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Caring for kids new to Canada

A guide for health professionals working with immigrant and refugee children and youth

Health Insurance for Immigrant and Refugee Families

Key points

  • Health professionals should support immigrants and refugees to understand how the Canadian health care system works, including insurance provisions, and advocate for newcomer patients when required.
  • Permanent residents in Canada qualify for provincial/territorial health insurance, but they should apply as soon as possible after arriving, and there can be a waiting period.
  • Refugees and refugee claimants may qualify for coverage under the Interim Federal Health Program.

Health insurance for permanent residents

Permanent residents can apply for provincial/territorial health insurance. They are encouraged to apply as soon as possible after arriving in Canada. Application forms are available online from each province or territory’s Ministry (or Department) of Health.

All provinces and territories except for British Columbia, Manitoba and Quebec provide permanent residents upon their arrival with full provincial health coverage equal to that of the resident population.1 British Columbia, Manitoba and Quebec impose a wait period of up to 3 months pending eligibility for provincial health insurance for permanent residents, during which time they are not covered by provincial insurance. Waiting periods may be waived in some cases. All babies born in Canada are considered Canadian citizens. Eligibility for health care may vary from province to province.

Immigration, Refugees and Citizenship Canada (IRCC) encourages permanent residents to apply for private health insurance to cover a provincial wait period. IRCC cautions that private insurance must be purchased within five days of arriving in Canada or the insurance company might not cover the individual. Be aware that private insurance is not an option for many families owing to pre-existing medical conditions or high costs; these families may remain uninsured. For more information, visit the Immigration, Refugees and Citizenship Canada website.

Health insurance for refugees and refugee claimants

There are two broad types of refugees in Canada: refugee claimants and resettled refugees.

Resettled refugees

A resettled refugee has applied to come to Canada from abroad and has been determined to be a refugee before arriving in Canada. Refugees resettled from overseas, such as government-assisted or privately-sponsored refugees, are classified as permanent residents upon arrival in Canada. All resettled refugees qualify for provincial or territorial health coverage because of this permanent resident classification but they may be subject to a waiting period of up to 3 months. 

Resettled refugees are eligible for limited, temporary coverage of health care benefits at no cost through the Interim Federal Health Program (IFHP), until they qualify for provincial or territorial health coverage. For some resettled refugees, the IFHP may continue to provide supplemental benefits after provincial/territorial health insurance is obtained for the duration of their sponsorship.

Refugee claimants

A refugee claimant has applied for refugee status from within Canada, having fled their home country. Applicants are refugee claimants until their claim is determined. Then they are either:

  • protected persons, and able to apply for permanent residency, or
  • rejected refugee claimants, and expected to leave Canada.

Refugee claimants and rejected refugee claimants are eligible for coverage from the IFHP. Rejected refugee claimants may be eligible for limited coverage until the date of their removal order. Refugee claimants and rejected refugee claimants are not eligible for general provincial/territorial health insurance. Depending on location, some programs may be available to individuals without status or who are non-insured or under insured. See for example for Newcomers to Canada in Toronto, https://www.healthequity.ca/

What is the Interim Federal Health Program?

The Interim Federal Health Program provides limited temporary coverage of health care costs to protected persons who are not eligible for provincial or territorial health insurance plans and where a claim cannot be made under private health insurance. These protected persons include resettled refugees, refugee claimants, certain persons detained under the Immigration and Refugee Protection Act and other specified groups.

Immigration, Refugees and Citizenship Canada defines the IFHP program as follows: “The IFHP is a payer of last resort when the beneficiary has no access to any provincial or territorial health care coverage or private health coverage for that service or product.1

This program underwent significant changes and cuts in 2012, but was eventually restored in 2016 after widespread and long-standing advocacy from the medical and newcomer communities.9

Eligibility and coverage

The IFHP provides health care coverage to:

  • protected persons, including resettled refugees,
  • refugee claimants,
  • rejected refugee claimants, and
  • certain other specified groups.

The IFHP provides three types of coverage:

Basic coverage provides coverage similar to provincial/territorial health insurance plans, such as:

  • inpatient and outpatient hospital services
  • services from medical doctors, registered nurses and other health-care professionals licensed in Canada, including pre- and post-natal care
  • laboratory, diagnostic and ambulance services

Supplemental coverage provides coverage similar to coverage allotted to recipients of social assistance benefits, with some variation by province or territory, such as:

  • limited vision and urgent dental care
  • home care and long-term care
  • allied health-care practitioners services such as clinical psychologists, occupational therapists, speech language therapists, physiotherapists, etc.
  • limited assistive devices, medical supplies and equipment.

