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.
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.
You will also need to show three more documents:
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.
You are eligible for OHIP if:
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.
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 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.
OHIP usually doesn’t cover dental services. However, OHIP may cover some dental surgery, if it’s done in a hospital.
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:
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
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 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.
The Ontario Government covers both military and aboriginal groups in their healthcare programs. Both have free access to medically necessary care as required by a licensed physician.
Aboriginal peoples are insured by OHIP. The government assists aboriginals by providing public health services and health promotion programs.
Regular Force personnel are eligible for OHIP coverage during specified periods, based on their duty status.
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.
|X-Rays and Exams||Maybe, if done in a hospital|
|Wisdom teeth||No, unless they're extracted in a hospital|
|Eye Exams||Applies to those under 18 and under, 65+ and for diabetics. One every 12 months|
|Laser Eye Surgery||Yes, for cataract and lens replacement surgeries|
|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|
|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|
|Birth Control (including IUD)||Yes, for women younger than 25 and for those with a low income|
|Fertility Treatment||Yes, for a single IVF cycle per patient under the age of 43|
|Dermatologist||Yes - If it is recommended by a doctor for medical reasons|
|Physiotherapy||Yes - Only if the services are performed in hospital or rehabilitation facility.|
|Podiatrist and Foot Care||Partially, up to $135 per patient per year|
|Allergist and Allergy Testing||Yes|
|Sleep Physician and CPAP Machines||Sleep Physician Yes, CPAP covered up to 75%|