Overview

OHIP provides coverage for health services received outside of Canada when regulatory criteria are met. There are 2 kinds of out-of-country (OOC) services that may be funded:

  1. OOC emergency health services for travellers
  2. Prior approved OOC health services

The following sections provide information on the prior approved OOC health services.

Doctor recommended out-of-country care

Applying for out of country prior approval

Before applying for out-of-country (OOC) prior approval, you must:

  • determine the patient needs out-of-country healthcare services
  • submit a prior approval application to the ministry for consideration
  • submit written confirmation from a specialist that regulatory criteria for funding are met and include appropriate medical records

Out-of-country prior approval forms

Forms are specific to the type of OOC service requested. You must use the application form that is appropriate for the OOC service requested.

Completed application forms can be:

  • mailed to the ministry at the address provided at the top of the form
  • sent by fax to 1-866-221-3536 or 613-536-3181

Forms

Processed applications

Once an application is processed, the ministry will send a decision letter to the submitting Ontario doctor and a copy of the decision letter to your patient.

If approved, this letter will outline the approved services, medical or treatment facility to provide services and service limits and inclusion/exclusions of funding.

The decision letter is based on the medical documentation provided with the application. Ontario doctors may submit another application or additional information if circumstances change.

Note: If your patient does not receive prior written approval from the ministry, OHIP will not fund their medical expenses. Your patient will be responsible for all costs.

Prior approved services

OOC services may be OHIP insured if the requested services and treatment are:

  • performed at a hospital or licensed health facility and
  • not experimental or for research or for a survey and
  • accepted in Ontario as appropriate in the same medical circumstances and
  • not performed in Ontario by an identical or equal procedure or performed in Ontario but a delay in services would:
    • result in death or
    • medically significant irreversible tissue damage

Even when medical services have prior approval, your patient is encouraged to buy private medical travel insurance and understand what the private policy covers.

Services not eligible for out of country funding

The ministry only covers costs for prior approved medical services.

Expenses not covered by OHIP include non-medical services such as travel, accommodations and meals unless they are part of insured hospital services.

Workplace Safety and Insurance Board (WSIB)

Services for a person entitled under the Workplace Safety and Insurance Act are not insured by OHIP.

If a work-related accident requires OOC medical services, the prior approval process is not applicable. A form should not be submitted to the ministry.

Your patient should contact the Workplace Safety and Insurance Board (WSIB) to discuss coverage.
For more information contact the Ministry of Health, Health Insurance Branch by:

Preferred provider arrangements

Regulation 552 under the Health Insurance Act authorizes the Ministry of Health (ministry) to enter into funding agreements also known as preferred provider arrangements (PPAs) with:

  • OOC hospitals
  • OOC health facilities

Facilities are selected for PPA status using criteria appropriate to the insured medical service that is covered by the PPA. Periodic reviews of PPAs are conducted by the MOH with support from Ontario experts, to ensure that the selection process remains current, competitive, and open.

PPA covered treatments and services

If an insured health service is covered by one or more PPA, but an Ontario patient receives the service or an equivalent service from an OOC provider that has not entered into a PPA with the ministry, then the amount payable is zero.

The ministry does not endorse, warrant, guarantee or otherwise certify the quality or standards of treatment or other services offered by preferred providers. These considerations should be reviewed by the patient in consultation with their attending physician(s).

Chimeric Antigen Receptor (CAR) T-Cell therapy

CAR T-Cell therapy is available to individuals aged 18 and older with Diffuse Large B-Cell Lymphoma (DLBCL) or those aged 18 to 25 with Acute Lymphoblastic Leukemia (ALL), upon prior approval from the ministry.

The ministry has established PPAs with the following United States (U.S.) facilities to provide CAR T-cell therapy with United States Food and Drug Administration (FDA)-approved  products to Ontario residents.

Diffuse Large B-Cell Lymphoma (DLBCL) and Acute Lymphoblastic Leukemia (ALL)

Karmanos Cancer Institute – DLBCL only 
4100 John R Street
Detroit, MI
48201
Rosewell Park Comprehensive Cancer Center
665 Elm Street
Buffalo, NY
14203
Cleveland Clinic
9500 Euclid Avenue
Cleveland, OH
44195

Ontario Health (formerly Cancer Care Ontario) oversees the Ontario CAR T-cell Therapy Program and facilitates the efficient processing of all OOC CAR T-cell funding applications. They also serve as the ministry’s representative in the collection of OOC applications directly for the ministry.

Learn more about CAR T-cell Therapy in Ontario

Proton Beam Therapy

The ministry has established PPAs with the following U.S. facilities to provide Proton Beam Therapy to Ontario residents who have received prior approval from the ministry.

