A Guide to the Ontario Health Insurance Plan (OHIP)

The Ontario Health Insurance Plan (OHIP) is a governmental health plan that provides basic health care services to anyone who lives in Ontario and meets the eligibility requirements. Read on to learn everything you need to know about how OHIP coverage works, the eligibility requirements, what’s covered, what isn’t, and more.

    What is OHIP?

    OHIP stands for the Ontario Health Insurance Plan. It is a government-run health plan that pays for many health care services, including visits to your family doctor and various specialists.

    OHIP provides Ontario residents with emergency and preventive care that’s free of charge. The costs of OHIP are covered through taxes. All Ontario residents pay for OHIP through their personal income tax.

    What is an OHIP Card?

    OHIP health card image

    Ontario residents older than 15 and a half years of age have to apply for an OHIP card in order to receive health care services that are covered and paid for by OHIP. Each person is assigned a 10-digit health number that works as a file number for all medical care providers in Ontario.

    The Ontario Health Card proves that you’re covered, and you have to show it every time you visit a doctor or an emergency room.

    Applying for OHIP

    To apply for OHIP, you have to fill out a form that you can find online or at your local ServiceOntario.

    You will also need to show three more documents:

    • Proof of citizenship or OHIP eligibility - birth certificate, passport, Temporary Confirmation of Registration Document, etc.
    • Proof of Residency - Employer record, income tax assessment, property tax bill, mortgage or rental agreement, etc.
    • Support of Identity - Credit card, employee ID, passport, student ID, driver’s license, etc.

    You can only apply in person, and you can only use a document once. So, for example, if you use your passport as proof of citizenship, you cannot use it as a Support of Identity document.

    Eligibility Requirements

    You are eligible for OHIP if:

    • Your main residence is in Ontario
    • You were in Ontario for at least 153 days in a 12-month period
    • You are a Canadian citizen or permanent resident
    • You are a “protected person”
    • You are registered as an Indian
    • You applied for permanent residence and the IRCC confirmed that you meet the requirements to have a permanent residence in Canada.

    Getting an OHIP Card

    To get an Ontario Health Card, you have to visit your local Service Ontario Centre with the original documents confirming your eligibility. In some cases, you may have to provide additional documents. For example, you may be required to provide a marriage certificate if you changed your name, and so on.

    Renewing or Replacing Your OHIP Card

    If you’re applying for a replacement health card because your last one expired, you have to bring the three original documents that prove your eligibility to your local Service Ontario.

    If you want to replace your health card because the last one was damaged, lost, or stolen, you can make your request by phone or in writing if the information shown on the card (such as your name, address, etc) has not changed and your card is still valid.

    OHIP Coverage

    OHIP covers many health care services, including visits to your family doctor, diagnostic services, treatment for illnesses or injuries, hospital and emergency care.

    OHIP does not cover dental care, eye care, prescription drugs for people aged 25 or older, and services that are not medical necessities, such as cosmetic surgery.

    Dental

    OHIP usually doesn’t cover dental services. However, OHIP may cover some dental surgery, if it’s done in a hospital.

    Prescription Drugs

    OHIP does not pay for prescription medicine if you’re older than 25. Your private insurance plan may also cover part of your costs. And the Ontario Ministry of Health has some programs that can cover some of your expenses for prescription medicine:

    Extended Health Care

    People who have high health costs but have an income that’s too high for them to be included in the Ontario Disability Support Program may be eligible for the Extended Health Benefit.

    The Extended Health Benefit may help with the cost of

    • Medical supplies, such as those for diabetic or incontinence
    • Assistive devices, such as hearing aids
    • Prescription drugs
    • Vision care
    • Dental care, if the recipient 17 years or younger
    • Transportation to and from medical appointments

    Travel, and Out of Province Coverage

    If you plan to travel outside of Canada for a period of time longer than seven months in a year, your OHIP coverage will still be available for up to two years if you have a valid health card and you lived in Ontario for at least 153 days per year for the two years prior to your leaving.

    OHIP will cover a limited amount of the treatment costs if you receive treatment outside of Canada. If you receive treatment in another Canadian province or territory, OHIP will cover some of the costs for physician and hospital services.

    Students & Seniors

    Students and seniors are covered by special programs, such as the OHIP+. OHIP+ covers the costs for more than 5,000 prescription drugs for anyone younger than 24 who is not covered by a private plan.

    Seniors who need long-term care are eligible for the Ontario Disability Support Program and will maintain their benefits through the ODB program without pay regardless of whether they also have a private plan or not.

    Coverage for Subgroups

    Aboriginals

    Aboriginal peoples are insured by OHIP. The government assists aboriginals by providing public health services and health promotion programs.

    Military

    Regular Force personnel are eligible for OHIP coverage during specified periods, based on their duty status.

    What OHIP Does Not Cover

    Cosmetic surgery
    Dental services performed in a dentist's office
    Eye exams for people between the ages of 20 and 64, except for those suffering from specific conditions
    Care services provided by non-licensed facilities
    Some physiotherapy services
    Preferred hospital accommodation, unless specifically prescribed by a physician
    Private duty nursing
    Prescription renewals done over the phone
    Completion of forms and certificates you may need for school, work, insurance, etc.
    Testimony in court

    Common Procedures and OHIP Eligibility

    There’s a lot of confusion about what is and what isn’t covered by OHIP. Here’s a quick breakdown of common procedures and their coverage eligibility.

    Dental
    X-Rays and Exams Maybe, if done in a hospital
    Wisdom teeth No, unless they're extracted in a hospital
    Vision
    Eye Exams One every 12 months
    Glasses No
    Laser Eye Surgery Yes, for cataract and lens replacement surgeries
    Surgery
    Rhinoplasty Yes, if it’s recommended by a doctor for medical reasons
    Breast Reduction Yes, if it’s recommended by a doctor for medical reasons
    Hospital
    Hospital stays Yes
    Ambulance transportation Partially, if medically necessary
    Giving birth Yes, if at least one of the parents are covered by OHIP and will be staying in the province for 153 days in the following year
    Therapy and Counselling
    Therapy is covered if done by a MD or a Nurse Practitioner. Counselling is not covered.
    Sexual Health
    Gynecologist Yes
    Erectile Dysfunction Yes
    Birth Control (including IUD) Yes, for women younger than 25 and for those with a low income
    Fertility Treatment Yes, for a single In Vitro Fertilization cycle per patient
    Specialists
    Dermatologist Yes
    Physiotherapy Yes
    Massage Therapy No
    Podiatrist and Foot Care Partially, up to $135 per patient per year
    Allergist and Allergy Testing Yes
    Sleep Physician and CPAP Machines Partially, covers up to 75% of the cost

    Extending OHIP Coverage

    Private health insurance can help extend your coverage. Private insurance can cover the costs of prescription drugs, dental procedures, glasses, and more.
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