WHITE PAPER – Spring 2016

285b4649 dad6 4bf2 a2a4 7b25665662beWHITE PAPER:
Enrolling in BC Health Care


Is Enrollment in BC Health’s Medical Insurance Plan required of employees who are not on local payroll or have global health insurance plans?


All Points often gets asked the above question by our clients. There is wording on the BC Health website which can lead to confusion as to the difference between applying and enrolling. In addition, BC’s Medical Insurance Plan’s (hereafter MSP) insurance premiums are means tested, which can make them quite expensive for senior executives who naturally would like to reduce any unnecessary costs, if they area already covered on a global health plan.

So, just to recap, the arguments typically made against enrolling in the MSP:

• The employee is not on payroll so they cannot have a forced deduction on a monthly basis from one’s pay;
• The employee has a global health care plan so does not require enrollment in the MSP and should not have to “double-pay” for unnecessary health care insurance.


Why bother? Application is necessary, even if it is to just opt out.
In February of 2016, All Points interviewed a BC Health Enrollment Specialist about the program and confirmed our understanding of the following:

•  It is mandatory for anyone eligible for MSP to complete the application for MSP;
•  “Under the Medicare Protection Act, enrolment with the Medical Services Plan (MSP) is mandatory for all eligible residents and their dependents.”


A resident is a person who meets all of the following conditions:


•  Must be a citizen of Canada or be lawfully admitted to Canada for permanent residence•  Must make his or her home in B.C.
•  Must be physically present in B.C. at least six months in a calendar year, or a shorter prescribed period.
•  Certain other individuals, such as some holders of study permits or working permits — which are issued under the federal Immigration and Refugee Protection Act and are valid for a period of six or more months — may be deemed residents.


So, in short, expatriates with work permits who reside in BC for more than 6 months are eligible and therefore must apply.


So, if we don’t have payroll in Canada, how do expatriates apply?


Applications are sent to households in the mail or are available online for submission. It is not relevant if the individual works for an employer who does not submit the applications on behalf of the employee. The individual must submit applications on their own.


Can expatriates opt out?
Yes, an eligible individual may elect to “opt” out of the coverage.If they do not want to participate in British Columbia’s provincial health care programs, they must complete and sign an Election to Opt Out statement and submit that statement to the Ministry of Health each year. It is important to stress that this is annual requirement.

Regardless, application must be done. All Points was informed that failure to apply may result in penalty.

Once an individual has opted out the application is still reviewed by the Enrollment Specialists at MSP who reserve the right to accept or decline the request to opt out. We were informed that Enrollment Specialists generally approve opt outs for individuals with work permits that carry private health insurance. However, we were also advised that opt outs are rarely, if ever approved for minors.

So, families will not be able to have their children opt out of the program, even though they might be approved to opt out themselves. At this point, it is in the expatriate’s best interest to have a hard look at the cost difference between enrolling their children and the whole family to see if it is worth it to opt out on their own, because they may receive different medical services (see risks to opting out below) than their children throughout the life of the assignment.

More on minors

•  In most instances, schools will require proof of MSP registration for enrollment.
•  The school requires the MSP registration on record in the event of an emergency at school.


Are there risks of opting out?

Yes, following are the risks of opting out according to the government of BC:

•  An individual who opts out will be required to confirm the opting out option every year after arrival; however they may not opt back into the program once they have opted out. This should be thoughtfully considered given the other possible disadvantages noted below.
•  Could you one day apply for permanent residency? It is unclear to All Points as to whether once opted out, an expatriate that decides to change one’s status to permanent residency, is allowed to opt back into the program, after years of not paying into the system.
•  Individuals without MSP coverage may struggle to find a family doctor as many require MSP coverage to accept new patients.
•  They may also struggle in getting in to see a specialist who may also require MSP coverage.
•  During the 12 month period for which the expatriate opts out, the Ministry of Health will not pay for any medical, hospital or other health care services, or for any items such as prescription drugs that might otherwise have been a benefit. This will be true regardless of whether the services/items are required on a routine or an emergency basis, due to illness or accident, and regardless of the cost involved.•  The employee will be responsible for paying the entire cost of health care services and items they receive during the opted out period.
•  The expatriate will be given a Notice of Exemption to show that they have opted out and must present that notice when medical, hospital and other health care services are accessed, and when purchasing items such as prescription drugs, that might otherwise have been a benefit.


Any decision as to whether to opt-in or opt-out of BC Health’s MSP should be made carefully. If an expatriate is hoping to avoid extra administrative work, then we recommend that they enroll because there is both initial and annual administration to opting-out. If the expatriate has children All Points also recommends enrollment in the MSP. If there is any risk that an expatriate may want to opt back into the program in the future, we also recommend that they opt-in on day one.

In fact, it is All Points’ recommendation that all expatriates enroll in the MSP. Why? Our recommendation is based on what we call the “superior customer service” argument. Receiving health services through the MSP is far easier than receiving health services through a global insurance plan. Swiping a card and receiving health services is far easier when compared to being out of pocket temporarily for expenses as applications are made to the global insurance plan. In addition, it is a very real fact that finding a doctor or a specialist may be harder, as noted above. Doctors and their staff always look for ways to reduce their administrative costs, and the simple truth is that their billing through the MSP is much easier and more regular than billing through global health insurance plans. Finding a doctor in Canada is not always easy, and reducing one’s options is not wise.

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