Inland sponsorship for pregnant wife & implications for RAMQ (Quebec) healthcare

[mahtax]

Hi all,

I'm a Canadian citizen living in the USA with my wife, an American citizen. Recently I accepted a job offer back in Canada, in Montreal. Since there was less than 12 months before my starting date, we decided that we would do the inland family sponsorship rather than applying from outside the country. I make most of the money in the marriage, and to go back to Canada I have to take a 40% paycut. Add the exchange rate, and it's just infeasible for us to pay 2 rents for the better part of a year while the application processes.

I understand that after approval of the sponsor application, within 3 months, the sponsored spouse can obtain an open work permit (OWP). However, in the beautiful province of Quebec, that is not enough to obtain provincial healthcare (RAMQ) coverage. Instead, you have to wait until Quebec extends you an Approval in Principle (AIP) - the last step of the process, typically occurs after 12 months. Then, you can register for RAMQ, and obtain it 3 months later, roughly 15 months after starting the process, the entire time uninsured unless you purchase private "gap" health insurance.

The plan was to purchase private insurance once we moved in a few months. However, it appears that my wife is pregnant now. As far as I can tell, you cannot get a private health insurance plan that covers a pre-existing pregnancy post-facto. There's no way to get her on the RAMQ in time (due date sometime in august/september).

I'm aware that in principle, if an individual gets a job (minimum 6 months contract) using their OWP, they can register with the RAMQ. But the chances of that happening at 7+ months pregnant are, well, pretty slim. Certainly we can't bank on it.

I'm strongly considering contacting my new employer and telling them I simply can't come. My current employer will be delighted to let me backtrack my resignation letter. I work in a small field; we are about 300 for the entire country. Backing out now after signing an offer letter & making them wait for me for half a year, means good chances of never coming back to Canada. But not backing out means going through a pregnancy uncovered by any insurance, which means we're SOL if there are complications at all. To me the choice seems easy.

Am I missing something here? Pregnancy, etc... in no way expedites the process to obtain public healthcare coverage, nor is private coverage possible, so that leaves no way at all to obtain coverage at this point, correct? I just want to ask the community before I burn my bridges, perhaps permanently.

 

[canuck78]

Hi all,

I'm a Canadian citizen living in the USA with my wife, an American citizen. Recently I accepted a job offer back in Canada, in Montreal. Since there was less than 12 months before my starting date, we decided that we would do the inland family sponsorship rather than applying from outside the country. I make most of the money in the marriage, and to go back to Canada I have to take a 40% paycut. Add the exchange rate, and it's just infeasible for us to pay 2 rents for the better part of a year while the application processes.

I understand that after approval of the sponsor application, within 3 months, the sponsored spouse can obtain an open work permit (OWP). However, in the beautiful province of Quebec, that is not enough to obtain provincial healthcare (RAMQ) coverage. Instead, you have to wait until Quebec extends you an Approval in Principle (AIP) - the last step of the process, typically occurs after 12 months. Then, you can register for RAMQ, and obtain it 3 months later, roughly 15 months after starting the process, the entire time uninsured unless you purchase private "gap" health insurance.

The plan was to purchase private insurance once we moved in a few months. However, it appears that my wife is pregnant now. As far as I can tell, you cannot get a private health insurance plan that covers a pre-existing pregnancy post-facto. There's no way to get her on the RAMQ in time (due date sometime in august/september).

I'm aware that in principle, if an individual gets a job (minimum 6 months contract) using their OWP, they can register with the RAMQ. But the chances of that happening at 7+ months pregnant are, well, pretty slim. Certainly we can't bank on it.

I'm strongly considering contacting my new employer and telling them I simply can't come. My current employer will be delighted to let me backtrack my resignation letter. I work in a small field; we are about 300 for the entire country. Backing out now after signing an offer letter & making them wait for me for half a year, means good chances of never coming back to Canada. But not backing out means going through a pregnancy uncovered by any insurance, which means we're SOL if there are complications at all. To me the choice seems easy.

Am I missing something here? Pregnancy, etc... in no way expedites the process to obtain public healthcare coverage, nor is private coverage possible, so that leaves no way at all to obtain coverage at this point, correct? I just want to ask the community before I burn my bridges, perhaps permanently.

You would face a similar situation in almost every province. Unfortunately there is no way to speed up sponsorship and it is hard to predict how fast your application will be processed. Should be less than 12 months if she is a US citizen. At least your child will have coverage after birth so no NICU costs. Insurers don’t usually cover labour and delivery for obvious reasons. Delivery is going to happen. This is really a personal decision.

