Wednesday, June 22, 2022

Who Is Eligible For Health Insurance

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Question Nr#33: Only one person is eligible to buy a group health insurance plan?

For those who make Canada their new home, universal health coverage can provide a sense of security and comfort. But it is a bit more complicated for those who fall through the gaps. If you have a loved one who is applying for a Super Visa, Insurance Hotline can give you more information about the kind of coverage they need. This gives you all peace of mind when you reunite in Canada.

Who Is Eligible Under Family Coverage

An eligible employee’s dependents are eligible for coverage. Eligible dependents include an employee’s spouse, domestic partner, unmarried children, and children adopted by the employee or the employee’s spouse. Eligibility requirements for a domestic partner are described in the next block.

Spouse

An employee’s current or legally separated spouse is eligible for coverage. A divorced spouse is not eligible.

Children

Coverage can include an employee’s children up to age 26 including, but not limited to, stepchildren and children under the employee’s legal guardianship living at home.

An employee’s unmarried children of any age incapable of self-support due to a mental or physical disability who were disabled before reaching age 26 can be covered subject to medical documentation as required by the claims administrator.

Note: The Research Foundation is required by law to permit employees subject to a child medical support order to enroll dependent children in a health care plan without regard to open enrollment restrictions.

Exclusions

An employee may not be covered both as an employee and as a dependent of another RF employee. If two members of the same family are employed at the Research Foundation, both can have individual coverage or one can have family coverage.

Q Am I Still Eligible For Ohip If I Temporarily Leave Ontario

You may be out of the province for up to 212 days in any 12-month period and still maintain your Ontario health insurance coverage provided that you continue to make Ontario your primary place of residence.

To maintain eligibility for OHIP coverage you must be an eligible resident of Ontario. This means that you must :

  • have an OHIP-eligible citizenship/immigration status; and
  • be physically present in Ontario for 153 days in any 12-month period; and
  • be physically present in Ontario for at least 153 days of the first 183 days immediately after establishing residency in the province; and
  • make your primary place of residence in Ontario.

If you will be out of the province for more than 212 days in any 12-month period, please refer to the Longer Absences from Ontario fact sheet.

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Who Is Not Eligible

The following employees are not eligible for health insurance:

  • employees working less than .50 FTE.
  • employees on summer appointments .
  • employees who are only on extra service appointments.
  • full-time SUNY students employed part time by the Research Foundation in an RF student title, whose work coordinates with education and training leading to fulfillment of academic requirements.

    Note: Students may be eligible for coverage under a separate plan.

Q My Photo Health Card Has Expired How Do I Renew My Health Card

Covered California: Open & Special Enrollment

Your photo health card has an expiry date that is linked to your date of birth. The first time you apply for a photo health card, the expiry date can be anywhere from two to seven years in the future. When your photo health card is renewed, the renewal date will always be five years in the future and linked to your date of birth.

Renewal notices for photo health cards are mailed approximately two months prior to the expiry date shown on the front of the photo health card; however, if it is more convenient, you can renew up to six months prior to the date of expiry.

To learn more about renewing your Ontario photo health card, refer to the fact sheet Renewing Your Photo Health Card.

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Am I Covered For Emergency Care Outside Of Canada

Doctor Bills Manitoba Health and Seniors Care will pay for emergency doctors services outside of Canada at a rate equal to what a Manitoba doctor would receive for a similar service.

Hospital Bills Emergency hospital care is paid on an average daily rate established by Manitoba Health and Seniors Care.

You may be charged more than the amount paid by Manitoba Health and Seniors Care for services provided outside Canada.

The difference above the covered amount may be substantial and is your responsibility.

Bring or mail your original bill to the Out-of-Province Claim Section at Manitoba Health and Seniors Care within 6 months of receiving care. If you have made payments on your bills, Manitoba Health and Seniors Care requires a receipt showing the amount paid. If you do not include your receipt, Manitoba Health and Seniors Care will pay the hospital or doctor directly.

For more information contact:

Manitoba Health and Seniors Care300 Carlton Street Business hours: Monday to Friday 8:30 to 16:30 For more information call: 204-786-7303Toll free:; 1-800-392-1207 Ext. 7303TDD/TTY: 204-774-8618TDD/TTY Relay Service outside Winnipeg: 711 or 1-800-855-0511

NOTE: The in-person Registration and Client Services Office at 300 Carlton St., Winnipeg will be temporarily closed to the public to support social distancing efforts.;Services will be available by telephone or email.;.

Overseas Student Health Cover

If youre in Australia on a temporary visa, you should consider buying insurance to cover the costs of medical treatment. Find out more about health cover for overseas visitors and overseas students.

International students who havent been able to return to Australia due to COVID-19 should contact their private health insurer to find out about options for extending, or suspending, their cover.;Some may offer a period of suspension, but they are not required to do so.