Prescription drug coverage provides coverage similar to coverage allotted to recipients of social assistance benefits, with some variation by province or territory, such as:

  • prescription medications and other products listed on provincial/territorial public drug plan formularies

The IFHP also provides coverage for the Immigration Medical Exam, which may take place outside or inside Canada. Visit the IRCC IFHP page for details and updates on IFHP coverage, including who is eligible for which type of coverage. Client eligibility can be confirmed by phone or online through the IFHP administrator Medavie Blue Cross (MBC). Medavie Blue Cross is the plan administrator for the IFHP. All health providers should register with them and obtain access to their web portal. The site allows providers to verify the coverage patients have at the time of their visit. A Reference Guide outlining how to verify coverage is available on their website.

All refugees are issued an IFHP certificate. The number on the certificate allows a provider to determine which coverage an individual refugee has. Because a refugee’s status may change, it is important for care providers to verify their coverage level with Medavie Blue Cross at every visit. This can be done by phone or through their online portal. Unfortunately, not all physicians, clinics and hospitals accept IFHP. Some refugees struggle to access timely care despite being covered for services.

Approved applicants receive an eligibility document, which is typically valid for 12 months. They need to apply to extend their IFHP coverage if they do not qualify for provincial/territorial health insurance within that time period.

For more information, refer to the Immigration, Refugees and Citizenship Canada website:

IFHP administration and claims

For information on submitting claims to the IFHP, refer to the Medavie Blue Cross IFHP Information Handbook for Health Care Providers.

Health care providers should:

  • Contact Medavie Blue Cross directly, at the point and time of service, to determine if the service(s) you plan are eligible. Access is adjudicated on an individual basis. Some services could require prior approval.
  • Contact Medavie Blue Cross each and every time you see the patient to determine if eligibility has changed.  Client eligibility can be verified by calling Medavie at 1-888-614-1880 or directly online. A Reference Guide for online verification is available on the website.

The Medavie Blue Cross website includes all required claim forms for printing and downloading, in addition to up-to-date schedules of covered benefits, information about claim submission procedures, answers to frequently asked questions, and information on the Electronic Claims Submission Service.

Health care for uninsured children

It is estimated that up to 200,000 undocumented (non-status) individuals are living in Canada.2 Estimates vary as to the number of uninsured children and youth, and there are no official statistics.

Non-status persons are those:

  • who have abandoned or withdrawn their refugee claim;
  • whose claim has been determined to be ineligible;
  • who stay after visitor, work or student permits have expired; or
  • who enter Canada irregularly.

Also, there are persons with precarious status, including temporary foreign workers, and those whose refugee claims have been denied but who are appealing this verdict. In some provinces or territories, permanent residents must wait a specific length of time (e.g., 3 months) before being eligible for provincial or territorial health insurance. During that time they are usually uninsured.

Rejected refugee claimants are eligible for IFHP public health or public safety health care coverage.

Emergency care is a legal and ethical obligation under the Canadian Medical Association’s Code of Ethics and framed in provincial/territorial hospital acts (e.g., the Public Hospitals Act of Ontario).3,4 Some health care institutions have internal protocols to determine whether non-urgent care should be provided to uninsured persons. Check with your area hospitals for any policies defining what constitutes emergency care and what does not. Definitions may vary.

Health care for the uninsured is sometimes available through community health centres and refugee health clinics. These often service a specific geographical area and are sometimes unable to take on new patients, especially if they live outside a specific catchment.5 Care providers should familiarize themselves with local resources available for this patient group.

Emergency or not?  A care gap for the uninsured

An 8-year-old boy arrives in your Ontario clinic. He is a permanent resident (Family Class) whose migration path included a Darfur refugee camp and time in Kenya. He arrived 3 weeks ago, and is subject to the 3-month wait period for provincial health insurance coverage. He presents with cough, fever and dyspnea. He has bi-basal crackles and his temperature is 39°C. You hear a 5/6 systolic murmur. You refer him to the hospital emergency room. He is uninsured, but you know a patient who has an urgent condition will not be turned away for the family's inability to pay. You are surprised to see him and his father in your clinic the following morning. ER admin staff determined that he did not meet their “criteria for an emergency.” His family lacked the $500 ER fee to be assessed. His condition has worsened. He has had no urine output for 24 hours.