 

[mahtax]

You would face a similar situation in almost every province.

I'm under the impression that most of the provinces allow you to use your open work permit to qualify for health care coverage based on the open work permit alone. Am I mistaken?

Where Quebec is different is that they require you to actually be using said open work permit and having a long-term job. So you're only covered if you manage to find a job while your application is being processed, but not if you're unemployed.

Unfortunately there is no way to speed up sponsorship and it is hard to predict how fast your application will be processed. Should be less than 12 months if she is a US citizen. At least your child will have coverage after birth so no NICU costs.

Small comfort in case of stillbirths, c-sections, hospitalization of the mother, etc...

Insurers don’t usually cover labour and delivery for obvious reasons.

They do if delivery is more than 10 months after the date that the policy takes in effect, actually. At least the one we were going to purchase is. Anyway, it's a moot point now. We weren't going to buy travel insurance 4 months ahead of the travel date.

You can also get insurance that covers against pregnancy complications, but it only covers up to 7 months, which again is worrisome.

Delivery is going to happen. This is really a personal decision.

Sure it is. I just want to make sure I'm not missing anything.

Sounds like I don't have much choice but to rip up my offer letter and resign myself to be an exile for the forseeable future.

 

[canuck78]

You would face a similar situation in almost every province.​

I'm under the impression that most of the provinces allow you to use your open work permit to qualify for health care coverage based on the open work permit alone. Am I mistaken?

Where Quebec is different is that they require you to actually be using said open work permit and having a long-term job. So you're only covered if you manage to find a job while your application is being processed, but not if you're unemployed.

Unfortunately there is no way to speed up sponsorship and it is hard to predict how fast your application will be processed. Should be less than 12 months if she is a US citizen. At least your child will have coverage after birth so no NICU costs.​

Small comfort in case of stillbirths, c-sections, hospitalization of the mother, etc...

Insurers don’t usually cover labour and delivery for obvious reasons.​

They do if delivery is more than 10 months after the date that the policy takes in effect, actually. At least the one we were going to purchase is. Anyway, it's a moot point now. We weren't going to buy travel insurance 4 months ahead of the travel date.

You can also get insurance that covers against pregnancy complications, but it only covers up to 7 months, which again is worrisome.

Delivery is going to happen. This is really a personal decision.​

Sure it is. I just want to make sure I'm not missing anything.

Sounds like I don't have much choice but to rip up my offer letter and resign myself to be an exile for the forseeable future.

Ontario requires you to wait 3 months to qualify for OHIP (even if you are pregnant) and have proof of a job lasting at least 6 months to get OHIP on a work permit.

Yes there are policies that cover pregnancy if you were not pregnant when the policy started but didn’t consider those since your wife is pregnant. Depending on your savings you could take a calculated risk and hope your wife will have an easy pregnancy with no complications before or after delivery. You could also talk to your new and old employer about delaying your plans for a year. Not much to lose at this point it seems.

 

[mahtax]

Ontario requires you to wait 3 months to qualify for OHIP (even if you are pregnant) and have proof of a job lasting at least 6 months to get OHIP on a work permit.

As far as I'm aware they and Quebec are the only two this draconian.

Depending on your savings you could take a calculated risk and hope your wife will have an easy pregnancy with no complications before or after delivery.

Sounds like a risky bet on top of having to dish out for private insurance and having to take a paycut. I considered it, but I'm going to pass on that.

You could also talk to your new and old employer about delaying your plans for a year. Not much to lose at this point it seems.

There's nothing lost in asking, but I suspect it won't fly and I'll just have to say I'm not going.

I'm guess I'm not missing anything after all - them's the breaks. Thanks for confirming.

 

[canuck78]

As far as I'm aware they and Quebec are the only two this draconian.



Sounds like a risky bet on top of having to dish out for private insurance and having to take a paycut. I considered it, but I'm going to pass on that.

There's nothing lost in asking, but I suspect it won't fly and I'll just have to say I'm not going.

I'm guess I'm not missing anything after all - them's the breaks. Thanks for confirming.

BC also has an up to 3 month wait to get insurance. The rules tend to be tougher in the provinces with the higher levels of immigration to prevent people from arriving to use medical services and then leaving. Given that your wife is a US citizen at least you have options. Although your future employer may not be impressed explaining that your wife will not have access to health insurance during pregnancy is an actual valid reason versus just changing your mind. Perhaps they will offer to cover any potential costs.

