full Payment of Insured Out of Country Health Services (1442-84) to the ministry for consideration.

You or your physician may fax completed Applications for OOC Prior Approval to : 1-613-536-3181.

When your application for OOC Prior Approval has been processed by the ministry, a decision letter will be sent to your Ontario physician and a copy sent to you. Your letter will clearly outline what service(s) have been approved, the facility where the service(s) are to be provided and the approved cost of the service(s).

The decision letter is based on the medical documentation provided with your application. If your circumstances change, a new prior approval application may be submitted to the ministry by your Ontario physician requesting new treatment and/or services as well as the proposed OOC physician/facility for consideration.

If you do not receive prior approval from the ministry before medical services are rendered outside of Canada, you will be responsible for any and all costs associated with this treatment and your medical expenses may not be funded by OHIP.

Prior Approved Services : (services that are provided outside Canada under special arrangements made prior to the medical services being received). The requested OOC services may be OHIP insured, if the "Prior Approval Application for Full Payment of Insured Out of Country Health Services" established that the services and treatment being requested are :

• Performed at a hospital or licensed health facility; and
• Not experimental or for research or for a survey; and
• Generally accepted in Ontario as appropriate for a person in the same medical circumstances as the insured person; and
• Either not performed in Ontario by an identical or equivalent procedure; or
• Performed in Ontario but the insured person must receive the services outside Canada to avoid a delay that would result in death or medically significant irreversible tissue damage.

NOTE : Even when medical services are prior approved, you are still encouraged to purchase additional private medical insurance and fully understand what your policy covers.

In the case of prior approvals, the ministry only covers costs for prior-approved medical services. Expenses incurred for non-medical services such as travel, accommodation and meals (except where included as part of insured hospital services) are NOT covered by OHIP.

Treatment that is generally accepted in Ontario as experimental, for research or a survey, including clinical and drug trials are also not covered by OHIP.

If you require OOC hospital or medical services as the result of a work-related accident, the prior approval process is not applicable and a form should not be submitted to the ministry. Please contact the Workplace Safety and Insurance Board (WSIB) to discuss coverage as OHIP does not insure services to which a person is entitled under the Workplace Safety and Insurance Act (WSIA).

For more information contact :

Accountability Management Branch, Provider Payment Programs – Out of Country Program
Health System Accountability and Performance Division
Ministry of Health and Long-Term Care
370 Select Drive, P.O. Box 168
Kingston, ON K7M 8T4
Tel : 1-888-359-8807
E-mail : OOCPriorApprovalInq.moh@ontario.ca
Fax : 1-613-536-3184

Accountability Management Branch, Provider Payment Programs – Out of Country Program
Health System Accountability and Performance Division
Ministry of Health and Long-Term Care
370 Select Drive, P.O. Box 168
Kingston, ON K7M 8T4
Tel: 1-888-359-8807
E-mail: OOCPriorApprovalInq.moh@ontario.ca
Fax: 1-613-536-3184

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