Facilities for Proton Beam Therapy

Cincinnati Children’s Hospital Proton Therapy Centre - Pediatrics Only (under 18 years old)
7777 Yankee Road, Suite 1000
Liberty Township, OH
45044
Massachusetts General Hospital - Pediatrics Only (under 18 years old)
55 Fruit Street
Boston, MA
02114
Northwestern Medicine Chicago Proton Center
4455 Weaver Parkway
Warrenville, IL
60555
University of Florida Health Proton Therapy Institute
2015 North Jefferson Street
Jacksonville, FL
32206
MD Anderson Cancer Centre
1515 Holcombe Boulevard
Houston, TX
77030
University of Pennsylvania Health System (“Penn Medicine”) - Adults Only (18 years and over)
3920 Chestnut Street
Philadelphia, PA 
19104

Note: If your patient’s proposed treatment plan requires in-patient rehabilitation therapy, we recommend considering Northwestern Medicine Chicago Proton Center.

Diagnostic imaging

The ministry has established PPAs with the following U.S. facilities to provide, non-emergency stand-alone diagnostic imaging (not part of a pre-approved treatment) to Ontario residents, provided they have obtained prior approval from the ministry.

Diagnostic imaging centers

Basha Diagnostics
30701 Woodward Avenue
Royal Oak, MI
48073
Great Lakes Medical Imaging LLC
199 Park Lane, Suite 300
Williamsville, NY
14221
St. Luke’s Hospital of Duluth
910 East 2nd Street
Duluth, MN
55805
Western New York MRI, LLP
2882 Elmwood Avenue
Kenmore, NY
14217

Mental health services

The ministry has established PPAs with the following U.S. psychiatric hospitals to provide the specified mental health services to Ontario residents who have obtained prior approval from the ministry.

Note: Mental health services that are not specified in the list are not insured, even if they are offered at one of the psychiatric hospitals mentioned below.

Programs for children and adolescents

Eating disorders

Rogers Behavioral Health
Level of care: Residential, in-patient and partial hospitalization
Minimum age: 12 years old
Locations:
Oconomowoc Main Campus
34700 Valley Road
Oconomowoc, WI
53066

The Eating Recovery Centre 
Level of care: Residential, inpatient and partial hospitalization
Minimum age: 12 years old
Locations:
Denver Pine
98 Spruce Street
Denver, CO
80230

Denver Jupiter
1830 Franklin Street
Denver, CO
80218

Plano Baylor
4708 Alliance Boulevard #300
Plano, TX
75093

Plano Legacy
5120 Legacy Drive
Plano, TX
75024

Walden Behavior Care 
Level of care: Residential and inpatient treatment
Minimum age: 11 years old
Locations:
Centre for Recovery
10 Carematrix Drive
Dedham, MA
02026

Obsessive Compulsive Disorder

Rogers Behavioral Health
Level of care: Residential and partial hospitalization
Minimum age: 12 years old
Locations:
Oconomowoc Main Campus
34700 Valley Road
Oconomowoc, WI
53066

Trauma-Based disorders treatment

Rogers Behavioral Health
Level of care: Residential
Minimum age: 8 years old
Locations:
Oconomowoc Main Campus
34700 Valley Road
Oconomowoc, WI
53066

Programs for adults (18 years and over)

Eating disorders

Rogers Behavioral Health
Level of care: Residential and inpatient
Minimum age: 18 years old
Locations:
Oconomowoc Main Campus
34700 Valley Road
Oconomowoc, WI
53066

River Oaks Hospital 
Level of care: Residential
Minimum age: 18 years old
Locations:
River Oaks Hospital
1525 River Oaks Road West
New Orleans, LA
70123

Obsessive Compulsive Disorder

Rogers Behavioral Health
Level of care: Residential and day treatment
Minimum age: 18 years old
Locations:
Oconomowoc Main Campus
34700 Valley Road
Oconomowoc, WI
53066

Trauma-Based disorders

Rogers Behavioral Health
Level of care: Day treatment for Anxiety and Depression and Post-Traumatic Stress Disorder
Minimum age: 18 years old
Locations:
Oconomowoc Main Campus
34700 Valley Road
Oconomowoc, WI
53066

West Allis Campus
11101 West Lincoln Avenue
West Allis, WI
53227

River Oaks Hospital
Level of care: Residential for Post-Traumatic Stress Disorder, Dissociative Identify Disorder, Major Depressive Disorder and others, whether with or without substance use
Minimum age: 18 years old
Locations:
River Oaks Hospital
1525 River Oaks Road West
New Orleans, LA
70123

Note: The mental health services and programs listed above are generally appropriate only for persons who are psychiatrically stable and ready to engage in therapy. Persons who are not psychiatrically stable should either seek or be directed to treatment in Ontario.

To learn more, read the list of designated psychiatric facilities under the Mental Health Act.