All about OHIP 2024: Coverage list, how to apply, renew

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Nishadh Mohammed updated on 29 October 2024

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

Citizens and residents benefit from this service, but each province works a little differently, and the OHIP, or the Ontario Health Insurance Plan, is one of the most impressive healthcare programs.

But how does the OHIP work? Are you eligible? What does it cover and what does it not? Find all this information and more in this comprehensive guide on OHIP.

OHIP Coverage: 6 Key Points

  1. OHIP provides coverage for emergency and preventative medical services but excludes certain treatments.
  2. OHIP+ offers free drug coverage for patients aged 24 and under.
  3. To apply for OHIP, visit a Service Ontario Centre with required documents.
  4. Renew your OHIP card for free in person or online, receiving the new card in 4 to 6 weeks.
  5. OHIP travel coverage has specific criteria, limited coverage for medically necessary treatment outside Canada.
  6. Consider private insurance for comprehensive coverage.

What is OHIP?

OHIP (Ontario Health Insurance Plan) is Ontario's publicly funded healthcare system that provides coverage for essential medical services. It provides coverage for a range of healthcare services, including doctor visits, hospital stays, tests, surgeries, and other essential/medically necessary treatments.

It gives essential medical coverage to eligible residents, including Canadian citizens, permanent residents, and protected persons. The main aim is to ensure that eligible individuals have access to necessary healthcare without facing financial barriers.

Administered by the Ontario Ministry of Health and Long-Term Care, it is funded through taxes paid by Ontario residents. For eligible individuals, there is no direct cost to enrol in the program and access the medical services covered.

Good to know

This guide on OHIP is current as of 2024. Please check back regularly for updates.

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 OHIP 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 Canada or not have necessary OHIP requirements or desire additional coverage, our free health insurance comparison tool is a quick way to receive a personalised quote for health insurance in just seconds.

You can also check out the necessary document list based on your residential status here on the official OHIP page.

Need coverage for services OHIP doesn’t cover? Compare private health insurance quotes here using our free tool below.

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How does OHIP know if you are out-of-country?

OHIP determines if you are out of the country based on several factors. When you travel outside of Canada, you must notify OHIP about your travel plans to maintain your coverage. It relies on the following information to determine if you are out of the country:

  • OHIP Health Card: It can track your travel status through your health card usage. When you receive medical services outside of Canada, healthcare providers may request your health card.
  • Documentation: You may be asked to provide documentation, such as travel records, to confirm your travel plans & duration overseas.
  • Notification: If you intend to be outside of Canada for more than 7 months in a 12-month period, you must notify to maintain your OHIP coverage for up to 2 years. Failure to do so can affect your coverage status.

By ensuring you fulfil the residency requirements, you can maintain your coverage while you are out of the country. Remember that OHIP provides limited coverage for medically necessary treatments received outside of Canada, so it's essential to consider supplemental travel insurance for full coverage during your travel.

What is an OHIP card?

The OHIP card, also known as the Ontario Health Insurance Plan card, is a crucial document issued by the Ontario government to eligible residents. It provides access to publicly funded healthcare services in Ontario.

Every eligible resident, including Canadian citizens, permanent residents, and protected persons, is entitled to an OHIP card. The card contains a unique 10-digit health number assigned to each individual, allowing them to receive insured health services.

With this card, residents can visit doctors, specialists, and hospitals without direct payment for most essential medical services. For the card, you must apply and provide necessary documents to prove Canadian citizenship or immigration status, residency in Ontario, and identity.

How do I get an OHIP card?

How to get an OHIP Card? Illustration Diagram
How to get an OHIP Card? Illustration Diagram

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

  1. Go in person to your nearest Service Ontario centre
  2. Complete a Registration for Ontario Health Coverage (form 0265-82) (You can download the form below)
  3. Provide the necessary, original documents proving:
    • Canadian citizenship or OHIP-eligible immigration status
    • Residency in Ontario
    • Your identity

You can download the OHIP registration form here.

Ready to apply? Visit your nearest Service Ontario Centre today.

What does OHIP cover?

OHIP provides vital medical services encompassing doctor visits, hospital care, diagnostic tests, and more, all without upfront payment. It's important to know that the coverage has limitations, much like public health care programs in other provinces like the MSP in BC. Certain treatments, prescription drugs, and non-urgent procedures may not be included.

