What is OHIP? All about the Ontario Health Insurance Plan

James James updated on 30 March 2023

Did you know that public healthcare systems pay for around 70% of health care costs in Canada? The country's universal public health system is a major accomplishment.

Citizens and residents benefit from this service, but each province and territory works a little differently. Ontario's public system is called OHIP, or the Ontario Health Insurance plan.

This guide goes into detail about OHIP. Learn about eligibility, how to apply, what is covered and more.

What is OHIP?

OHIP is Ontario's public health insurance plan. It covers many emergency and preventative medical care costs. While many people are aware of the basics covered by OHIP, such as doctor visits and emergency health care, costs that are not covered can sometimes be a grey area and cause some misunderstanding.

Services OHIP covers part or all of:

  • Doctor visits
  • Hospital visits and stays
  • Medical or surgical abortions
  • Eligible dental surgery
  • Eligible eye-health/optometry services
  • Ambulance services
  • Travel for health services if you live in Northern Ontario

If you need coverage for one of the services or treatments not covered by OHIP, you could benefit from a supplemental insurance plan to ensure you have the coverage you need.

Services NOT covered by OHIP include:

  • Prescription drugs provided in non-hospital settings for individuals under the age of 65
  • Alternative medicine consultation treatments, including Chinese medicine, homeopathy and Reiki 
  • Chiropractic services
  • Many birth control methods
  • Dental services provided in a dentist’s office
  • Eyeglasses, contact lenses
  • Laser eye surgery
  • Cosmetic procedures and many dermatology services
  • Immunizations for travel (Hepatitis A, Hepatitis B, Twinrix, HPV)

Non-covered services can be expensive and come as an unpleasant surprise when you are least able to deal with them. We highly recommend getting a private insurance plan.

It can help you access better care when you need it while saving you from large, unexpected expenses.

How do I apply for OHIP?

To apply for OHIP you must first book an appointment with the Service Ontario Centre.

For your appointment, you must bring the following three documents that prove:

1. You are a citizen or eligible resident of Ontario
2. You live in Ontario
3. You are not using another person’s identity

What is OHIP Plus/OHIP+?

OHIP+ provides drug products for patients 24 years and under who are not covered by a private plan, at no cost. Those who are eligible for OHIP Plus do not need to enroll. All they need is a health card number and a valid prescription for an eligible medication.


Common eligible medications include:

  • Antibiotics to treat infections
  • Inhalers for asthma
  • Medications for diabetics such as insulin and diabetes test strips
  • Medications to treat arthritis, epilepsy and other chronic conditions
  • Medication/drugs for attention deficit disorder (ADHD)
  • Medications/drugs to treat childhood cancers or other rare conditions
  • Epinephrine injectable products
  • Medications/drugs to treat mental health conditions
  • Help to quit smoking: This can include up to a year of pharmacist-assisted counselling and medication for those who are 18 years or older

Medication that is not on this list may be eligible for reimbursement under private health insurance plans.

Good to know

See our guide on private healthcare insurance in Ontario

How do I get an OHIP card?

To get an OHIP card, you must apply by submitting an application with the appropriate documents. To apply, follow these steps:

  1. Go in person to your nearest ServiceOntario centre
  2. Complete a Registration for Ontario Health Coverage (form 0265-82)
  3. Provide the necessary, original documents proving:
    • Canadian citizenship or OHIP-eligible immigration status
    • residency in Ontario
    • your identity
  4. Ontario residents who are eligible for OHIP are assigned a unique 10-digit health number for the purpose of obtaining insured health services.
Registration for Ontario Health Insurance Coverage
Registration for Ontario Health Insurance Coverage
Download

Good to know

Want to know more about Ontario's Health's OHIP card? See our OHIP card guide here.

How do I renew my OHIP card?

You can renew your OHIP card free of charge, in person or online. After submitting the appropriate documents for your renewal, your card will be mailed to you in approximately 4 to 6 weeks.

To renew online, make sure you have:

  • Your most recent health card
  • Your current driver’s licence
  • A printer to download and print your temporary documents.

Having a printed version of your temporary documents is important to help prove that you have renewed your card online. You should be sure to carry the temporary document with you until your new card arrives in the mail.

You can renew your OHIP card online here.

To renew your card in person, make sure you bring:

  • You current health card
  • An original document that proves your Canadian citizenship or OHIP-eligible immigration status.
  • An original printed or digital proof of residency in Ontario or if your Canadian Citizenship or immigration status has changed since receiving your last health card, bring your most recent citizen or immigration document.
  • An original document that confirms your identity
  • If you are applying under your married name for the first time, you will need to bring a marriage certificate
  • The health card renewal form below
OHIP Health Care Renewal
OHIP Health Care Renewal

For a full list of accepted documents see below:

Ontario Health Insurance Plan (OHIP) Document List
Ontario Health Insurance Plan (OHIP) Document List

How much does OHIP cost?

