In a decision handed down by the Health Services Appeal and Review Board, an Ontario worker and her family were denied continued eligibility for health coverage under the Ontario Health Insurance Plan (OHIP) due to her employment with a company based outside the province.
The board ruled they were ineligible for OHIP coverage because S.S., a temporary foreign worker, was employed by a company located in Quebec and Nova Scotia, not Ontario. Under Ontario regulations, temporary foreign workers must be employed by an Ontario-based employer to qualify for the province’s publicly funded health insurance.
“The Appellant does not have an OHIP-eligible status as set out in section 1.4 of the regulation,” the ruling stated. “As a consequence, neither the Appellant nor her husband or child can be considered an OHIP-eligible resident of Ontario at this time.”
Background
S.S., who has worked remotely for Fieldcore Services Solutions, a subsidiary of General Electric, since 2021, initially qualified for OHIP coverage. Her temporary foreign worker status allowed her to receive benefits along with her spouse and daughter. However, after her attempt to renew coverage in early 2023, ServiceOntario denied the renewal, citing the location of her employer outside Ontario.
S.S. contested this decision, leading to an April 2023 ruling by the OHIP Eligibility Review Committee (OERC) that briefly reinstated coverage. However, this was reversed in November 2023, when the OERC determined the reinstatement had been granted in error.
“The coverage that was provided by the OERC in April 2023 was provided in error,” read the OERC’s November 2023 letter. It concluded that S.S.’s employment with an out-of-province employer made her ineligible for OHIP coverage under section 1.4(6) of the Health Insurance Act.
The appeal
In response to the OERC’s reversal, S.S. filed an appeal with the Health Services Appeal and Review Board, asserting that her work in Ontario, despite her employer’s location, should qualify her and her family for coverage.
According to the appellant, S.S. holds a valid work permit under the Immigration and Refugee Protection Act (IRPA) and has been employed full-time on Ontario-based projects for more than six consecutive months. She further argued that her T4 tax slips, which show tax payments to the Ontario government, support her claim of employment in the province.
Additionally, S.S. highlighted the growing prevalence of remote work, suggesting that her employment situation should be viewed through the lens of modern work arrangements. “The reinstatement of OHIP coverage for her and her family is important for the ongoing health care of her family,” the submission read.
However, OHIP’s defence emphasized that the regulatory requirements for coverage mandate that the employer must be physically located in Ontario. The policy rationale, it argued, was to ensure that temporary foreign workers were filling a labour market need within the province.
“Persons who hold a valid work permit but… work for employers outside Ontario do not have an OHIP-eligible status listed in the regulation and are not eligible for OHIP,” the respondent noted.
Board’s decision
The board ultimately agreed with the respondent’s interpretation, ruling that the requirement for an employer to be based in Ontario could not be overlooked, regardless of remote work dynamics.
“The phrase ‘work full-time for an employer in Ontario’ could only mean that the employer must be physically located in Ontario,” the decision noted, adding that this requirement aligns with the intent of the regulation to serve Ontario’s labour market.
The board acknowledged the challenges S.S. faces, particularly as her daughter is in need of continued health care. “The Appeal Board appreciates the Appellant’s predicament… the Appellants have little or no prospect for publicly-funded health insurance coverage in these provinces.”
Implications of remote work
In its decision, the board reflected on how remote work has changed the employment landscape, noting that “the policy rationale for the ‘employer in Ontario’ requirement may no longer be as relevant as it once was.”
However, the ruling emphasized that the board is bound by current regulations and cannot grant coverage on grounds of compassion or hardship if the conditions outlined in the legislation are not met.
For more information, see Saadat v Ontario (Health Insurance Plan), 2024 CanLII 86363 (ON HSARB).