What does OHIP cover?What does OHIP not cover?
Doctor visits
Prescription drugs provided in non-hospital settings for individuals under the age of 65
Hospital visits and stays
Alternative medicine consultation treatments, including Chinese medicine, homeopathy, and Reiki
Medical or surgical abortions
Chiropractic services
Eligible dental surgery
Many birth control methods
Eligible eye health/optometry services
Dental services provided in a dentist’s office
Ambulance services
Eyeglasses, contact lenses, laser eye surgery
Travel for health services if you live in Northern Ontario
Cosmetic procedures and many dermatology services
Blood tests (when medically necessary)
Immunizations for travel (Hepatitis A, Hepatitis B, Twinrix, HPV)
OHIP Coverage List

With a private health insurance plan most of these services uncovered by OHIP will be significantly taken care of by the provider. Not just that you could use our comparator tool below to customize your coverage and get quotes from Canada's best health insurance based on your unique needs.

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Is physiotherapy covered by OHIP?

In most cases, OHIP does not include coverage for non-essential or elective services like physiotherapy. Physiotherapy is considered an outpatient service and is typically not covered for the general population.

However, there are some exceptions where it may cover physiotherapy for specific individuals, such as those who have undergone specific surgeries or treatments. Additionally, some individuals may qualify for publicly funded physiotherapy programs through other government initiatives or assistance programs.

Good to know

How to find a physiotherapy near me covered by OHIP? To find ohip-funded physiotherapy services near you, you can use the "Find a Doctor" or "Find a Healthcare Provider" tool on the Ontario government's website. You can search for physiotherapists in your area who accept public coverage. Keep in mind that the Ontario healthcare insurance plan covers physiotherapy services only for specific medical conditions and situations, such as post-stroke rehabilitation or certain surgeries.

Does OHIP cover eye exams?

OHIP generally does not cover routine eye exams for adults. However, there are some exceptions where it may cover eye exams for specific groups of people, such as:

  1. Children: One full eye examination per year for children under the age of 20.
  2. Seniors: One full eye examination per year for seniors aged 65 and older.
  3. People with specific eye conditions: Eye exams for individuals with certain medical conditions, such as diabetes or glaucoma may be covered.

Non-covered services like comprehensive eye exams and physiotherapy sessions 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.

What is the OHIP schedule of benefits?

The OHIP Schedule of Benefits (SOB), or OHIP coverage list, is a detailed document that outlines all the medical services and procedures covered by OHIP. It includes information on what services are considered medically necessary, the types of treatments, diagnostic tests, and surgeries that are covered, as well as the payment rates for healthcare providers.

This schedule helps ensure that you receive covered services without extra charges while excluding non-covered services like cosmetic procedures. For more comprehensive details, you can refer to the official OHIP schedule or consult our guide on OHIP coverage.

Download the schedule of benefits/OHIP coverage list under each category below for 2024:

How do I renew my OHIP card?

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

To renew OHIP card online, make sure you have:

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

You should be sure to carry the temporary document with you until your new card arrives in the mail. You can renew your card online at services.gov.on.ca.

To renew your card in person, you need:

  • Current health card
  • Original document that proves Canadian citizenship or eligible immigration status.
  • 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.
  • 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

To switch to a photo health card or apply for a new Ontario health card, you will need to provide 3 original documents: Proof of Canadian citizenship or eligible immigration status, Proof of residency in Ontario with your current address, and Proof of identity with both your name and signature.

No photocopies or online print-outs accepted. Additional documents may be requested. For a full list of accepted documents, you could download the PDF below.

Meanwhile, if you have a lost OHIP card, you must report the loss to Service Ontario immediately. You can do this by calling their toll-free number at 1-888-376-5197. Obtain a new card by following the procedure mentioned above.

What does OHIP cover for seniors over 65?

All OHIP-insured seniors aged 65 years and over, automatically qualify for the Ontario Drug Benefit Program (ODB), 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.

Is ozempic covered by OHIP?

Ozempic is included in the coverage of the Ontario Drug Benefit program, catering to eligible seniors aged 65 years and above. To qualify for this coverage, individuals must possess a valid Ontario health card and have a prescription for Ozempic.

