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Ontario Provincial Health Insurance Plan

OHIP is Ontario’s health care plan. Through OHIP, the province pays for many of the health services you may need.
To meet the minimum qualifications for OHIP you must be physically in Ontario for 153 days in any 12‑month period.

DENTAL
- What is covered: Ontario Health Insurance Plan (OHIP) covers in-hospital dental surgeries such as fracture repair; tumor removal; reconstructive surgeries; medically necessary tooth; removal (prior approval by OHIP is required).
- What is NOT covered: OHIP does not cover dental services provided in a dentist’s office.

DRUGS
- What is covered:
If you need to go to the hospital, Ontario health insurance covers medications for inpatients (once a patient is discharged, prescribed medications are not covered). The Ontario Drug Benefit (ODB) program covers most of the cost of prescription drugs listed in their formulary if you are eligible (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). For full details see the ODB website: https://odano.ca. If you have high prescription-drug costs – compared to your household income – you might qualify for the Trillium Drug Program (https://www.ontario.ca/page/get-help-high-prescription-drug-costs)
- What is NOT covered: Ontario Health Insurance Plan (OHIP) does not cover prescription drugs provided in non-hospital settings (e.g. antibiotics prescribed by your family doctor).

TRAVEL INSURANCE
- What is covered:
Starting January 1, 2020, Ontario is launching a new program to fund out-of-country dialysis services, ensuring that Ontarians living with kidney failure can continue to receive support for the dialysis care they need when they are travelling outside of Canada. OHIP covered up to $210 per treatment.
- What is NOT covered: As of January 1, 2020, the Ontario government no longer covers emergency healthcare expenses under OHIP when Ontario residents travel out of the country. Within Canada, you are only covered for services mandated by the Canada Health Act, which are: Hospital services provided to in-patients or out-patients, if the services are medically necessary to maintain health, prevent disease or diagnose or treat an injury, an illness, or a disability. Medically required physician services rendered by medical practitioners.
Ontarians travelling abroad are always encouraged to purchase the appropriate travel insurance coverage in the event emergency health and doctor services are needed out of the country.

VISION
- What is covered:
Ontario Health Insurance Plan (OHIP) covers the cost of one major eye exam (for vision and general eye health) every 12 months, plus any minor assessments you need, but only if you are: 19 years and younger or 65 years and older. If you are 20 to 64 years old, and you have a specific medical condition affecting your eyes that requires regular monitoring, OHIP will cover a major eye exam for you once every 12 months and any follow-up appointments related to the condition. You may be eligible for additional eye care if you are on the Ontario Disability Support Program (ODSP) or Ontario Works.
- What is NOT covered: OHIP does not cover eyeglasses, contact lenses, laser eye surgery, and eye exams for Ontarians between ages 20 and 64.

PARAMEDICAL
- What is covered
: Ontario Health Insurance Plan (OHIP) covers between $7-16 of each visit to a registered podiatrist (foot-health services) up to $135 per patient per year, plus $30 for x-rays. You will need to pay for the remainder of the cost of each visit. Surgeries performed by podiatrists are not covered by OHIP. Coverage for speech therapy when performed in a hospital only. Physiotherapy is covered for seniors age 65 and over, individuals age 19 and under, and individuals of any age needing physiotherapy after being hospitalized (non-hospital physiotherapy services for seniors are no longer covered as of Aug. 1, 2013).
- What is NOT covered: No coverage for Chiropractor, Acupuncturist, Osteopath, Psychologist, Massage Therapy, or Naturopath services.

HOSPITAL ROOM
- What is covered:
Ontario Health Insurance Plan (OHIP) provides coverage for standard ward room only. If you need to go to the hospital, OHIP covers doctor and nursing services; services to diagnose what’s wrong (such as blood tests and x-rays); medications for inpatients (once a patient is discharged, prescribed medications are not covered); accommodation and meals if you have to stay (if you want a private or semi-private room, you or your private insurance will have to pay some or all of those hospital fees).
- What is NOT covered: Ontario Health Insurance Plan (OHIP) does not cover private or semi-private hospital rooms.

PRIVATE DUTY NURSING AND MEDICAL EQUIPMENT
- What is covered:
The Assistive Devices Program covers a portion of the cost of medical equipment or supplies for eligible residents of Ontario with valid OHIP. Some home care services are available for eligible residents.
- What is NOT covered: Home care services and medical equipment are funded in many different ways: by the government (Ontario and/or local governments); by non-profit organizations who receive donations to deliver these types of services; by your private insurance or benefit plans (for example, private health insurance); by you (for example, when you pay for services yourself).
Many people who want to stay in their own homes will arrange a mix of services funded in a number of different ways.

HEARING AIDS
- What is covered:
The Assistive Devices Program covers 75% of the cost of equipment and supplies (if you have a disability requiring the equipment or supplies for six months or longer).
- What is NOT covered: You are responsible for 25% of the cost of a hearing aid device.

AMBULANCE
- What is covered
: Your ambulance transportation costs are fully covered between hospitals if treatment is not available anywhere in Ontario.
- What is NOT covered: You are responsible for an ambulance service co-payment charge of $45.00 for in-province ambulance services if a physician deems your ambulance service medically necessary ($240.00 co-payment if the service is deemed medically unnecessary).

Helpful links:

 

 

Visit www.ExtendedHealth.ca or call toll free 1-877-838-0020 to get a quote or apply for Extended Health care insurance.

 

get a free quote

 

IMPORTANT NOTE: The information on this web page is for illustration purposes only. Every effort has been made to ensure the accuracy of the information. Coverage details are subject to change. For complete benefits, terms, conditions, limitations, and exclusions, please contact the Ontario Ministry of Health and Long-Term Care.

 

Last revised in September 2020.

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