 

[canuck_in_uk]

Hi all,

I'm a Canadian citizen living in the USA with my wife, an American citizen. Recently I accepted a job offer back in Canada, in Montreal. Since there was less than 12 months before my starting date, we decided that we would do the inland family sponsorship rather than applying from outside the country. I make most of the money in the marriage, and to go back to Canada I have to take a 40% paycut. Add the exchange rate, and it's just infeasible for us to pay 2 rents for the better part of a year while the application processes.

I understand that after approval of the sponsor application, within 3 months, the sponsored spouse can obtain an open work permit (OWP). However, in the beautiful province of Quebec, that is not enough to obtain provincial healthcare (RAMQ) coverage. Instead, you have to wait until Quebec extends you an Approval in Principle (AIP) - the last step of the process, typically occurs after 12 months. Then, you can register for RAMQ, and obtain it 3 months later, roughly 15 months after starting the process, the entire time uninsured unless you purchase private "gap" health insurance.

The plan was to purchase private insurance once we moved in a few months. However, it appears that my wife is pregnant now. As far as I can tell, you cannot get a private health insurance plan that covers a pre-existing pregnancy post-facto. There's no way to get her on the RAMQ in time (due date sometime in august/september).

I'm aware that in principle, if an individual gets a job (minimum 6 months contract) using their OWP, they can register with the RAMQ. But the chances of that happening at 7+ months pregnant are, well, pretty slim. Certainly we can't bank on it.

I'm strongly considering contacting my new employer and telling them I simply can't come. My current employer will be delighted to let me backtrack my resignation letter. I work in a small field; we are about 300 for the entire country. Backing out now after signing an offer letter & making them wait for me for half a year, means good chances of never coming back to Canada. But not backing out means going through a pregnancy uncovered by any insurance, which means we're SOL if there are complications at all. To me the choice seems easy.

Am I missing something here? Pregnancy, etc... in no way expedites the process to obtain public healthcare coverage, nor is private coverage possible, so that leaves no way at all to obtain coverage at this point, correct? I just want to ask the community before I burn my bridges, perhaps permanently.

You should have applied outland as soon as you decided to move back. American outland apps average around 6 months.

RAMQ does reimburse pregnancy-related costs incurred during wait period. If you apply outland ASAP, she may get PR before giving birth, in which case she would qualify for reimbursement of the birth costs during the wait period.

 

[mahtax]

You should have applied outland as soon as you decided to move back. American outland apps average around 6 months.

Is this true? The CIC website quotes 12 months, which is what other people who were applying to Quebec seemed to indicate (9-12 when it's all said and done). If I'd known it was closer 6 months, I'd have applied outland much sooner. Besides, at the time I accepted the offer, about two months ago, we were sitting at around 5 months before the move in date. It seemed pretty risky based on the 12 month estimate.

Remember that it has to clear both Canada and Quebec offices, doesn't that delay things a bit?

RAMQ does reimburse pregnancy-related costs incurred during wait period.

The website in french specifies you have to give the RAMQ letter that shows you've registered and are in that 3 month waiting period for that to be true. Unfortunately you can't do that until you have the AIP, which takes about 12 months from landing.

If you apply outland ASAP, she may get PR before giving birth, in which case she would qualify for reimbursement of the birth costs during the wait period.

Yeah, but I can't bank on that, and I have to make arrangements job-wise now. I'm on a work visa in the US myself, if I stop working here I have to leave. I wouldn't want to be in a situation where I'm unemployed here and have to leave for Canada and leave her behind. If there's a delay, any delay, by the time I'm supposed to move, it'll be too late to back off and stay, as my work permit would not have been renewed.

 

[canuck_in_uk]

Is this true? The CIC website quotes 12 months, which is what other people who were applying to Quebec seemed to indicate (9-12 when it's all said and done). If I'd known it was closer 6 months, I'd have applied outland much sooner. Besides, at the time I accepted the offer, about two months ago, we were sitting at around 5 months before the move in date. It seemed pretty risky based on the 12 month estimate.

Remember that it has to clear both Canada and Quebec offices, doesn't that delay things a bit?



Yeah, but I can't bank on that, and I have to make arrangements job-wise now. I'm on a work visa in the US myself, if I stop working here I have to leave. I wouldn't want to be in a situation where I'm unemployed here and have to leave for Canada and leave her behind. If there's a delay, any delay, by the time I'm supposed to move, it'll be too late to back off and stay, as my work permit would not have been renewed.

American apps are generally processed much faster than the posted time, Quebec or not.

No one can make the decision for you.

 

[scylla]

Has she already completed the medical? One of the challenges you will face is that she has to complete a medical as part of the sponsorship process that includes an x-ray. It's generally not recommended for pregnant women to get x-rays although this is obviously a very personal choice and best made with the consultation of your wife's doctor. Good luck with the decision.