Ozempic (semaglutide) is however not covered for the general population. Ozempic is a prescription medication used to treat type 2 diabetes, and its coverage may be subject to change based on updates to the provincial drug formulary.

How is OHIP dental coverage for seniors?

OHIP dental coverage is rather limited for both the general population and seniors. OHIP does not provide comprehensive dental coverage for seniors. Basic dental services, such as cleanings, fillings, and routine check-ups, are not covered. Seniors in Ontario typically need to pay out-of-pocket for most dental services.

However, there are some exceptions. The Ontario government provides limited dental coverage for seniors who qualify for the Ontario Drug Benefit (ODB) program. Seniors who are 65 years and older and have a low income may be eligible for dental coverage under the ODB program.

Coverage is limited to specific dental services, like examinations, cleanings, and X-rays, and has certain income thresholds and co-payments. For comprehensive coverage, seniors may consider purchasing private dental insurance or exploring dental discount programs offered by various organisations.

Good to know

Is wisdom teeth removal covered by OHIP? In most cases, OHIP does not cover the removal of wisdom teeth. Wisdom teeth removal is typically considered a dental procedure rather than a medically necessary one. As a result, it falls under dental care, which is not covered by OHIP.

How is OHIP physiotherapy coverage for seniors?

OHIP does not provide comprehensive coverage for physiotherapy services for seniors. While it does cover some physiotherapy services for certain medical conditions, the coverage is limited and typically applies to specific populations, such as those receiving home care or in long-term care facilities.

For seniors who require physiotherapy services beyond what OHIP covers, they may need to pay for these services out-of-pocket or seek additional coverage through private health insurance plans or other government assistance programs.

While the additional benefits provided by the OBD program are indeed impactful, services such as home care, massage, physiotherapy and dental services that are not covered can be quite expensive and can create an uphill challenges for seniors.

However, there are many health insurances you can buy for seniors providing them significant coverage. You could find out for yourself by using our comparator tool below and get quotes for the best health insurances that suit your unique needs.

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Are hearing tests covered by OHIP?

Yes, the Ontario Health Insurance Plan covers hearing tests, but there are some specific conditions and limitations. It covers hearing tests performed by licensed audiologists or physicians when the tests are medically necessary.

Typically, it covers hearing tests for the following groups:

  1. Children (up to the age of 18 years) for diagnostic purposes.
  2. Adults (aged 19 to 64 years) if the hearing loss is sudden and unexplained or due to a recent head injury.
  3. Seniors (65 years and older) for regular hearing tests every 3 years.

It's important to note that OHIP may not cover hearing tests for adults (aged 19 to 64 years) for routine hearing evaluations or hearing tests related to hearing aids or other non-medical purposes.

Is cataract surgery covered by OHIP?

Yes, cataract surgery is covered by the Ontario Health Insurance Plan. It covers the cost of medically necessary cataract surgery, which is performed to remove clouded lenses in the eyes (cataracts) that significantly impair vision and interfere with daily activities.

To be eligible for OHIP coverage for cataract surgery, you typically need a referral from an optometrist or ophthalmologist who has determined that cataract surgery is medically necessary based on your eye health and visual impairment.

It is important to note that while it covers the basic cost of cataract surgery, there may be additional costs associated with specialized intra-ocular lens implants or other services beyond the standard procedure.

Are podiatrists covered by OHIP?

OHIP provides coverage for some services provided by podiatrists when they are deemed medically necessary. Podiatrists are specialists in the treatment of foot and ankle conditions.

The coverage for podiatry services typically includes the assessment and treatment of specific medical conditions and foot deformities that impact a person's mobility and overall health. Some common conditions that may be covered include foot infections, foot ulcers, ingrown toenails, and certain foot deformities that cause pain or difficulty walking.

However, it's important to note that not all podiatry services are covered by OHIP. Routine foot care, such as nail trimming, callus removal, and other non-medically necessary services, is generally not covered.

Is Insulin covered by OHIP?

Yes, insulin is covered by OHIP. To receive coverage for insulin, individuals typically need to have a valid Ontario health card and a prescription for insulin from a qualified healthcare provider, such as a doctor or endocrinologist. The prescription is essential to demonstrate medical necessity and justify the coverage of insulin.

