What Is The Ontario Health Insurance Plan (OHIP)?

What Is The Ontario Health Insurance Plan (OHIP)?

Written by Caitlin Wood
Last Updated October 3, 2022

The public healthcare system of Canada, which covers a significant portion of healthcare costs, is seen as an achievement in the universal public health system of the country. Although the coverage may vary by province and territory, the Canadian public healthcare system is designed to provide citizens and inhabitants with basic health coverage.

In Ontario, the public health system is called the Ontario Health Insurance Plan (OHIP). Find out what is covered under OHIP and who’s eligible.                                       

What Is OHIP?

OHIP is Ontario’s public health care plan. Residents of Ontario can benefit from OHIP, which is funded by payroll taxes and supported by the government. While Ontario’s healthcare system is a high-quality system, it is not always enough when other medical costs, such as dental, vision, or prescriptions, are incurred.  

What’s Covered By OHIP?

OHIP covers the following:

  • Doctors visits
  • Visits and stays in the hospital
  • Abortions by medicine or surgery
  • Eligible dental surgeries performed in a hospital 
  • Eligible optometry services
  • Podiatry services
  • Ambulance services
  • Travel for medical care if you live in Northern Ontario. 

Are All Ontario Residents Covered By OHIP?

In order to be eligible for coverage, you’ll need to meet all of the minimum requirements, as well as one of the extra requirements listed below. 

Minimum Requirements 

  • Ontario must be your primary place of residence
  • You must be in Ontario for 153 days in any “12-month period”. Of the first 183 days of living in Ontario, 153 must be lived in Ontario.

Additional Requirements

You must additionally meet at least one of the following requirements to qualify for OHIP:

  • You are a Canadian citizen
  • You are an Indigenous person
  • You are a permanent resident in Canada
  • You worked full-time (with a valid work permit) for at least 6 months for an Ontario company.
  • You are a “protected person,” such as a refugee or someone who is particularly vulnerable.

Can Non-Ontario Residents Qualify For OHIP?

OHIP does not cover visitors from other Canadian provinces or territories and visitors from outside Canada. Before travelling to Ontario, check what your provincial/territorial health insurance plan or private health insurance plan covers.

How much does it cost to see a doctor in Ontario without OHIP?

Without OHIP medical coverage, a doctor visit can cost you a lot more than the average Ontario. Visitors from other provinces should expect to spend more, while residents of Ontario should expect to pay less. Additional factors that affect the cost include the day of the week and whether or not you are obtaining treatment on holidays. 

How To Apply To OHIP?

To apply for OHIP, you must schedule an in-person appointment at a ServiceOntario center.

Make sure you bring the following three documents to your appointment:

*Photocopies are not accepted.

How Do I Get An OHIP Card?

Once you apply for OHIP at your nearest ServiceOntario centre in person and are approved, you will be sent an Ontario health card. This card will prove that you are covered by OHIP. You will need to provide this card every time you visit the doctor. 

OHIP For Seniors 

Loss of employer-sponsored coverage and expensive healthcare costs due to an increased risk of chronic conditions may make it difficult for Canadian seniors to afford supplemental health insurance after retirement. Thankfully, seniors in Ontario have access to Ontario Drug Benefit Program.  

The Ontario Drug Benefit Program, sometimes known as the ODB program, is automatically available to all OHIP-insured seniors aged 65 and up. This program provides increased coverage to seniors, ensuring they have access to the healthcare they require.

What Does The ODB Program Cover?

The ODB program helps cover the costs of around 5,000 different prescription products. It also offers coverage for allergy shots, diabetes products, drugs for HIV and some nutrition products. 

While the OBD program’s additional benefits are of value to seniors, services such as home care, massage, physiotherapy, and dental care are not covered.

What Is The OHIP Schedule of Benefits and Fees?

The OHIP schedule of benefits, sometimes known as the SOB, is a comprehensive list of all medical services, which doctors can submit charges to the Ontario government. Each medical service has its code and a certain sum that the government has decided to pay the doctor for that service.

Here is a link to the OHIP benefits schedule

OHIP FAQs

Does it cost to have OHIP?

Residents of Ontario who are OHIP eligible are entitled to free emergency and preventative treatment. Participating doctors in the province bill the government through OHIP for their services.

What happens if I am not eligible for OHIP?

If you are informed you do not qualify for OHIP by the OHIP Eligibility Review Committee, you have the right to contest their decision and ask for a review. If you disagree with or are dissatisfied with their decision, you have 15 days to appeal the OHIP Eligibility Review Committee’s decision to the Health Services Appeal and Review Board.  If you require medical care in Ontario but do not qualify for OHIP, you’ll have to pay out of pocket or through your private insurance (if you have it). 

Do You Need To Reapply For OHIP?

If you leave Ontario for more than 212 days in a “12-month period”, you may need to reapply for OHIP at a specialized Service Ontario center. If you’re not sure, you can contact Service Ontario.  

Caitlin Wood is the Editor-in-Chief at Loans Canada and specializes in personal finance. She is a graduate of Dawson College and Concordia University and has been working in the personal finance industry for over eight years. Caitlin has covered various subjects such as debt, credit, and loans. Her work has been published on Zoocasa, GoDaddy, and deBanked. She believes that education and knowledge are the two most important factors in the creation of healthy financial habits. She also believes that openly discussing money and credit, and the responsibilities that come with them can lead to better decisions and a greater sense of financial security.

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