Read our collection of resources for international students.

A collection of resources about overseas student health cover for the general public and private health insurers.

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If Youre Pregnant But Not Eligible For Publicly Funded Healthcare

If youre pregnant and your partner is eligible for publicly funded health and disability services, you can get some maternity-related services in NZ even if youre not eligible for other services.

If you and your partner are not eligible, you have to pay for maternity care or use health insurance to help cover the cost.

Q What Should I Do If I Move

Who is eligible for unemployment benefits?

It is important that ServiceOntario has your current address to ensure your coverage remains active and for any direct communication with you.

There are three ways to update your address:

For more information refer to OHIP Bulletin 8089, fact sheets Changes to OHIP Coverage for Eye Care Services and Health Services.

Northern Health Travel Grant;:

You may be eligible for a Northern Health Travel Grant to help pay transportation costs if you live in northern Ontario and must travel long distances for specialty medical care.

Services in Other Canadian Provinces and Territories;:

Most of your Ontario health coverage benefits can be used across Canada. The province or territory you are visiting will usually bill Ontario directly. If you have to pay for health services you receive in another part of Canada, you can submit your receipts to your local OHIP Claims office to be considered for reimbursement. Prescription drugs from pharmacies, home care services, ambulance services and long-term care services provided in other provinces and territories are not covered.

Services Outside Canada;:

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How Does My Health Plan Know To Offer Me Cobra

If youre eligible for COBRA health insurance, you wont get a COBRA election notice from your health plan if the health plan doesnt know about your life-changing event. Someone has to tell the health plan administrator. This is known as “giving qualifying event notice.

The employer will tell your health plan if your loss of coverage is due to the termination of the employee, death of the employee, employee Medicare eligibility, or reduction of employee work hours. Its your responsibility to tell your health plan if your loss of coverage is due to divorce, legal separation, or a young-adult losing dependent status under plan rules.

In some cases, you may be tempted to withhold notice. If the employer and health plan dont know youre legally separated, you might think you wont have to pay the COBRA health insurance premiums. Youd just continue on with spousal coverage as though youre a married couple. Think again.

Youre required to give qualifying event notice in a timely manner. Not giving qualifying event notice is a type of fraud; youre basically stealing health insurance coverage for which youre no longer eligible. The employer may demand reimbursement for its share of the monthly premiums paid for the coverage you were no longer eligible to receive. The health plan may demand reimbursement for the health care it paid for while you were receiving coverage fraudulently.

Q How Do I Change My Name On My Health Card Upon Dissolution Of My Marriage

To change your name on your photo health card to reflect your birth name or a previous married name, you must visit a ServiceOntario centre, complete a Change of Information and present the original of one of the following:

  • A divorce certificate which includes your previous name and the requested name
  • A marriage certificate which includes your previous name and the requested name
  • Birth certificate
  • Change of name certificate

If you do not already have a photo health card, you must also provide three original documents to prove citizenship, Ontario residence and identity.

If you have any questions regarding your own specific situation, call the ServiceOntario, INFOline at 1-866-532-3161.

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I’m New To Canada How Do I Apply For Coverage

If you are moving to or returning to Manitoba from outside of Canada, eligibility is based on proof of your legal status in Canada and your residence in Manitoba.

Who is eligible for Manitoba Health and Seniors Care coverage?

Returning Canadians You are eligible for coverage the day you arrive in Manitoba when proof of your Canadian citizenship, arrival date and residence status are provided.

Permanent Resident You are eligible for coverage on your date of arrival in Manitoba when proof of Permanent Resident Status is provided or on the date Permanent Resident Status is granted.

Work Permit If your Work Permit is valid for at least 12 months in Manitoba, you and any family members listed on the Work Permit are eligible for coverage as of the date it was issued. If your Work Permit is less than 12 months, you are not eligible until you receive an extension allowing you to stay in Manitoba for at least 12 months. You will then be covered as of the date of the extension.

Study Permit Effective September 1, 2018, individuals with a Study Permit from Immigration, Refugees and Citizenship Canada are no longer eligible for health insurance coverage through Manitoba Health and Seniors Care .

When you register, you will need to:

Provide proof of residence in Manitoba: 6 months in a calendar year.

Are New Canadians Eligible For Provincial Health Insurance

COBRA Insurance: Understanding Eligibility, Timelines and ...

Universal health care is often touted as one of the benefits of living in Canada. But not everyone who lives here can access it. There are strict rules about eligibility that may affect many new residents.

Depending on your status, you may have only limited coverage. You may be covered by special programs run by the federal government. If you are welcoming a family member to Canada under the Super Visa program, they need private health insurance. In short, it’s complicated, but you may have more options that you think.

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Is My Health Insurance Subject To Cobra

Not all health plans have to offer COBRA continuation coverage. Your plan does if its a group plan offered through a private-sector employer with at least 20 full-time employees . COBRA also applies to most state and local government health plans.

