Summary of OHIP Coverage and Benefits
As of January 1, 2018, Ontario residents 24 years of age or younger are covered for eligible prescription drugs that are listed with the Ontario Drug Benefit (ODB) or the Exceptional Access Drugs formularies. For more information go to the Ontario government’s OHIP+ web page. UPDATE: as of April 1, 2019, OHIP+ will be the second payer IF the Ontario resident has private health insurance coverage. OHIP+ will still be the primary payer for those residents who do not have private health insurance coverage.
Ontario’s provincial healthcare plan is referred to as OHIP, which stands for the “Ontario Health Insurance Plan”.
OHIP coverage is available 3 months after a person establishes residency in Ontario.
If you have just moved to Ontario from another country or if you are a returning expat then apply for OHIP as soon as you arrive in Ontario.Affordable Health & Dental Plans
We offer health plans that:
- Have no medical questions.
- Are guaranteed acceptance.
- Come with instant, online quotes.
Health and dental coverage starting from $82.20 per month!
Services Offered by OHIP Coverage
The following services are partially or fully covered by OHIP.
- Medically necessary services provided by a qualified doctor.
- Medically necessary services provided in a hospital, including meals, required drugs, procedures and public wards (semi-private and private rooms not covered).
- Eye examinations ONLY IF: you are under the age of 20 or 65 and up (one exam per year), or; you have a medical condition that requires regular eye examinations (one exam per year is covered).
- Registered podiatrist services are partially covered under OHIP (note that surgery is not covered). Coverage is $7 to $16 per visit, with an annual maximum of $135 per person. There is also $30 for x-rays.
- Ambulance services IF:
- You have a valid health card and transportation occurs between medical facilities.
- Ambulance transportation is deemed medically necessary. There is a $45 co-payment if transportation did not originate at a medical facility (e.g. pick-up at your home), UNLESS you are receiving social assistance, in which case the $45 fee is waived.
- For full ambulance cost details please click here.
- Home care and long-term care are usually not covered, although this depends on the needs of the applicant. Click here for more information.
- Mammograms are covered via the OBSP (Ontario Breast Screening Program) for all women who: are between the ages of 50 to 74 years old (no referral needed), or; are between the ages of 30 to 69 and are considered to be a high risk (referral is required). Mammograms are also covered if you are referred to a publicly funded Ontario hospital or clinic by a physician.
- Midwife services.
- Dental surgery performed in a hospital. For example, fracture repair, tumor removal, reconstructive surgery and medically necessary tooth removal (tooth removal requires prior OHIP approval).
- Some birth control pills / oral contraceptives are covered IF you are younger than 25 years old (covered by OHIP+ program). If you are 25 or older than there MAY be coverage if you are considered “low-income” and qualify for a specialty drug program.
- Surgical abortions if performed in a hospital or clinic. Mifegymiso is also covered if you have a prescription from your doctor.
Please note that you may be billed if you miss an appointment with a physician or if your health card isn’t valid. You must cancel an appointment at least 24 hours in advance to avoid being charged this fee.
Northern Health Travel Grant
You may be eligible for a Northern Health Travel Grant if you reside in northern Ontario and have to travel a long distance to obtain special medical care. This grant pays 41 cents per kilometer travelled. There is a deductible of 100 km.
If you live in one of the following areas you may be eligible for assistance: Algoma, Manitoulin, Cochrane, Kenora, Sudbury, Nipissing, Parry Sound, Rainy River, Timiskaming, or Thunder Bay.
For enrolment information please click here.
Services NOT Covered by OHIP
- Ambulance transportation services if not deemed medically necessary (maximum cost of $240).
- Routine eye examinations for people between the ages of 20 and 65.
- Glasses and contact lenses.
- Laser eye surgery.
- Eye exams required by third parties or potential employers.
- Physiotherapy is usually not covered, UNLESS you meet one of the following conditions:
- You are less than 20 years of age or are 65 or 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 (the reason you were hospitalized).
- You are a client of Ontario Works or the Ontario Disability Support program and are referred by a physician or nurse practitioner.
- Any dental services performed in a dental office.
- Paramedical services such as chiropractors, massage therapists, naturopaths, acupuncturists and osteopaths are usually not covered. If you are under 20 or are 65 or older then there MAY be publicly funded coverage available for physiotherapy services.
- Necessary emergency medical treatment obtained outside of Canada (e.g. while traveling) is only covered on a very limited basis (via the Out-of-Country Travellers Program); it is highly recommended to have travel insurance protection if traveling outside of Canada. Out of province ambulance costs are not covered.
- Prescription drugs if you are 25 or older (as of January 1, 2018), although assistance MAY be available (see below), depending on your personal situation.
- Any cosmetic surgery.
- Semi-private and private rooms in a hospital.
- Birth control pills and other contraceptives UNLESS you are 24 or younger OR you qualify for a specialty drug program (e.g. low-income family).
Ontario Drug Benefits
Prescription drugs are usually not covered by the Ontario Health Insurance Plan; however, there is assistance for those who need help in paying prescription costs. The Ontario Drug Benefit (ODB) program provides coverage for the following people who possess a valid Ontario health card and meet one of the following requirements:
- Seniors who are aged 65 and older.
- Residents under the age of 25.
- Ontario residents who are on social assistance i.e. Ontario Disability Support Program and/or Ontario Works.
- 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 and are registered with the Trillium Drug Program (see below).
For a complete listing of prescription drugs that are covered by the ODB program (including OHIP+) please click here.
Ontario residents who DO NOT qualify for the ODB program have the option of applying for the Trillium Drug Plan. The TDP provides drug benefits to Ontario residents who have high prescription costs in relation to their net income, and/or have little or no private insurance coverage.
Protect yourself from costs not covered by OHIP. Get free, instant health insurance quotes!
(please consider sharing this article)
Last updated March, 2019