To maintain your provincial health care coverage you must be physically present in your province for a certain period of time.  This issue is either talked about a lot or people are unaware its even an issue.  When they mean out of the province this would include time spent in other provinces not just other countries. Failure to meet the provincial guidelines will result in loss of coverage.  The following outlines the high level requirements for each of the provinces.

In B.C., Saskatchewan, Manitoba, Quebec, Prince Edward Island, and Nova Scotia you are required to be physically present in your province for at least 183 days (six months) during each calendar year. In Alberta and New Brunswick you must be present in the province for 183 days during a 12-month period (not the same as a calendar year).  In Ontario you must be present in the province for a total of five months in the previous 12.  In Newfoundland and Labrador you must be present for at least four months in the previous 12. These days can be in the aggregate (several short trips), or one long one.

You can apply to your provincial jurisdiction for extensions to these rules for specific extend stays and they are usually granted.

Now I for one can't figure out how they would ever track the out of province visits and they probably can't. My guess is alarm bells go on if they start receiving medical bills from other provinces so it is most likely incident based.

The second issue focuses on understanding any length of stay restrictions for your private out of country medical travel insurance.  Its imperative you get clarity from your provider and if you can bear it, read the actual policy.  For example, you might have coverage as part of one of the premium credit cards you own and it may be very good coverage.   However if you dig a little deeper, you may find, as I did, that yes I'm covered but the coverage is only valid for periods of thirty days of continuous out of country travel.  You have to get your butt back to your home country before the 30th day expires or call them and pay for an extension.  It took me some time to figure out who to call but the service was very effecient at getting me the extended coverage I needed.