You wont be eligible for COBRA if there is no health plan to continue because your employer went bankrupt. In addition, COBRA doesnt apply to health plans offered by the federal government, by churches, or by some church-related organizations.

For example, when I resigned from my nursing job with Florida Hospitals, I wasnt eligible for COBRA health insurance. This had nothing to do with me; it was because my former employer, Florida Hospitals, is part of Adventist Healthcare, an organization run by the Seventh Day Adventist Church. Because Florida Hospitals is a church-related organization, its employee health plan isnt subject to the COBRA law.

But when I quit my job working at a Kaiser Permanente hospital, I was eligible for COBRA health insurance. Kaiser is a large, private-sector, non-church related employer. Kaisers health plan was subject to the COBRA law; it had to offer me COBRA continuation coverage.

More Health Cover And Choice

Depending on your policy, private health insurance pays some or all of the costs of:

  • treatment in public or private hospitals as a private patient with the doctor of your choice
  • health services that are notcovered under Medicare such as physiotherapy, dental and optical.

Private health insurance might also help you access some hospital services more quickly.

Find out more about what private health insurance covers.

You can still choose to be a public patient in a hospital if you have private health insurance.

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If I Need An Ambulance Is It Covered By Manitoba Health And Seniors Care

Manitoba Health and Seniors Care will cover medically-necessary, land ambulance inter-facility transports when patient is being transported between designated health-care facilities for diagnostic tests or treatment, or from a more specialized level of care to another facility closer to home for rehabilitation or recovery.

Eligibility criteria for coverage of inter-facility medical transports includes:

  • the patient must be a resident of Manitoba with a valid Manitoba Health card,
  • the patient must medically require transportation by ambulance as determined by a physician, and
  • the patient is being transferred between designated health-care facilities for diagnostic tests or treatment, or from a more specialized level of care to another facility closer to home for rehabilitation or recovery.

In addition, patients are not eligible for funding under the Manitoba IFT program if one of the following applies:

Out of Province Transport of Manitobans

If you require an ambulance while out of the Province there are no subsidies/coverage from the Manitoba government. You will be charged by the ambulance service/company that provides the service at full cost recovery. The rate for out of province ambulance service may be substantially higher than rates charged local residents, as local subsidies will not apply.

Air Ambulance Transfers

Air ambulance transfers may be an insured service in one of three ways:

What Documents Should I Bring When I Register

Am I eligible for Obamacare?

When applying for a new health card, you must bring three original documents to prove your OHIP-eligible citizenship/immigration status, your residence in Ontario, and your identity.

If you are a member of a military family, refer to the fact sheet Military Family Members and the Military Family Member Document List.

If you have questions about what documents to bring with you when you register for OHIP coverage, contact ServiceOntario INFOline at 1-866-532-3161 or visit your local ServiceOntario Centre.

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Q Do I Need To Cancel My Ohip Coverage If I Plan To Move To A Location Outside Ontario

You should contact the Ministry of Health and Long-Term Care with any change of address. If you move to a location outside Ontario, you should inform the ministry of your new address and the date of your move as soon as possible. To inform the ministry of your move, you can either :

  • Send a letter to your local ServiceOntario Centre. You must include your name, health card number, telephone number, current address and new address including postal code.

The ministry will end your OHIP coverage based on the information that you provide.

Q How Do I Change My Name On My Health Card To My Married Name

To change your name on your health card to reflect your married name, you must visit a;ServiceOntario centre;, complete a Change of Information and present the original of one of the following:

  • Certificate of Marriage
  • Certified copy of Statement of Marriage
  • Original marriage document issued outside of Ontario which contains the names of both spouses
  • A record of marriage form
  • Change of name certificate

If you are changing your name to reflect a ‘common-law’ marriage, you must visit a ServiceOntario centre, complete a Change of Information and present the original of one of the following:

  • Change of Name certificate
  • Certified copy of the court order for a change in surname
  • Notarized affidavit of the facts supporting the use of the ‘common-law’ surname

If you do not already have a photo health card, you must switch to a photo health card in order to change your name. You will be required to provide three original documents to prove citizenship, Ontario residence and identity.

If you have any questions regarding your own specific situation, call the ServiceOntario INFOline at 1-866-532-3161.

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Lawfully Residing Targeted Low

States have the option to provide CHIP and Medicaid coverage to children and pregnant women who are lawfully residing in the United States and are otherwise eligible for coverage, including those within their first five years of having certain legal status. If states do not adopt this option, federal law requires a 5-year waiting period before many legal immigrants are permitted to enroll in Medicaid and CHIP. Learn more about providing health coverage to lawfully residing children and pregnant women at 2107 of the Social Security Act, and in;SHO# 10-006 . A;list of states;providing Medicaid and CHIP coverage to lawfully residing children and/or pregnant women.

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