Provincial plans come first

Canada’s public health insurance is universal and paid for through taxes. The Canada Health Act sets national standards, and each province and territory runs its own plan with its own eligibility rules. Eligible residents are covered for medically necessary hospital and physician services, and they apply to the plan of the province or territory where they live rather than through an employer.

That design shapes every other decision on this page. An employee in Toronto holds an OHIP card, one in Vancouver is enrolled in British Columbia’s MSP, and one in Montreal is covered through RAMQ. When someone moves between provinces, the former province keeps covering them for up to three months while they register with the new one, so a move inside Canada leaves no gap in public cover.

Arrival rules in Ontario and British Columbia

Ontario asks applicants to make the province their primary residence and to be physically present for 153 days in any 12-month period, or 153 of their first 183 days. They also need one further qualifying status, such as citizenship, permanent residence or a qualifying work permit. Once those conditions are met, OHIP has no waiting period. A work-permit holder can qualify after working full time for an Ontario employer for at least six months, and their spouse and dependants can qualify as well.

British Columbia works differently. A newcomer’s MSP coverage begins only after the rest of the month they arrive plus two further months. The province tells people arriving from outside Canada to arrange private health insurance before they land and keep it until MSP starts, and it warns that most private insurers will not cover pre-existing conditions, pregnancy included. If you are relocating someone into BC, that gap is the first thing to plan around.

Drugs, dental and vision sit outside the public plan

Provincial plans pay for prescription drugs, dental care, vision care, home care and ambulance services only for certain groups, such as seniors, children and people on social assistance. Everyone else covers those costs directly or through private insurance. That is why Canadian group benefits commonly bundle drug, dental, vision and paramedical cover alongside the provincial plan.

Tax treatment follows the structure of the benefit. Under federal rules, what an employer contributes to a private health services plan (PHSP), such as a medical or dental plan, is not a taxable benefit for the employee. Premiums an employer pays for a non-group individual policy are a taxable benefit. Paying for one person’s individual policy and enrolling them in a group plan can therefore land quite differently for the employee, so check with a Canadian tax professional before you choose.

Quebec’s drug insurance rule

Quebec’s public plan is administered by the Régie de l’assurance maladie du Québec (RAMQ), which also runs a public prescription drug plan for people with no access to a group plan. Whether to offer group insurance in Quebec is the employer’s call. RAMQ’s guidance indicates, however, that an employee eligible for a group or employee-benefit plan that includes prescription drug coverage generally has to join it rather than rely on the public drug plan.

For a US company with one person in Quebec, the rule matters once you offer a group plan: if it includes prescription drug coverage, the employee generally joins it instead of the public drug plan. Whatever you set up, find out early whether it counts as a group plan with drug coverage for Quebec purposes.

Where an international plan fits

An international plan cannot stand in for provincial cover. Provincial insurance is resident-based and run by each province, so a global policy can only top up the public plan or fill its gaps. In practice it works as one way to supply the drug, dental and vision layer, or as bridge cover during a waiting period like British Columbia’s, rather than as the employee’s main health insurance. Our overview of international health insurance for remote employees explains how these plans work across countries.

The BC warning about pre-existing conditions applies to bridge cover generally, so ask early how any plan treats them, and keep the federal tax rule above in mind when comparing an individual policy with a group plan.

Employer of record, entity or contractor

Resident and non-resident employers generally carry the same payroll duties for work done in Canada: deducting Canada Pension Plan (CPP) contributions, Employment Insurance (EI) premiums and income tax. Canada has no national employer health premium, but some provinces charge a payroll tax that funds health care. Ontario’s Employer Health Tax applies to pay for employees who report to, or are attached to, an Ontario permanent establishment, and eligible employers below a set payroll level are exempt.

Many US companies without a Canadian entity hire through an employer of record. The EOR becomes the legal employer, runs payroll and statutory contributions, and can often provide a group benefits plan. A genuinely self-employed contractor arranges their own cover and pays both shares of CPP on their own return, and the CRA can rule on whether a worker is an employee or self-employed. Our page on health coverage for EOR employees and contractors abroad compares the setups.

Your US policies deserve a look as well. The guide to insurance changes for remote teams covers workers’ compensation, employment practices liability and cyber for staff who work away from the office.

Asking for an introduction

When you are ready to look at options, use the form on this page. Tell us the province where your employee lives, how many people you have in Canada, whether family members need cover, and whether you hire directly or through an employer of record. We pass those details to a benefits partner whose work centres on health cover for people employed across borders. The partner and the insurer decide eligibility, plans and pricing; our role is the introduction. For the rest of the section, start with employee benefits for small businesses.

A few useful answers

Common questions

Does a remote employee in Canada need private health insurance?

The provincial plan covers medically necessary hospital and physician services for eligible residents. Most working-age adults pay for drugs, dental and vision themselves or through private cover, which can also bridge a waiting period such as British Columbia’s.

Can an international plan replace OHIP or MSP?

No. Provincial cover is based on residence and run by each province, so an international plan sits on top of it as a top-up or gap filler.

Is employer-paid health cover a taxable benefit in Canada?

Under federal rules, employer contributions to a private health services plan, such as a group medical or dental plan, are not a taxable benefit. Premiums the employer pays for a non-group individual policy are.

Does a US company pay a health premium for a Canadian employee?

Canada has no national employer health premium. The employer deducts CPP contributions, EI premiums and income tax, and some provinces add a payroll tax that funds health care, such as Ontario’s Employer Health Tax.

What happens to public cover if the employee moves to another province?

Their former province keeps covering them for up to three months while they register with the plan in the new province.

International Health Insurance for Remote Employees in Canada