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geekyknitter Posts: 1
Posted On: 10/7/2016
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First, I apologize if this is here somewhere, I tried to search for it but couldn't find the information I was looking for.
Second, a little background. I am a dual US/Canadian Citizen currently living and working in the US with insurance coverage provided by my job. I am considering my options for a move to Ontario in the spring and one of the things that I would like to have a plan for is insurance coverage. In moving I will keep my job but lose my employee status and will be come an independent contractor so I will need to figure this out on my own. I have three topics two of which comes with a lot of sub questions.
1) What premiums does a self-employed person pay to OHIP?
2) I travel a lot for work and will continue to do so after I move. It is unlikely that I will be able to meet the 153 days of physical presence in the first 6 months for instance although as a rule I would expect to have no trouble being in Ontario for the 153 days annually. I know that there is an exception for mobile workers but I can't seem to find any information about what you have to do to apply for it. Is this something that you do in advance? What kind of documentation is required? How is the 153 days calculated? For instance if I am travelling for work and I leave Monday morning and return Thursday evening does that count as 2 days out of the country and 2 days in the country or four full days out of the country?
3) How do pre-existing conditions work?
don't have any big medical problems but I do have a few things, notably a problematic shoulder that requires fairly regular PT in order to stay fully functional. This is covered under my current insurance and I don't expect any gaps in my insurance coverage (I plan to purchase a private policy to cover the three month gap between moving and getting OHIP).
I know that in the US, even before the latest round of reforms pre-existing conditions were covered as long as you had continuous health insurance, is this true of OHIP also?
What about private plans? Also is there a time limit on pre-existing conditions, like if you have been covered for x years then it doesn't matter if a problem was caused by a pre-existing condition?
Any advice you can give will be appreciated, even if that advice in the form of a recommendation of someone to talk to.
Thank you.
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Moderator Moderator Posts: 4142
Posted On: 10/17/2016
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Hello,
Thank you for sharing your situation and question with us.
Regarding your first question,
1) What premiums does a self-employed person pay to OHIP?
You can find some detailed information on the Ministry of Finance website in the Ontario Health Premium section. Here is an excerpt,
Who pays the premium?
The premium is based on income. If you were a resident of Ontario at the end of the year, and your taxable income (line 260 of your personal income tax and benefit return) is more than $20,000, you have to pay the premium. Individuals with taxable income of $20,000 or less are exempt.
and
Self-employed individuals and individuals who pay income tax instalments
Self-employed individuals who remit tax by instalments must include an estimated amount for the Ontario Health Premium. Instalment interest may be charged if these instalment payments are insufficient.
and
How much will my premium be this year?The premium ranges from $0 if your taxable income is $20,000 or less, to $900 if your taxable income is more than $200,600.
The actual amount is calculated when you file your annual personal income tax and benefit return, on form ON428.
Regarding your second question,
2) I travel a lot for work and will continue to do so after I move. It is unlikely that I will be able to meet the 153 days of physical presence in the first 6 months for instance although as a rule I would expect to have no trouble being in Ontario for the 153 days annually. I know that there is an exception for mobile workers but I can't seem to find any information about what you have to do to apply for it. Is this something that you do in advance? What kind of documentation is required? How is the 153 days calculated? For instance if I am travelling for work and I leave Monday morning and return Thursday evening does that count as 2 days out of the country and 2 days in the country or four full days out of the country?
Regarding your question about physical presence, you can find some information on the
website in the
section.
Here is an excerpt,
Absences Outside CanadaYou may be eligible for continuous OHIP coverage if you are away from Ontario for one of the following reasons :
- Study full-time outside of Canada
- Work outside of Canada
- Charitable work outside of Canada
To be eligible for continuous OHIP coverage during one of these absences, you must first meet certain physical presence requirements. You must be physically present in Ontario for at least 153 days in each of the 2 consecutive years immediately before the absence.
To confirm your eligibility for continuous OHIP coverage during any longer absence from Ontario, you should contact your local ServiceOntario centre before you leave the province. Go to ServiceOntario.ca/findservicesto find the centre nearest to you. You will need to show a document explaining the reason for your absence as required (for example, a letter from your school, employer or sponsoring charitable organization).
As suggested on the Ministry of Health and Long-Term Care website, you may want to try and contact ServiceOntario directly for some information specific to your situation.
Call ServiceOntario, INFOline at:
1-866-532-3161 (Toll-free in Ontario only)
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm
You may want to try and call the Toronto line from outside Ontario or Canada. You may have to pay long distance charges.
Regarding your third question,
3) How do pre-existing conditions work?
In terms of OHIP coverage, it is not based on new or pre-existing conditions. However, there are certain things that may not be covered.
You can find some helpful information in our Settlement.Org What services does OHIP cover? article.
I hope this information is helpful. Please let us know if you have further questions and if there is any follow up to your question/situation.
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Anna
Settlement.Org Content and Information/Referral Specialist, CIRS
Settlement.Org
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