It's important to note that it may cover certain types or brands of insulin, and there may be specific criteria for coverage, such as age restrictions or medical conditions. Patients should consult their healthcare provider and the OHIP guidelines to ensure they meet the eligibility criteria and understand the extent of coverage for their insulin medication.

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.

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 OHIP address change is up-to-date. Keeping your address up-to-date will also ensure that you receive any communications from the ministry about your coverage.

To update or make an OHIP address change, 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 coverage, call the OHIP phone number at 1-866-532-3161 or visit your local ServiceOntario Centre. You could also get in touch at the OHIP contact number 1-800-268-1154 for any queries on eligibility, application procedures, and any other questions related to Ontario's health insurance program.

It is advised to have your health card number and other relevant information ready when calling for efficient assistance.

How does OHIP for international students work?

International students studying in Ontario on a study permit are generally not eligible for OHIP coverage. International students staying in Ontario for six months or longer are required to have private health insurance to cover their medical needs during their stay in Canada.

Many post-secondary institutions in Ontario offer health insurance plans tailored for international students. These plans typically cover medical services, prescription drugs, emergency medical expenses, and other essential healthcare needs. Alternatively, international students can purchase private health insurance from various insurance providers.

However, other provinces may have different rules. For example, some provinces like British Columbia, Manitoba, and Quebec offer provincial health insurance for international students, but eligibility and coverage may vary.

Good to know

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

How is OHIP for new immigrants?

New immigrants to Ontario are eligible for OHIP coverage if they have permanent resident status, have applied for permanent residence, or are protected persons such as refugees. To apply, new immigrants must submit the necessary documents, including proof of Canadian citizenship or immigration status, proof of residency in Ontario, and proof of identity.

What does OHIP cover when you travel?

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 to be covered while traveling.

  • 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

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:

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

In case of emergency outpatient services, it will pay whichever of the following is less:

  • Up to $50/day
  • Amount billed by hospital

For emergency inpatient services it will pay up to:

  • $400/day for services provided in operating room, CCU, ICU and neonatal or paediatric special care unit.
  • $200/day for lower levels of care

To claim for reimbursement, you need to complete the OHIP Out of Country Claim form, providing the necessary documentation about the services received outside of Canada.

How is OHIP coverage out of province?

OHIP provides limited coverage for medical services received outside of the province of Ontario. It will typically cover medically necessary services at the rate that would be paid in Ontario for similar services. However, there may be some differences in coverage and billing procedures between provinces.

If you are an Ontario resident and need to make a claim for eligible healthcare expenses incurred while outside of the province, you can do so by using the "OHIP Out of Province Claim Form".

Other services in OHIP Coverage

Does OHIP cover therapy?

The Ontario Health Insurance Plan does not typically cover therapy provided by psychologists or other mental health professionals in a private practice setting. However, it does cover some psychiatric services provided by psychiatrists or family physicians.

To access therapy services covered by OHIP, you would generally need a referral from a physician or psychiatrist, and the services would need to be provided within a hospital or a publicly funded mental health agency.

For most other forms of therapy provided by psychologists, social workers, or other mental health professionals in private practice, public healthcare does not cover the costs. Patients often use private insurance plans, employee assistance programs (if available), or pay out-of-pocket for these services.

Does OHIP cover ADHD testing?

Yes, OHIP covers ADHD (Attention Deficit Hyperactivity Disorder) testing in Ontario. It provides coverage for medical services that are deemed medically necessary, and this includes diagnostic assessments for ADHD when recommended by a qualified healthcare professional. ADHD testing typically involves a comprehensive evaluation by a healthcare specialist, such as a pediatrician, psychiatrist, or psychologist, who specializes in assessing and diagnosing ADHD.

Does OHIP cover physiotherapy?

OHIP covers physiotherapy for specific groups, including seniors aged 65 and older, youth under 20, and individuals on Ontario Disability Support Program (ODSP) or Ontario Works. It also covers those who require physiotherapy after being hospitalized.

The coverage is for treatments deemed medically necessary to restore function, but ongoing or maintenance therapy is generally not covered. Private insurance or out-of-pocket payments may be required for others. For more details, read our full guide on OHIP physiotherapy coverage.

