There’s a variety of sterilization methods available, including vasectomy, tubal ligation, and salpingectomy. One crucial aspect for patients to consider is the coverage provided by the Ontario Health Insurance Plan (OHIP). Health insurance coverage can influence the accessibility and affordability of these procedures. Understanding what sterilization methods are covered by OHIP will help you make informed choices that align with your future goals.

What is Sterilization?

Sterilization is a permanent form of birth control. It involves a surgical procedure that prevents conception. This method of birth control is for individuals or couples that are certain they do not want to have any more children in the future. Sterilization is the most effective form of birth control. For this reason, those interested must carefully considering whether to get sterilized. Although reversals are sometimes possible, the success rates vary. Anyone uncertain about sterilization should utilize alternative non-permanent birth control methods.

OHIP Coverage For Vasectomy

What is a Vasectomy? 

A vasectomy is a surgical procedure for male sterilization. It is the only sterilization method available to men. The procedure involves cutting or blocking the tubes that transport sperm from the testicles to the urethra. The cutting and/or blocking of these tubes prevents sperm from mixing with semen during ejaculation, eliminating the chances of fertilization and pregnancy. It’s important to note that a vasectomy does not have an immediate effect. The sperm will remain in the reproductive system even after the procedure. Patients should use an alternative form of contraception for a short period, usually about 3 months or until a follow-up sperm analysis shows no sperm.

Will OHIP Cover a Vasectomy? 

If referred by a doctor, the Ontario Health Plan (OHIP) can cover a vasectomy procedure, as well as preoperative surgical consultations and postoperative follow-up visits. If you do not have a family doctor to refer you, you can receive a referral from a walk-in clinic. The out-of-pocket cost for a vasectomy is around $500-1000 CAD. 

Private Insurance Options For a Vasectomy

If you don’t qualify for OHIP, or prefer to pay privately, most private insurance providers in Canada cover vasectomy procedures. Please refer to your healthcare provider to know for sure what level of coverage is available to you. 

OHIP Coverage For Tubal Ligation

What is Tubal Ligation?

Tubal ligation is a surgical procedure for women that serves as a permanent form of birth control. During the procedure, doctors will block, cut, or seal the fallopian tubes, which are the passages through which eggs travel from the ovaries to the uterus. By preventing the eggs from reaching the uterus, the patient can no longer become pregnant.

Will OHIP Cover Tubal Ligation?

Tubal litigations performed by a gynecologist. In order to see a gynecologist, you must get a referral from a family doctor or walk-in clinic. Once referred, OHIP will cover tubal ligation. If you need to pay out-of-pocket, tubal litigation will cost $2000 to $5000 CAD. 

Private Insurance Options For Tubal Ligation

Without OHIP, there are other options available for Tubal Ligation outside of paying out-of-pocket. Most private insurance providers will cover the procedure. Please inquire with your insurance provider to verify the level of coverage available to you. 

OHIP Coverage For Salpingectomy/Fallopian Tube Removal

What is a Salpingectomy?

A salpingectomy is a surgical procedure that involves the removal of one or both fallopian tubes. Salpingectomy is a sterilization method, but the procedure is also performed for other medical reasons. A salpingectomy can address ectopic pregnancies, and serve as a treatment for certain gynecological conditions such as ovarian cancer, pelvic inflammatory disease, or severe endometriosis. This procedure is generally more costly and complex than tubal ligation. 

Will OHIP Cover a Salpingectomy?

For the purposes of birth control, OHIP has covered salpingectomy procedures. However, changes may be made to only include the treatment of gynecological conditions or ectopic pregnancies as viable for OHIP coverage. To ensure a salpingectomy for birth control is covered, speak with a physician about your options. 

When paying out-of-pocket, a salpingectomy can cost anywhere between $3000 to $13000 CAD

Private Insurance Options For a Salpingectomy

The majority of insurance providers do cover salpingectomy procedures for birth control, gynecological issues, and esoteric pregnancies. Reach out to your insurance provider to confirm what level of coverage is provided before proceeding with the salpingectomy. 

Does OHIP Cover Sterilization Reversal Surgeries? 

The reversal of sterilization is not covered by OHIP. If you’re wondering whether private insurance will cover any reversal, most providers will say no. Reversals are considered an elective surgery, and your insurance provider is not obligated to cover it. The reversal of a tubal ligation will cost anywhere from $1500-$2000 out-of-pocket. The out-of-pocket cost for a vasectomy reversal averages between $8000 to $10,000. 

Salpingectomy reversal is not possible when the fallopian tubes have been completely removed. A partial salpingectomy is reversible, but the procedure will not be covered by OHIP or private insurance. Even if the reversal is successful, the patient may continue to experience issues conceiving. 

Understanding the potential out-of-pocket costs associated with sterilization allows you to effectively manage your reproductive health needs. Open communication with healthcare providers is key to finding the most suitable sterilization method.