New to Ontario? Here's Why You Need Private Health Insurance!

Posted on October 30, 2018

Moving to Ontario for a new job or school?

Congrats on starting a new chapter in your life, as well as an adventure!

But do you have health insurance to cover you?

Canada has single-payer health insurance, and this applies to those living in Ontario. But if you've just moved to Ontario, it may take a while for it to kick in. This can also be true if you live in another province and make the move to Ontario.

One way to remedy this is by purchasing private health insurance. That way, you can be sure that your medical needs, and that of your family's, are covered.

How Long Does It Take for Ontario Health Insurance (OHIP) to Kick In?

Once you arrive in Ontario, it can take up to three months for OHIP to kick in. This starts after you have been approved for OHIP.

There are some cases where OHIP kicks in immediately. This applies to refugees as defined by the Refugee Board of Canada, internationally adopted children who have been adopted by Ontario parents, babies and those who move from another province into Ontario to live in a care home.

Everyone else must wait the requisite time period.

If I've Left Ontario, Do I Need to Reapply for OHIP?

If you've left Ontario for more than 212 in a year, you will need to reapply for OHIP. This could leave you a gap of time in which you are not insured.

What If I Move to Ontario from Another Province?

As Medicare is covered by each province, you may not be covered when you first arrive in Ontario. As, such, purchasing private health insurance is a good idea until OHIP becomes active.

If you're just traveling to Ontario from another province, you should check to make sure that your province's insurance will cover you in the event of an emergency. In some cases, purchasing travel insurance is recommended to ensure you have all of your bases covered.

Who is Eligible for OHIP?

Before you start your private health insurance plan, you should be aware of who receives OHIP coverage. If you find you are not eligible to receive OHIP, private medical insurance is a good idea to consider.

To receive OHIP, you must reside in Ontario permanently and intend to make it your home for the foreseeable future. You must live in Ontario 153 days per year. These 153 days must be within the first 183 days that you start to live in Ontario.

Additionally, there are extra criteria.

You must meet one of the following:

  • Be a permanent resident
  • Have applied for permanent residency and meet the requirements. You must not have received a denial.
  • Be a Canadian citizen
  • Be an Indigenous person
  • Have a valid Live-In Caregiver Program work permit
  • Have a valid work permit for an Ontario employer, where you work full-time for at least six months
  • Have a Temporary Residence Permit
  • Are a refugee or protected person
  • Are a member of the clergy working full-time in Ontario for at least six months

If you do not meet the criteria, you should consider getting private health insurance.

What Will OHIP Cover?

If you're new to Canda, you should be aware that Medicare, the single-payer health insurance, does not cover everything. As such, you need to evaluate if you also need private health insurance in addition to OHIP. Some Canadians decide to take this route for "double insurance," and to receive benefits they would not have otherwise received with just OHIP.

OHIP covers most medical needs. But like other provincial health insurance, it does not cover laser eye surgery, cosmetic surgery, eyeglasses or contacts, prescription drugs (unless administered in the hospital) and dental care at the dentist's office.

If you receive dental care in the hospital or a more complex dental procedure that requires admittance to the hospital, this is typically covered.

Do I Qualify for Private Health Insurance?

Whether you qualify for individual insurance policies depends on a variety of factors. However, most people will find an insurance plan that is appropriate for them and their family.

Some more comprehensive insurance policies will require you to either be in good health or have no pre-existing conditions. Others do not require this, or any medical underwriting whatsoever. Those that do not require medical underwriting may be limited in their scope of what they cover. Additionally, those that cover more of your needs tend to be more expensive.

You will need to work with an insurance agency to decide which policy is right for you and your family. You may need to have a doctor release your medical records in order to be approved.

How Long Does Private Health Insurance Take to Kick-In?

Unlike OHIP, private medical insurance kicks in immediately. There is no cooling off period or a need to wait several weeks or months for your coverage to begin. You may start using it as soon as you're approved and make the payments.

Can I Get Short-Term Health Insurance?

Different providers will have different policies related to health insurance. Some will offer short-term health insurance that can cover you for your three months as you wait for OHIP. Others may require a more extensive commitment.

Shorter health insurance coverage might mean higher monthly rates and premiums. However, it is up to you how long you wish the insurance to cover you.

What Does Private Health Insurance Pay For?

Private health insurance will depend on your policy. However, they typically cover a portion of your expenses toward doctor visits, X-rays and diagnostics, eyeglasses and contacts, prescription drugs and dental care.

Some private health insurance companies may also help you offset the costs of medical devices such as hearing aids. You may also receive some money toward psychotherapy, naturopaths, physical therapy and home care if you become unable to care for yourself.

Some insurance policies will pay for everything related to these concerns and issues. Others will pay a percentage of the fees, or up to a certain amount of money. After that, you will become responsible for any fees incurred.

Private health insurance typically does not cover cosmetic surgery. It may cover plastic surgery, or reconstruction surgery, however.

Benefits of Buying a Long-Term Plan

You may decide that you like private insurance much that you want to stay on it. That's absolutely fine. You can also combine it with OHIP. In fact, some insurance companies state that anyone who wants to be insured must have already applied for insurance through OHIP.

Some benefits of long-term private health coverage include travel insurance. Many people don't even think about travel insurance until they travel. However, this is often necessary if you go out of the province, or even the country often.

Other countries have single-payer healthcare, but as a Canadian, you may not be entitled to it. Instead, you will need to have some form of coverage, or you risk having to pay for it all out of pocket.

As such, having private health coverage can save you sometimes thousands of dollars.

Medicare does not cover prescription drugs, which can get very expensive for Canadians with long-term health issues. If you need regular medication to thrive, you might want to consider purchasing health insurance that offers drug costs. Otherwise, you must pay for it out of pocket.

You also will not receive much dental care from Medicare, unless it is an emergency that must be treated at the hospital. Otherwise, you may be looking forward to painful issues that you put off treating due to finances.

Lastly, waiting for a doctor to see you can take a long time. This is because with OHIP, you're put on a list when you need to see a doctor or have a procedure performed. Depending on a variety of factors, this means it could take weeks or even months to be seen.

With private health insurance, you can skip the queue and see a doctor immediately. In many cases, you can also get diagnostics and other procedures done more quickly as well. Thus, you won't need to stay in pain or wondering about what is going on with your body. Instead, you'll have answers, or a treatment, much more quickly.

Should I Spring for Private Health Insurance?

Private health insurance is, indeed, recommended for individuals just moving to Ontario. You don't have to keep it, especially if the expense cannot be justified. However, it is better to have private health insurance until OHIP kicks in just in case. It would be worse to be caught without health insurance in the event of an emergency.

For more information on Canadian health insurance policies and options, visit our website.

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