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Everything You Need to Know About Health Insurance in Toronto

on 27 Dec, 2018

So you’re making the move to Toronto. Congratulations! We know you’re going to love strolling the Kensington Market, sampling the Distillery District and experiencing some of the finest health care options in the country.

Wait, say again?

Yes, your experience with the health care system in Toronto can be one of the best available under Medicare in Canada. That is, it can be if you approach it the right way and do things in a certain order and under a certain timetable.

In fact, there is one tip we’ll cover a bit later on in this overview of health insurance in Toronto that could save you thousands of dollars out of pocket.

Apply Immediately After You Move

There’s so much involved in any move that it’s easy to let the bureaucratic items fall by the wayside. It’s much more fun to explore your neighborhood than change your driver’s license address or apply for coverage under the Ontario Health Insurance Program (OHIP).

You should do both as soon as you possibly can, however. There is a time limit and incentive to do so. There is at least a three-month waiting period between the time you apply for OHIP and when you can be covered, so you want to get that clock ticking as soon as possible.

Eligibility Requirements

We say “at least” because there are big differences in how long you must wait before you are eligible to enroll in OHIP depending on where you are moving from.

To be eligible to enroll, you must:

  • be a Canadian citizen, permanent resident or among one of the newcomer to Canada groups who are eligible for OHIP;
  • be in Ontario on a valid work permit and are working full-time in Ontario, for an Ontario employer, for at least six months
  • be physically present in Ontario for 153 days in a 12-month period;
  • be physically present in Ontario for at least 153 days of the first 183 days immediately after establishing residency in the province;
  • make your primary place of residence in Ontario.

If you’re moving to Toronto from another province or territory your waiting period will be three months. If you’re moving from another country, your waiting period will be six months.

What OHIP Does and Doesn’t Cover

The province’s health plan covers the basic services mandated plus additional benefits. Stays in the hospital and medical practitioner services when deemed medically necessary are covered of course. So are eligible dental surgeries or optometry and podiatry services. Some ambulance services may also be covered.

Beginning in January 2018, OHIP also covers the cost of some medications for residents aged twenty-five and younger.  This is a benefit not enjoyed by residents of other provinces.

OHIP doesn’t cover prescription drugs not provided in the hospital including antibiotics prescribed by your family doctor, etc. Nor does it cover most dental services, eye exams or glasses, and contact lenses, or cosmetic surgeries.  Also, some services may only be partially covered or offered under strict circumstances.

How to Apply for OHIP

Whether you are new to the country or the province, you will need to apply for OHIP in person at a Service Ontario Centre. You can find a list of centers on the Ontario government website. The site also contains a list of the documents you will need to bring with you when you apply.

Be careful and double-check the locations, however. Some of them are kiosks that do not offer full-services or take applications. On the other hand, there are some centers that will let you book an appointment instead of waiting in the general queue.

Once you’ve made your application, there are still two things you should do during your waiting period.

Begin Searching for a Doctor

There is a marked shortage of family practitioners across Canada. In some parts of the country, it can take up to a year to find a family doctor accepting new patients. Because Toronto is such a large city, there are more doctors located here. However, there are also more families, so the sooner you get started on your search the better.

Setlement.org recommends you try these places to gather recommendations:

  • Ask a friend or family member if their doctor is accepting new patients
  • Use the Doctor Search found on the College of Physicians and Surgeons of Ontario website
  • Ask the nearest hospital if it has a family practice unit
  • You can also ask a worker at your local settlement agency

In addition to all the above, you should also register at Health Care Connect, the official site to find a doctor under the Ontario Health Insurance Plan.

If you are moving to Toronto from another province, you still need to go through the application process and wait three months to be eligible under OHIP. However, your health care card from your former province will continue to provide you with coverage under that province’s or territory’s plan.

That means you will be covered for the basic hospital stays and doctor services under a reciprocal agreement with your former province. However, any additional benefits you received under private insurance that you purchased yourself or through an employer will cease.

Buy Private Health Insurance in Toronto

It may be tempting to think you can go without insurance for your three or six month waiting period, but the benefits of having health coverage far outweigh the risks.  The costs associated with even a minor accident can easily be double or triple the cost of coverage.

Here is that tip we mentioned earlier that can save you big money:

If you moved because of a job change, you may be covered by your new employer’s coverage. However,  you may want to invest in your own private insurance plan.

You have the most flexibility in choosing just the services and coverages you and your family need under a plan you buy for yourself. You will find plans that will cover you just for your waiting period, but the premiums for these short-term plans can be higher than you might pay through an employer plan.

A long-term plan, on the other hand, may save you hundreds or thousands of dollars in premiums and covers more than an employer’s plan. Once you have such a plan, you can keep it, even if your employer offers a supplemental plan for all employees.

Explore Your Options Today

Not all private insurance programs accept all applicants. Nor do they all offer the same coverage to all applicants. If you have a pre-existing condition or take a particular medication, your options may be limited.

Check out Insurdiary’s guide to determining your best private options for health insurance in Toronto today.

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