Learning points:

  • Ask about your patient’s immigrant or refugee status. Recognize that newcomers may be reluctant to share this information. Be familiar with health insurance eligibility rules, and make sure your patients have applied for what they are entitled to.
  • Refer the family to a local settlement agency if they are not already connected.
  • Check with area hospitals for policies defining what constitutes an emergency and what doesn’t before sending newcomer patients there.
  • Write a referral letter for ER staff specifying the exact nature of a patient’s condition and why it constitutes an emergency.
  • Be aware that immigrant and refugee families often have very limited funds and may not be able to afford prescribed medications. Also, they may not be eligible for provincial/territorial social assistance plans which include drug benefits.
  • Advocate for better treatment of similar cases in the future.

Health concerns for uninsured patients

Uninsured and underinsured patients are at risk for poor health outcomes. They report higher levels of anxiety, stress and advanced illness.6 They may also:

  • delay or forego seeking health care, including prenatal and preventive health care,
  • be denied care when they seek it,
  • be discriminated against when they seek care,
  • endure financial hardship from paying for care when resources are severely limited.

One study conducted in Brussels found that pregnant women without health insurance who did not receive adequate prenatal care experienced more perinatal deaths and premature births.7

Another Canadian study found that immigrant women are three times more likely to receive inadequate prenatal care; those without health insurance are 19 times more likely.8 Its authors noted that:

“60% of pregnant women who have come to our clinic had deficiencies in prior antenatal care, having lacked adequate provider contact, pelvic examination, screening for diabetes or counselling about the use of folic acid.… Others who are entitled to health benefits lack the knowledge, documentation or means to secure them: 5% of our uninsured youth, mostly children born in Canada to uninsured newcomers, are in fact Canadian citizens.”

These authors also suggest that Canadian health professionals commit to the following:

  • Supporting immigrants who are eligible to obtain health insurance coverage.
  • Increasing capacity limits and relaxing enrolment criteria at community clinics.
  • Advocating for the elimination of the 3-month waiting period in provinces that require it.
  • Advocating for emergency health insurance coverage for newcomers who need it but whose claims are still in process (for example, pregnancy and newborn care are covered in Quebec for this group).

Health care professionals can also help by explaining Canadian health care processes to newcomer parents and caregivers and by supporting them to navigate the system. The Ontario Council of Agencies Serving Immigrants provides videos in multiple languages with basic information for newcomers about the health system. Physicians and health professionals working with new immigrants and refugees need to be aware of their province’s or territory’s rules, regulations and health coverage entitlements, and be able to explain these to families. 

Selected resources

References

  1. Citizenship and Immigration Canada. Information sheet for Interim Federal Health Program beneficiaries.
  2. Salehi R. Intersection of health, immigration, and youth: A systematic literature review. J Immigr Minor Health 2010;12(5):788-97.
  3. Canadian Medical Association. CMA Policy: CMA Code of Ethics (Update 2004).
    See item 19.
  4. Government of Ontario. Public Hospitals Act, RSO. 1990, c P.40.
  5. Caulford P, D’Andrade J. Health care for Canada’s medically uninsured immigrants and refugees: Whose problem is it? Can Fam Physician 2012;58(7):725-7.
  6. Simich L, Wu F, Nerard S. Status and health security: An exploratory study of irregular immigrants in Toronto. Can J Public Health 2007;98(5):369-73.
  7. Barlow P, Haumont D, Degueldre M. Obstetrical and perinatal outcomes of patients not covered by medical insurance. Rev Med Brux 1994;15(6):366-70.
  8. Caulford P, Vali Y. Providing health care to medically uninsured immigrants and refugees. CMAJ 2006;174(9):1253-4.
  9. CBC News, 2016. Liberal government fully restores refugee health care program. 

Other works consulted

  • Arya N, McMurray J, Rashid M. Enter at your own risk: Government changes to comprehensive care for newly arrived Canadian refugees. CMAJ 2012;184(17):1875-6.
  • Canadian Paediatric Society, 2012. Cuts to refugee health program put children and youth at risk [Commentary]
  • Delvaux T, Buekens P, Godin I, et al. Barriers to prenatal care in Europe. Am J Prev Med 2001;21(1):52-9.
  • Miedema B, Hamilton R, Easley J. Climbing the walls: Structural barriers to accessing primary care for refugee newcomers in Canada. Can Fam Physician 2008;54(3):335-6.
  • Raza D, Rashid M, Redwood-Campbell L, et al. A moral duty: Why Canada’s cuts to refugee health must be reversed. Can Fam Physician 2012;58(7):728-9.

Editor(s)

  • Robert Hilliard, MD
  • Mahli Brindamour, MD

Last updated: October, 2020