 

[mahtax]

Has she already completed the medical? One of the challenges you will face is that she has to complete a medical as part of the sponsorship process that includes an x-ray. It's generally not recommended for pregnant women to get x-rays although this is obviously a very personal choice and best made with the consultation of your wife's doctor. Good luck with the decision.

I'm not worried about that, ironically enough. My job is literally to assess and advise on radiation risk in the context of healthcare, mostly from radiation therapy but also xray imaging. The risk from a chest x-ray to pregnant women is negligible to the point of ridiculousness. The amount of radiation to the fetus from a chest x-ray is much lower than the whole body radiation dose from air travel, and yet there isn't anyone out there trying to prevent women from flying in the first trimester, which is when the fetus is the most sensitive to radiation.

People suggest that women avoid chest x-rays during pregnancy because of social and psychological issues around radiation, not factual ones. There is absolutely not even one iota of evidence to suggest that a chest x-ray could be dangerous to pregnant women. At least, it's less dangerous than the cosmic radiation from a flight, yet no doctors are grounding women as soon as they indicate they're pregnant, which is what they should be doing if a chest x-ray is an unacceptable risk.

Ironically, your suggestion to discuss this with the doctor is pretty common, but it's wrong. Family doctors don't have the foggiest clue about radiation risk. They don't take radiation biology classes. They know the very basic that everyone knows (radiation = bad), unless they happen to be radiologists or radiation oncologists, or other specialists who deal directly with radiation (and even then... they rely on people like me for that advice, it's not their area of expertise, just one with which they're tangentially involved). Family doctors are literally not qualified to give that advice, and yet they do and no one bats an eye.

So anyway, that's not a problem.

American apps are generally processed much faster than the posted time, Quebec or not.

That would have been good to know ages ago. Bit too late now, sadly.

No one can make the decision for you.

I mean there's no decision to make, I'd have to be a fool to risk it when I have a perfectly good job that pays twice as much in the US. It's just a damned shame. And they wonder why there's brain drain.

 

[canuck_in_uk]

I mean there's no decision to make, I'd have to be a fool to risk it when I have a perfectly good job that pays twice as much in the US. It's just a damned shame. And they wonder why there's brain drain.

To be fair, it seems that your situation is a result of your own personal decisions and family planning, so not really a "brain drain" situation.

 

[mahtax]

To be fair, it seems that your situation is a result of your own personal decisions and family planning, so not really a "brain drain" situation.

When I came to the US on a work visa, my work visa cost me 50$ (plus tax) at the border to process and took about 30 minutes. My health coverage started on the day I started working, and would have covered me were I pregnant, diabetic, ridden with cancer, or had any other health issue. My spouse is similarily covered from day one, were they or not a US citizen.

In contrast, it takes 15 months in the province of quebec to get healthcare coverage if one applies from within, whereas that's not the case for other provinces.

Tell me this is perfectly crafted policy without a single flaw, and that it discourages not a single one.

 

[canuck_in_uk]

When I came to the US on a work visa, my work visa cost me 50$ (plus tax) at the border to process and took about 30 minutes. My health coverage started on the day I started working, and would have covered me were I pregnant, diabetic, ridden with cancer, or had any other health issue. My spouse is similarily covered from day one, were they or not a US citizen.

In contrast, it takes 15 months in the province of quebec to get healthcare coverage if one applies from within, whereas that's not the case for other provinces.

Tell me this is perfectly crafted policy without a single flaw, and that it discourages not a single one.

Visa-exempt people who qualify for a work permit pay $155 at the Canadian POE and it takes less than 30 minutes.

That was private insurance that either you or your employer paid for. Huge difference between that and getting taxpayer-funded health coverage. I'm sure all of the other people who moved to the US without such an employer to pay for their insurance or the significant funds needed to afford health insurance, along with everyone else in the US in the same situation, don't have the same rosy feelings about it as you. I believe the average Americans pay to have a baby is $10k, they die trying to ration their insulin, lose their houses and retirements paying the bills for cancer etc.

It doesn't take everyone 15 months to get coverage in Quebec. That just happens to be the situation that you are in. You could have applied outland a few months ago and probably had PR before summer. Your wife could have gotten the work permit and a job. You could have delayed getting pregnant so that you didn't even have to deal with any of this. You could move to another province. Not all provinces have wait periods and not all require work permit holders to have jobs to get coverage. Some even cover visitor spouses of Canadians.

No policy is perfect but that is the same for every country, including the US. You can't blame policy for the choice you have to make.

