10 Services not Covered by OHIP: What You Need to Know
By Krista DeKuyper | June 28, 2022 |
Did you know that there are many services that are not covered by OHIP? The Ontario Health Insurance Plan is a government-run program that provides health insurance to residents of Ontario. It covers a wide range of services, but there are some exceptions. In this blog post, we will discuss 13 services that are not covered by OHIP. This includes dental care, prescription drugs and eye exams. If you need any of these services, you will have to pay out of pocket for them.
- Ambulance transportation services if not deemed medically necessary
- Routine eye examinations for people between the ages of 20 and 65.
- Glasses and contact lenses.
- Dental Care
- Prescription Drugs
- Physiotherapy
- Paramedical Services
- Semi-private and private rooms in a hospital
- Necessary emergency medical treatment obtained outside of Canada
- Birth control pills and other contraceptives
Ambulance Transportation
A lot of people think that ambulance transportation is covered by OHIP regardless of the situation. That’s not true. If it’s a medical emergency that you’re covered by OHIP but if the transportation is not deemed medically necessary, then you’ll need to pay a maximum cost of $240.
Routine Eye Examinations
For people between the ages of 20 and 65, routine eye examinations are not covered by OHIP. However, if you have diabetes or other chronic medical conditions that could affect your vision, OHIP will cover the cost of your eye exam (once per year).
Glasses and Contact Lenses
People who need glasses are out of luck, you’ll need to pay out of pocket. The same goes for contact lenses unless you have a medical condition that requires them.
Dental Care
This is a big one. Dental care is not covered by OHIP at all. This includes routine dental check-ups, cleanings, and fillings. If you need any of these services, you will need to pay out of pocket.
Some people think that they are covered for dental care if they are pregnant or have a child under the age of 18. However, this is not the case. Prenatal and infant dental care is not covered by OHIP.
If you have a disability that affects your ability to eat, drink, or swallow, you may be eligible for dental care coverage through the Ontario Disability Support Program (ODSP).
Update for 2023
The federal government now offers the Canada Dental Benefit. This benefit is intended to help lower dental costs for eligible lower-income families. Parents can apply if their child is receiving dental care, is under 12 years old and is not covered by private health insurance. For more information, please visit the Government of Canada website.
If you’re a senior (65+) read this blog to see what 4 services OHIP covers for you.
Prescription Drugs
If you need prescription drugs, you will need to pay out of pocket. OHIP does not cover the cost of prescription drugs.
There are some exceptions to this rule. If you qualify for the Ontario Drug Benefit program. This program covers a portion of the cost of your prescription drugs. You will need to meet one of the following requirements and possess a valid Ontario health card
- Seniors who are ages 65 and older
- Residents under the age of 25
- Ontario residents who are on social assistance
- Ontario residents who reside in long-term care homes and homes for special care
- Ontario residents who are receiving professional home care services
- Residents who have high drug costs compared to their income are registered with the Trillium Drug Program.
Physiotherapy
Physiotherapy is usually not covered by OHIP unless you meet the following conditions
- you are less than 20 years of age or are 65 and older AND have been referred by a physician stating that you require physiotherapy
- you have been discharged as a hospital inpatient after an overnight stay and need physiotherapy to recover from your injury or condition
- you are a client of Ontario Works of the Ontario Disability Support program and are referred by a physician or nurse practitioner
Paramedical Services
Chiropractors, massage therapists, naturopaths, acupuncturists and osteopaths are not covered by OHIP. If you are under 20 or are 65 years or older there MAY be publicly funded coverage available for physiotherapy services
Semi-private and Private Rooms in a Hospital
Most of the time, when you get admitted to the hospital, you’ll be put in a ward with several other people. If you want a private or semi-private room it will cost you extra.
Treatment outside Of Ontario
If you find yourself outside of Ontario and get sick then OHIP will not cover you. It may cover you if you’re a part of the Out of Country Travellers Program. The government of Canada recommends all Canadians get travel insurance if travelling outside of Canada.
Birth Control
Birth control is not covered by OHIP unless you’re 24 or younger or you qualify for a special drug program.
To learn more about birth control covered through OHIP read this blog.
Private Health Insurance
Canadians are fortunate to have free health care but their provincial plan can only cover certain things. From above there are at least 10 services not covered by OHIP. If you have a private health insurance plan it will help cover the costs of things not included in your provincial plan like dental, vision, physio and more.
Common FAQs about OHIP coverage
Does OHIP cover surgery?
Yes. for the most part at least. OHIP will cover surgeries that are medically necessary. OHIP however will not cover laser eye and cosmetic surgery. These you will have to pay for yourself or be covered by your insurance provider.
Does OHIP cover x-rays?
Yes. OHIP will cover x-rays, MRI, CT scans if it is medically necessary and you have a requisition from a doctor.
If you don’t have a private health insurance plan and are looking for one HealthQuotes can help. Use our instant quoting tool to compare quotes from leading insurance providers.