Are dermatologists covered by OHIP?

Dermatologists are covered by OHIP if the visit is for a medically necessary reason, such as diagnosing or treating conditions like acne, eczema, rashes, or skin cancer. You don't need a referral for medically urgent concerns, but some non-urgent cases may require one from your family doctor.

Cosmetic treatments, like removing skin tags or treating wrinkles, are not covered. For these, you'll need to pay out-of-pocket or use private insurance. For more detailed information, check out our full guide on OHIP dermatology coverage.

Is a chiropodist covered by OHIP?

The Ontario Health Insurance Plan covers the services of a chiropodist or podiatrist in certain situations. Chiropodists and podiatrists are foot specialists who diagnose and treat various foot and lower limb conditions.

It's important to note that OHIP may not cover certain services provided by a chiropodist or podiatrist that are considered routine or not medically necessary. It covers the services of a chiropodist or podiatrist if the following conditions are met:

  1. You have a valid health card.
  2. The chiropodist or podiatrist is licensed and registered to practice in Ontario.
  3. The services provided are considered medically necessary to treat foot and lower limb conditions.

Does OHIP cover weight loss programs?

It typically does not cover weight loss programs. Weight loss programs, including diet plans, gym memberships, and weight loss medications, are considered elective or lifestyle-related services, and OHIP does not provide coverage for them.

However, there may be specific cases where weight loss treatments are covered under OHIP if they are deemed medically necessary for the treatment of certain health conditions.

In case of situations wherein a person's excess weight is causing or exacerbating a medical condition, and a healthcare provider deems weight loss treatment necessary for managing that condition, then certain medical interventions may be covered.

Is varicose vein treatment covered by OHIP?

In general, OHIP does not cover the treatment of varicose veins when it is considered a cosmetic procedure. Varicose veins are dilated and twisted veins that usually appear on the legs and can cause discomfort or pain.

If varicose veins are causing significant medical issues or complications, it may cover their treatment. For example, if the varicose veins lead to venous ulcers or other serious medical conditions, the treatment may be eligible for coverage. However, each case is assessed individually based on medical necessity, and coverage is subject to approval.

Is ear wax removal covered by OHIP?

Yes, ear wax removal is covered by OHIP when it is medically necessary. If a patient is experiencing a significant buildup of earwax that is causing hearing loss or discomfort, a qualified healthcare professional, such as a family doctor or an ear, nose, and throat (ENT) specialist, may perform the procedure to remove the excess earwax.

However, it's essential to note that not all instances of ear wax removal are covered. If the procedure is considered routine and not medically necessary, it may not be covered. Routine ear wax removal, such as for maintenance of ear hygiene, is typically not covered.

Is skin tag removal covered by OHIP?

In most cases, skin tag removal is not covered by OHIP. Skin tag removal is considered a cosmetic procedure and is generally not considered medically necessary. As a result, individuals seeking to have skin tags removed for cosmetic reasons may need to pay for the procedure out-of-pocket.

However, there could be exceptions in certain situations where skin tag removal is deemed medically necessary. For instance, if a skin tag is causing irritation, bleeding, or interfering with daily activities, a healthcare professional may consider it medically necessary to remove the skin tag. In such cases, OHIP might cover the removal procedure.

Are vasectomies covered by OHIP?

Yes, vasectomies are covered by OHIP in Ontario. It covers the cost of a vasectomy as a permanent form of birth control for individuals who meet the eligibility criteria. To be eligible for OHIP-covered vasectomy, you must be:

  1. A resident of Ontario with a valid Ontario health card.
  2. 18 years of age or older.

It is important to note that while it covers the cost of the vasectomy procedure itself, there may be additional costs for any pre-vasectomy consultations or post-vasectomy follow-up visits. These additional costs may vary depending on the healthcare provider.

Good to know

Is abortion covered by OHIP? Yes, abortion is covered. OHIP covers the cost of medically necessary abortion services, including both medical and surgical abortions. This means that individuals with a valid Ontario health card can access abortion services at no direct cost to them.

FAQs on OHIP Coverage

What does the OHIP stand for?