 

[mahtax]

Visa-exempt people who qualify for a work permit pay $155 at the Canadian POE and it takes less than 30 minutes.

That was private insurance that either you or your employer paid for. Huge difference between that and getting taxpayer-funded health coverage.

The irony is that I of course also receive private healthcare coverage through my employer in Quebec; it just doesn't do squat if you don't also have an RAMQ card.

I'm sure all of the other people who moved to the US without such an employer to pay for their insurance or the significant funds needed to afford health insurance, along with everyone else in the US in the same situation, don't have the same rosy feelings about it as you. I believe the average Americans pay to have a baby is $10k, they die trying to ration their insulin, lose their houses and retirements paying the bills for cancer etc.

No one is moving to the US to be unemployed and on the streets. In fact, that's not possible, unless you're already a US citizen. If you're employed, you get healthcare - that's one of the provisions of the Affordable Care Act. If you're not, you do have to purchase health insurance on your own - but either way, they cannot discriminate based on pre-existing conditions such as pregnancy. Either way, you could get covered.

It doesn't take everyone 15 months to get coverage in Quebec. That just happens to be the situation that you are in. You could have applied outland a few months ago and probably had PR before summer.

Summer would have been too late. I start work in March. I can't afford to pay rent and living expenses in two different countries for 4+ months.

Your wife could have gotten the work permit and a job.

Non-french speaking americans will probably take a little while to get a job in Quebec, even in Montreal. That was never really in the cards, unfortunately.

You could have delayed getting pregnant so that you didn't even have to deal with any of this.

Well, there we are. That was the plan, and if things had gone according to plan, I wouldn't have needed to post here. As they say, no good plan survives first contact with the enemy.

Now that we are pregnant, there seems to be no options but to avoid returning.

You could move to another province.

I could choose a province at random and go be unemployed there. Maybe I can qualify for welfare? Not unemployment if I leave my job willingly.

In my field there is typically 2-3 positions posted each year. There are more openings, of course, but they tend to be filled internally. I applied for one in Manitoba two years ago, and one in Ontario last year. I didn't land either. This year I landed one in Montreal. That's probably my best and only chance in the forseeable future. I don't get to decide which province I end up in, unfortunately. Realistically, my only prospects at this point are New Brunswick or Nova Scotia. Nova Scotia hasn't posted their positions externally since 2015, and no one's retiring in New Brunswick in the next 5 years.

I guess I could go back to school, eat hundreds of thousands of dollars worth of opportunity cost, and hope I can land a job in my new field. But that's unreasonable when I already have a perfectly good career going.

Not all provinces have wait periods and not all require work permit holders to have jobs to get coverage. Some even cover visitor spouses of Canadians.

Yes, the fact that not all provinces are the same is what is particularly frustrating. Also the contradictory and confusing information out there. The fact that the open work permit, on its own, does not give access to RAMQ took us by surprise. And I'd done my homework, to the fullest extent of my capabilities! The immigration websites are vague to the point of uselessness, the process is obscure, and the rules don't make sense. Even the fact that outland applications are faster coming from the US - that's nowhere on the CIC website that I could find, or in the forums.

No policy is perfect but that is the same for every country, including the US. You can't blame policy for the choice you have to make.

I can and do blame policy. Here you have a highly educated Canadian citizen, willing to eat the significant loss of income to reverse the brain drain and come contribute to my native country, getting a job in one of the best medical centers of the country. My wife also holds a PhD. We have a job lined up for me, we'll be contributing to the Canadian economy, and we'll be even bringing a new baby into Canada and offsetting future immigration needs that way. We'll have no problems integrating culturally. Rationally, the country should see us as a best-case scenario and craft policy to make it easy for us to come home.

But policy means there's no way for us to get coverage now. There are no exceptions or fast-tracks for pregnant women (it would be rational for there to be), there is no grace during the time the application is being evaluated (as there used to be, according to the information we were able to find). No, there's just no way to get to B from A. Hell, you can fast-track a passport application, or a proof of citizenship application.

To add insult to injury, if I was a foreign Master's Student, or a postdoc coming in to work 2 years and bugger off, or anyone on a work visa, I could bring my wife as a dependent, and she would be covered either immediately or within 3 months, depending on the province, no muss no fuss. Ironically and cruelly, me being a citizen makes it much harder for my wife to get healthcare than if I were a foreigner.

Don't pretend it makes any sense, that it's fair, or that it's righteous. I'm not an expert on each countries' immigration process, but I doubt a majority of them make it as difficult as Quebec/Ontario does.