Health Insurance for Immigrant and Refugee Families
- Health professionals should help 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. Coverage varies depending on status.
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.
- British Columbia
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Prince Edward Island
All provinces and territories except for Ontario, British Columbia and Quebec provide permanent residents upon their arrival with full provincial health coverage equal to that of the resident population. Ontario, 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. For example, in Ontario there are certain exceptions. All babies born in Canada are considered Canadian citizens and automatically qualify for provincial/territorial health coverage.
Citizenship and Immigration Canada (CIC) encourages permanent residents to apply for private health insurance to cover a provincial wait period. CIC 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 Citizenship and Immigration Canada website.
Health insurance for refugees and refugee claimants
There are two broad types of refugees in Canada: refugee claimants and 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.
A refugee claimant has applied for refugee status from within Canada, having fled their home country. Applicants are considered to be 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. Eligibility for coverage for refugee claimants is now subject to recent changes in IFHP rules based on whether or not the refugee claimant arrives from a designated country of origin. 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; however some provinces offer some coverage on a temporary basis if the services are not covered by the IFHP or by private insurance. Ontario has published details of their program online. Contact your provincial/territorial ministry or department of health for more information.
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.
Citizenship and Immigration 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.
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 depending on the category the newcomer belongs to at the time:
- Expanded health care coverage provides coverage similar to provincial/territorial health insurance plans, as well as some supplemental health care products and services such as prescription medication, limited dental and vision care, home care and long-term care.
- Health care coverage provides coverage similar to provincial/territorial health insurance plans, including coverage for hospital services, physician services, laboratory services, diagnostic and ambulance services only if urgent or essential, as defined by the IFHP. Medications and immunizations are covered only if they are needed to prevent or treat illness that poses a public health risk or to treat a condition of public safety concern.
- Public health or public safety health care coverage includes vaccines, medications, laboratory and diagnostic services, and doctor and hospital services only if they are needed to diagnose, prevent or treat a disease that poses a risk to public health or a condition of public safety concern.
Visit the CIC IFHP Summary of Benefits 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.
Many refugee claimants have health care coverage upon arriving in Canada which will change to public health or public safety health care coverage if their claim is rejected. Refugee claimants from Designated Countries of Origin (DCOs) have public health or public safety health care coverage only.
Resettled refugees are permanent residents upon arrival and are eligible for provincial/territorial insurance as well as IFHP coverage. They have the most comprehensive package of coverage from the IFHP: expanded health care coverage.
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 Citizenship and Immigration website:
- Interim Federal Health Program: Summary of Benefits
- Interim Federal Health Program: Information Sheet for Interim Federal Health Program Beneficiaries
- Health Care - Refugees
- Guide 5568 - Application for Interim Federal Health Program Coverage (IFHP)
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.
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 illegally.
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.
- 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:
- Helping 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 helping 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. An information sheet for IFHP beneficiaries is available from CIC.
- Bridge Clinic, Raven Song Community Health Centre, a website supported by Vancouver Coastal Health, offers public health screening and primary health care services for government-sponsored refugees, access to interpreters, and information about other community agencies.
- Canadian Association of Community Health Centres
- Christie Refugee Welcome Clinic provides holistic primary health care services and information to a culturally diverse inner city community in Toronto.
- Citizenship and Immigration Canada
- Citizenship and Immigration Canada. Refugees: Health care – Refugees. This webpage features information on the Interim Federal Health Program (IFHP)
- Health Canada
- Health Canada. Provincial/territorial role in health. This web page includes links to provincial and territorial health ministries and for P/T health insurance cards.
- Medavie Blue Cross provider portal
- Refugee health, a website supported by Vancouver Coastal health, has an overview of national coverage (e.g., the IFHP), refugee categories and the settlement process, guidelines on medical issues, and assessment tools.
- Regent Park Community Health Centre (Toronto)
- Settlement.Org is Ontario-based but has information and links for health, housing, employment and more.
- Women’s College Hospital Crossroads Clinic provides a wide range of comprehensive medical services to newly arrived refugee clients and for their first 2 years in Toronto.
- Citizenship and Immigration Canada. Information sheet for Interim Federal Health Program beneficiaries.
- Salehi R. Intersection of health, immigration, and youth: A systematic literature review. J Immigr Minor Health 2010;12(5):788-97.
- Canadian Medical Association. CMA Policy: CMA Code of Ethics (Update 2004).
See item 19.
- Government of Ontario. Public Hospitals Act, RSO. 1990, c P.40.
- 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.
- 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.
- 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.
- Caulford P, Vali Y. Providing health care to medically uninsured immigrants and refugees. CMAJ 2006;174(9):1253-4.
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.
- Robert Hilliard, MD
Last updated: December, 2014