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

OHIP covers part or all of:

  • Doctor visits
  • Hospital visits and stays
  • Medical or surgical abortions
  • Eligible dental surgery
  • Eligible eye-health/optometry services
  • Ambulance services
  • Travel for health services if you live in Northern Ontario

If you are in need of additional coverage not seen here on this list, a supplemental plan could ensure you are provided with full coverage for the services you need. For a personalized quote in just seconds, try our free health insurance comparison tool.

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Who is eligible for OHIP?

For OHIP eligibility, you must be included in one of the following categories:

  • You are a Canadian citizen, permanent resident or are registered as an Indian under the Indian Act.
  • You have submitted an application for permanent residence in Canada, and Citizenship and immigration in Canada has confirmed that you meet the eligibility requirements to apply for permanent residence.
  • You are a “protected person” such as a refugee or a person in need of protection.

Additionally, you must be in Ontario for at least 153 days of the first 183 days immediately following the date you established residence in Ontario. You also need to be sure you are in Ontario for at least 153 days in any 12-month period.

You deserve quality healthcare coverage that fits your needs. Should you for any reason find yourself ineligible for OHIP or desire additional coverage, our free health insurance comparison tool is a quick way to receive a personalized quote for health insurance in just seconds.

What does OHIP cover for seniors?

All OHIP-insured seniors aged 65 years and over, automatically qualify for the Ontario Drug Benefit Program, commonly referred to as the ODB program. This program provides seniors with expanded coverage to ensure they have access to the healthcare they need.

Additional benefits for seniors include:

  • Coverage for visits to the optometrist every two years
  • Coverage for most prescription medications

Seniors may see significant changes in their ability to afford supplemental health insurance after retiring due to factors like a loss of employer-sponsored benefits and higher healthcare costs due to the increased risk of chronic illnesses. This can make it difficult for seniors to cover their medical expenses.

While the additional benefits provided by the OBD program are indeed impactful, services such as home care, massage, physiotherapy and dental services are not always covered. This can create challenges for seniors.

For this reason, seniors could benefit from a supplemental plan to maximize coverage and give them the support they need. Our anonymous health insurance comparison tool offers an easy way to compare quotes in just seconds.

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

Ontario residents without OHIP medical coverage can expect to pay anywhere from $50 to $150 for a doctor visit depending on what type of service is needed. Foreign visitors can expect to pay more, while residents of Ontario may pay less. Additional factors such as the day of the week or whether or not you are receiving treatment on a holiday may also contribute to the cost.

What is OHIP’s schedule of benefits?

Commonly referred to as the SOB, the OHIP schedule of benefits lists every medical service that doctors are able to bill the Ontario government for. Each medical service is given a specific code, with a fixed dollar amount that the government has agreed to pay the doctor for that service.

Download the OHIP schedule of benefits below:

OHIP Schedule of Benefits
Download

How do I change my address with OHIP?

If you are moving/or have moved, by law, you are required to inform the Ministry of Health and long-term care of your change of address. In order to keep your OHIP coverage active, it is important that you make sure your address is up-to-date. Keeping your address up-to-date will also ensure that you receive any communications from the ministry about your OHIP coverage.

To update or change your address with OHIP, may use one of the following options:

  • By mail: Send a letter or visit your local ServiceOntario centre. You must include your name, health number, telephone number, current address and new address including postal code.
  • In-person: Visit the centre nearest you
  • Online: To update or change your address online, visit: ServiceOntario.ca/addresschange

How do I contact OHIP?

For questions regarding your OHIP coverage, call the OHIP phone number at 1-866-532-3161 or visit your local ServiceOntario Centre.

What does OHIP cover when you travel?

You must qualify in order to receive coverage with OHIP while travelling. To qualify, you should have a valid OHIP health card and meet all of the physical presence and primary place requirements under the Health Insurance Act and its Regulations.

  • Is not expired
  • Has your correct personal information on it
  • Has your current and up-to-date address

To receive coverage for your medical service or treatment while travelling, it must be:

  • Medically necessary
  • Provided at a licensed hospital or licensed health facility
  • For an illness, disease, condition or injury that is acute and unexpected, not pre-existing and requiring immediate treatment

If you are qualified, and your treatment or service is eligible to receive coverage, it is important to remember that OHIP will only cover a limited amount of costs for treatment and services while travelling outside of Canada.

For doctor services, OHIP will pay whichever of the following is less:

  • The actual amount billed by the doctor(s) who treated you outside of Canada
  • The rates listed in and paid to Ontario physicians in the OHIP schedule of benefits for physician services.

For emergency outpatient services, OHIP will pay whichever of the following is less:

  • Up to $50 per day
  • The amount billed by the hospital

For emergency inpatient services OHIP will pay up to:

  • $400 per day for services provided in the operating room, coronary care unit, intensive care unit and neonatal or pediatric special care unit.
  • $200 per day for lower levels of care

How does OHIP know if you are out of the province?

