The tourism bureau confirmed that the Cuban Government is aware that most provincial health insurance plans, such as OHIP or RAMQ, do not provide direct coverage for out-of-country emergency medical services, and that visitors carrying only provincial government health insurance cards would be required to pay Cuban hospitals, clinics, doctors and other providers in full, at the time of treatment. They would then have to file for reimbursement with their provincial plans and they could expect only a small portion of their claims to be paid. THIA reminds Canadians that reimbursements for out-of-country hospital and medical services are based on rates pre-determined in each province and normally cover only a fraction of the charges travellers are required to pay.

"The announcement that Cuba would accept provincial health insurance cards as proof of insurance has prompted some of Canada's vacation and tourism operators to imply that additional travel health insurance was not mandatory for meeting the May 1, 2010 medical coverage requirement; which may technically be correct," says Martha Turnbull, president of THIA. "However, some of these announcements have left the mistaken impression that provincial government health insurance will cover the cost of emergency medical services in Cuba, which could result in travellers having to pay out of pocket. Such an impression provides a disservice to Canadian travellers, who may end up with significant unexpected costs," she adds.

Canadians who elect not to purchase supplemental travel medical insurance should consider the following facts:

• Most Canadian provincial government health insurance plans do not make direct payments to out-of-country hospitals, doctors or clinics.

• In-patient hospitalization is reimbursed at pre-set rates depending on the province, and can range from as low as $75 per day in B.C., to $200 in Ontario ($400 in ICU) and varying rates in other provinces. The cost of these services in Cuba exceeds these amounts.

• Wait times for reimbursement by provincial health plans range between 90 days and 18 months.

• Provincial plans do not cover the cost of ground ambulance in Cuba or repatriation back to Canada by commercial airline or air ambulance. 

• Many outpatient clinics and lab services, or other incidental charges related to out-of-country emergency medical care are not covered by the provincial health plans.

• All provincial health plans strongly urge their residents to purchase supplemental travel insurance for any trips they make out of the country.