OHIP stands for the Ontario Health Insurance Plan. It is the government-run health insurance program that covers medically necessary health care services for residents of Ontario, such as visits to the doctor, hospital stays, and certain tests and procedures. All eligible residents can apply for OHIP coverage.

How much does OHIP cost?

OHIP is free for all eligible Ontario residents. There are no monthly premiums or costs to enroll. However, some medical services not covered by OHIP, such as dental care, prescription drugs, or vision care for adults, may require out-of-pocket expenses or private insurance.

Are dermatologists covered by OHIP?

Yes, dermatologists are covered by OHIP if the visit is for a medically necessary reason, such as diagnosing or treating skin conditions like acne, eczema, or skin cancer. However, OHIP does not cover cosmetic treatments, like removing moles for aesthetic reasons or treating wrinkles.

Are you covered by OHIP after 25?

Yes, you are still covered by OHIP after age 25 for medically necessary services. However, if you were receiving coverage for prescription medications under the Ontario Drug Benefit (ODB) plan as a dependent, this benefit ends at 25, and you may need to explore private insurance for medication coverage. Your regular OHIP benefits, like doctor visits and hospital care, continue without age restrictions.

How many physio sessions does OHIP cover?

OHIP covers physiotherapy sessions for eligible individuals (seniors, youth, and those on certain social assistance programs), but the number of sessions depends on the assessment by a qualified healthcare provider. Typically, the coverage is for necessary treatments to restore function, but ongoing or maintenance therapy may not be covered.

How to become an Ontario resident from another province?

To become an Ontario resident from another province, you must move to Ontario and make it your primary home. You need to live in the province for at least 153 days in a 12-month period. Then, apply for OHIP at ServiceOntario with documents proving your identity, residency, and status. OHIP coverage begins after a 3-month waiting period.

Who is eligible for OHIP?

To be eligible for OHIP, you must be a resident of Ontario. This means you must make Ontario your primary home and be physically present in the province for at least 153 days in any 12-month period. You also need to meet certain criteria such as being a Canadian citizen, permanent resident, or holding an eligible immigration status.

Does OHIP cover surgery?

Yes, OHIP covers most medically necessary surgeries, including those performed in hospitals. This includes services such as consultations, hospital stays, and follow-up care related to the surgery. However, elective or cosmetic surgeries not deemed medically necessary are not covered by OHIP.

What does OHIP not cover?

OHIP does not cover services that are not deemed medically necessary, such as cosmetic surgeries, prescription medications (outside of hospital stays), dental care, routine eye exams for those aged 20 to 64, and certain types of therapy, like physiotherapy or chiropractic care, unless specific conditions are met. For these, private insurance or out-of-pocket payment is required.

Does OHIP cover physiotherapy?

OHIP covers physiotherapy only for specific groups: seniors aged 65 and older, youth under 20, and those who are hospitalized or receiving care through specific programs. Additionally, individuals on the Ontario Disability Support Program (ODSP) or Ontario Works may qualify. For others, physiotherapy services generally require private insurance or out-of-pocket payment.

IS skin tag removal covered by OHIP?

Skin tag removal is only covered by OHIP if it is deemed medically necessary, such as when the skin tag causes pain, irritation, or potential health risks. If the removal is for cosmetic reasons, it is not covered by OHIP, and you would need to pay out-of-pocket or seek private insurance for coverage.

Read more about OHIP

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Nishadh Mohammed
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Nishadh Mohammed is a seasoned news editor and financial writer, working with HelloSafe since May 2023. Nishadh has developed expertise in financial markets, insurance, and investment products, with a deep understanding of the Canadian financial landscape. He has honed his SEO skills and content marketing strategies while writing for Canadian publishing houses. Armed with a master's in Business Analytics and extensive journalistic experience, Nishadh uniquely combines data proficiency and thorough research to deliver comprehensive and accessible information.

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

author-profile-picture Nishadh Mohammed 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.

author-profile-picture Nishadh Mohammed 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?

author-profile-picture Nishadh Mohammed 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?

author-profile-picture Nishadh Mohammed 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?

author-profile-picture Nishadh Mohammed 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 ..

author-profile-picture Nishadh Mohammed 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?

author-profile-picture Nishadh Mohammed 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

author-profile-picture Nishadh Mohammed 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.

author-profile-picture Nishadh Mohammed 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