You must notify OHIP about your travel plans in order to keep your coverage active while you are out of the province. If you intend to be outside of Canada for more than seven months in any 12-month period, you can keep your OHIP coverage for up to two years.

To make sure your coverage remains active during that time you must

  • Have a valid health card
  • Make Ontario your primary home
  • Be in Ontario for at least 153 days a year in each of the two years immediately before you leave the country

Travel tip: Before you leave, be sure to take the following items with you to the nearest ServiceOntario to make sure your coverage stays active during the duration of your time out of the Province.

  • your health card
  • proof of residency (e.g. mortgage, lease or rental agreement, property tax bill, valid driver’s licence)
  • proof of employment or charity work (e.g. contract/letter from employer/charity)

You may also want to consider supplemental travel insurance to maintain full coverage for any medical costs you might encounter while you are away.

Read more about OHIP:

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9 comments
Mollie
on

My husband was a family doctor, who recently passed away. OHIP feels they over paid him and want money back. However no where on the forms is there any number, web address or any other information to help me address this situation . They are also charging me interest monthly on monies owed . I need a number of someone who can help me resolve this issue

James James Our expert

Hi Mollie,
For this kind of situation, you might want to request the help of a professional, such as a lawyer. Someone with law expertise should be able to look at your situation in detail and explain to you what your options are.

Have a nice day,
The HelloSafe team

Mario A.
on

I have just been advised from a specialist that I will require a Liver Fibre Scan. I’ve been told this procedure is not covered by OHIP (why?). I have been told the procedure will cost $90. I am over 67. I am surprised by the non coverage. Please be kind enough to explain why a procedure (test) necessary for a responsible diagnosis is not covered.

James James Our expert

Hi Mario,
Some medical interventions are not covered by OHIP yet because they are new or because they represent an alternative for another kind of procedure. Fibroscans for example, are still sometimes considered alternatives to biopsies, and thus are not covered.

Have a nice day,
The HelloSafe team

Ben A.
on

My 83 year old mother is a U. S. citizen and needs knee surgery. Can the be done in Ontario and billed to her U.S. health insurance?

James James Our expert

Hi Ben,
It depends on the insurance policy of your mother. You can read the detail of her insurance contract to find out whether or not she is covered when in a foreign country.

Have a nice day,
The HelloSafe

Gurdeep K.
on

Hello, I am senior and permanent resident of Canada. I have recently came to Canada and became PR and do not have any income.
I want to know if I have to pay any share when I buy medicines prescribed by the family doctor and what is the process.
Is there a phone number that I can call and know the details?

James James Our expert

Hi Gurdeep,
OHIP covers a large number of medications.
If you want to check if a particular drug is covered or not, you can use the medication coverage search engine directly on OHIP's website.

Have a nice day,
The HelloSafe team

Kim
on

My 85 year old mother who lives in Ontario is traveling to Manitoba? What will OHIP cover for her if she has a medical issue while she is in Winnipeg?

James James Our expert

Hi Kim,
When moving temporarily to another province, physician services and services provided in a public hospital are covered, as soon as they are medically necessary. Other services that are normally covered by OHIP, such as ambulance services or prescription drugs (given outside an hospital) are not covered.
If your mother will be away from Ontario for more than seven months, she needs to confirm the coverage before leaving, by calling ServiceOntario.

Have a nice day,
The HelloSafe team

Anthony A.
on

I need to reapply .. I haven’t been to Ontario since 1986 .. I’m presently in the USA but plan to return home ..

James James Our expert

Hi Anthony,
You can apply for OHIP directly on the government of Ontario website.

Have a nice day,
The HelloSafe Team

Nancy
on

Why do some seniors not pay the $100 every year in August?

James James Our expert

Hi Nancy,
These 100 $ are called the "deductible" of prescription drugs coverage. Depending on their income, some seniors pay it and some do not.
If you are a single senior, you pay the deductible if you earn more than 22,200 $ a year.
If you are a senior couple, you pay the deductible if your combined income is over 37,100 $ a year.

Have a nice day,
The HelloSafe team

Pam
on

Hello, does OHIP cover part of the cost for Dental work such as braces, visaline for low income families. I'm not working.thx

James James Our expert

Hi Pam,
Unfortunately, OHIP only covers heavy dental surgeries such as correction of birth defects, jaw diseases, or face damage resulting of an accident.
Braces and Invisalign are not covered.

Have a nice day,
The HelloSafe Team

Jeff S.
on

Can you advise me as too which insurance coverage I should get?
I need additional coverage, to cover either benign or malignant tumor removal.

James James Our expert

Hi Jeff,
You might want to check out our Health Insurance comparator to find the perfect plan for you.

Have a nice day,
The HelloSafe Team