Summary of OHIP Coverage and Benefits
Ontario's provincial healthcare plan is referred to as OHIP, which stands for the "Ontario Health Insurance Plan".
OHIP coverage is available 3 months after a person establishes residency in Ontario.
If you have just moved to Ontario from another country or if you are a returning expat then apply for OHIP as soon as you arrive in Canada.
Please use the following as a summary of OHIP benefits and coverage.
Services Covered by OHIP
- Medically necessary services provided by a qualified doctor.
- Medically necessary services provided in a hospital, including meals, required drugs, procedures and public wards (semi-private and private rooms not covered).
- Eye examinations if you are under the age of 20 or 65 and up (one exam per year).
- Services provided by podiatrists are partially covered under OHIP.
- Ambulance services if:
- Transportation occurs between medical facilities.
- Deemed medically necessary. There is a $45 co-payment if transportation did not originate at a medical facility e.g. pick-up at your home.
- Home care and long-term care: may be covered, based on the needs of the applicant. Click here for more information.
- Mammograms are covered via the OBSP (Ontario Breast Screening Program) for all women over the age of 50 with no doctor's referral required. Women that are at special risk of getting breast cancer are also covered for a mammogram if they have a doctor's referral.
- Midwife services.
Please note that you may be billed if you miss an appointment with a physician or if your health card isn't valid.
Northern Health Travel Grant
You may be eligible for a Northern Health Travel Grant if you reside in northern Ontario and have to travel a long distance to obtain special medical care. This grant helps to offset your travel costs.
Services NOT Covered by OHIP
- Ambulance transportation services if not deemed medically necessary (maximum cost of $240).
- Routine eye examinations for people between the ages of 19 and 65.
- Glasses and contact lenses.
- Some physiotherapy may be partially covered or not at all.
- Routine dental services such as examinations, fillings, cleanings and non-surgical extractions.
- Podiatrists are only partially covered by OHIP.
- Paramedicals such as chiropractors, massage therapists, naturopaths, podiatrists, acupuncturists and osteopaths.
- Necessary emergency medical treatment obtained outside of Canada (e.g. while traveling) is only covered on a very limited basis; it is highly recommended to have travel insurance protection if traveling outside of Canada. Out of province ambulance costs are not covered.
- Prescription drugs, although assistance MAY be available (see below).
- Any cosmetic surgery.
- Semi-private and private rooms in a hospital.
Ontario Drug Benefits
Prescription drugs are not covered by the Ontario Health Insurance Plan; however, there is assistance for those who need help in paying prescription costs. The ODB program (Ontario Drug Benefit) provides coverage for the following people who possess a valid Ontario health card and are:
- Seniors 65 and older.
- Ontario residents who are on social assistance i.e. Ontario Disability Support Program and/or Ontario Works.
- Ontario residents who reside in long-term care homes and homes for special care.
- Ontario residents who are receiving professional home care services.
For a complete listing of prescription drugs that are covered by the ODB program please click here.
Ontario residents who DO NOT qualify for the ODB program have the option of applying for the Trillium Drug Plan. The TDP (Trillium Drug Program) provides drug benefits to Ontario residents who have high prescription costs in relation to their net income, and/or have little or no private insurance coverage.
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Last updated March 2016