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What You Need to Know About the Ontario Health Care System

on 24 Nov, 2018

Since 2006, the number of preventable deaths in Canada and Ontario has been dropping. From 2013-2015, there were only 69 preventable deaths in the province in that 3 year period.

But how does the Ontario health care system actually work? And who has access to it? Read on to find out.

Canada’s Medical Care System in a Nutshell

Canada’s publicly funded health care system has evolved over the past 40 years and will continue to do so in the future.

The premise remains unchanged – universal health care coverage is provided on the basis of need, not the ability to pay.

Each province in Canada handles their residents’ medical care autonomously. Read on to learn about the Ontario health care system.

Ontario Health Care System

The Ontario Health Insurance Plan (called OHIP for short) is the province’s publicly funded health care plan.

To access all the medical care the province offers, individuals must present an Ontario health card each time they use any medical service including visiting a walk-in clinic or having a medical test done.

In order to be covered by OHIP, there must be a medical reason to receive a service. Elective procedures such as cosmetic surgery are not covered under OHIP.

OHIP covers a variety of health services such as visits to a family doctor, walk-in clinic, emergency room visits, medical tests, and necessary surgeries.

Hospitals

If you need to stay in the hospital, OHIP covers your accommodation and meals, any diagnostic tests such as x-rays, any medications for in-patients, as well as access to doctors and nurses.

OHIP provides shared hospital accommodations. If an individual wishes, he or she can pay for a private or semi-private room. Many private insurance policies provide semi-private coverage as well.

OHIP covers dental surgery that is performed in hospitals such as reconstructive surgeries and tumour removal.

Ambulance services to a hospital may be partially or fully covered by OHIP depending on whether a physician deems your ambulance service medically necessary or not.

Optometry

If you are 19 years old or younger, or over the age of 65, OHIP covers one major eye exam every 12 months. People aged 20-64 may be covered under OHIP if they have a specific medical condition that affects the eyes and requires regular monitoring.

Services not covered by OHIP

OHIP does not cover prescription medication when you are not a patient in a hospital. During your hospital stay, prescription medication is covered.

Dental services that take place in a dental clinic are not covered under OHIP. Neither are prescription glasses, contact lenses or laser eye surgery.

Cosmetic surgery is not covered by OHIP.

Who Is Eligible for OHIP

Individuals must apply for an Ontario health card in person or by mail.

To qualify for OHIP, individuals must meet all these qualifications as follows:

  • you must be in Ontario for 153 days during a 365-day time period
  • you must be physically in Ontario for at least 153 days of your first 183 days in the province
  • Ontario must be the place of your primary residence.

In addition to those minimum qualifications, you must also meet at least 1 of the following additional requirements:

  • are a Canadian citizen
  • are an Indigenous person (registered under the federal Indian Act)
  • are a permanent resident or have applied for permanent residence
  • are in Ontario on a valid work permit
    • your spouse and any dependents also qualify in this case
  • are a convention refugee or other protected person
  • have a Temporary Resident Permit
  • are a clergy member who can legally stay in Canada and is ministering full time in Ontario for at least 6 months
    • your spouse and any dependents also qualify in this case

For more information about who can qualify for OHIP visit the Service Ontario website.

When OHIP Coverage Begins

After you are approved for OHIP, it may take up to 3 months for you to receive coverage. Many people who are new to Ontario choose to get private insurance in the beginning.

There are a few exceptions who get immediate coverage. For example, babies born in Ontario who are Canadian citizens receive coverage immediately.

So do certain internationally adopted children adopted by Ontario residents.

Protected persons including convention refugees receive immediate OHIP coverage. Those who move to Ontario from elsewhere in Canada into a long-term care home receive immediate OHIP coverage also.

First Step: Primary Health Care Services

When Ontarians need medical care, they first access primary health care services.

This first point of contact may be all that is needed for many individuals. For example, a person may visit a family doctor or walk-in clinic and get a prescription and go home.

Other times, patients require further testing or treatment. In these cases, they are referred to other healthcare specialists that provide secondary services.

Secondary Services

Referrals to secondary services may be made by doctors, hospitals, community agencies and even the patients at times.

There are a wide variety of secondary services that may or may not be covered under OHIP.

For example, the medical care provided in long-term care facilities is covered under OHIP. Yet room and board are not. Sometimes, room and board are subsidized by the Ontario government.

Bottom Line

Thanks for reading. We hope this guide into the Ontario health care system has given you a good look at what you can expect from medical care in Ontario.

Now that you are familiar with what OHIP does and doesn’t cover, you may want to consider a Manulife insurance plan for health and dental coverage.

Search for the lowest insurance rates in Canada. Get a free, no obligation quote today.

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