Is it covered by OHIP?

James Rodriguez James Rodriguez updated on 2022-05-10

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If you need to know how much OHIP covers for medical services versus what you may be responsible for, the tool at the top of this page can help. Just use the search bar to select the treatment you are seeking. It will let you know how much OHIP will cover and how much will be left for you or your private insurance to pay.

As you likely already know, Canada offers its citizens universal healthcare. However, depending on what province you live in, your coverage can vary greatly. Some provinces offer broader coverage for free of charge while others offer only medically-necessary treatments. In Ontario there are some gaps in coverage. In these cases you will need to pay some costs out of your pocket or through your private supplemental health insurance. 

Did you know if you are a resident of Ontario, you are eligible Ontario Health Insurance Plan? There can be some confusion about what OHIP covers and what it does not. 

Our guide will go over what OHIP covers, how much it covers, how to apply for OHIP and how to shop for the best private insurance.  

What is OHIP?

If you are a resident of Ontario, you may be eligible for the government-run health plan known as the Ontario Health Insurance Plan. This is commonly referred to just as OHIP. OHIP is paid through and funded by your taxes.

OHIP pays for a variety of healthcare services; however, these services must be deemed medically necessary. Services include visits to your family doctor and specialists. Additionally most basic and emergency health care services are covered by OHIP.

To learn more see our deep dive into OHIP and how it works.

What does OHIP cover?

OHIP covers medically-necessary treatment. The tool at the top of this page will also let you check if something is covered and for how much. We have compiled a table to break down exactly what is covered under OHIP.

ServicesWhat is covered:
DoctorsWhether you visit your doctor, or if you see one in a walk-in clinic, OHIP covers the full cost of your services – as long as they’re medically necessary.
Hospital visits and staysIf you need to go to the hospital, OHIP covers:
  • doctor and nursing services
  • diagnostic testing (blood work, x-rays)
  • medications while inpatient (once a patient is discharged, prescribed medications are not covered)
  • accommodation and meals if you have to stay

Note: 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
Dental surgery in hospitalSome dental surgeries need to be performed in a hospital because they are complex and/or you have another medical condition that needs monitoring during the procedure.
OHIP covers in-hospital dental surgeries such as:
  • fracture repair
  • tumor removal
  • reconstructive surgeries
  • medically necessary tooth removal (prior approval by OHIP is required)
Optometry (eye-health services)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
  • 65 years and older

If you are 20 to 64 years old, and you have a qualifying 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. Covered conditions are:
  • diabetes mellitus
  • glaucoma
  • cataract
  • retinal disease
  • amblyopia
  • visual field defects
  • corneal disease

OHIP may also cover a major eye exam if it has been requested for a specific reason by your doctor (they will need to give you a referral form).
Podiatry (foot-health services)OHIP covers between $7 and 16 per visit to a registered podiatrist (up to $135 per patient per year). It also covers $30 for x-rays. You will need to pay for the remainder of the cost of each visit.
Ambulance servicesIf you need an ambulance for a medical emergency, OHIP covers part or all the costs.
Travel for northern-Ontario residentsIf you have to travel long distances for specialized medical care, OHIP may help pay for your travel and accommodation through the Northern Health Travel Grant.
Abortion servicesOHIP covers the cost of:
  • surgical abortions that take place in a hospital or clinic
  • Mifegymiso (a pill that induces abortion in early pregnancy) if you have a prescription from your doctor
OHIP covered medical treatments and procedures

What is not covered under OHIP?

While OHIP covers many basic medical services, there are also services not covered that could leave you with a costly bill. Services excluded under OHIP are

  • Prescription drugs provided in non-hospital settings (e.g. antibiotics prescribed by your family doctor)
  • Dental services provided in a dentist’s office
  • Eyeglasses, contact lenses
  • Laser eye surgery
  • Cosmetic surgery

We highly recommend taking out a private health insurance plan for extra coverage to protect you against large medical bills and assure your ability to pay for treatments, prescription drugs and dental care.

You can compare the best health insurance in Ontario to find a plan that works for you.

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Does OHIP cover physiotherapy?

Physiotherapy services received at government-funded physiotherapy clinics are covered through OHIP. A physiotherapist will provide assessment and treatment services, including rehabilitation following an injury or hospital stay.

However, not everyone individual is eligible for physiotherapy cover under OHIP.

With a valid OHIP card you can receive government-funded physiotherapy if you are:

  • 19 years or under
  • 65 years or older
  • any age after an overnight hospital stay (within the last 12 months) for a condition requiring physiotherapy
  • a recipient of the Ontario Works or the Ontario Disability Support Program (any age, OHIP card not required)

A private health insurance plan can cover physiotherapy for any age. Having good health insurance coverage is important. You never know when an injury may occur requiring physiotherapy. 

Does OHIP cover eye exams and prescription lenses?

Annual eye exams are fully covered by OHIP for children (19 or younger) and for seniors (65 or older). If you are an adult between the ages of 20 and 64 years old, routine eye exams are not covered by OHIP and will need to be paid out of pocket or through private insurance. 

Note that adults with specific eye conditions requiring regular monitoring are covered for an eye exam every 12 months. Additional follow-up appointments related to that condition are also covered. 

Prescription lenses and contacts are not covered under OHIP and need to be purchased out of your own pocket. Private health insurance can help you to defray the costs. 

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Is therapy covered by OHIP?

Therapy is covered by OHIP is treatment is done by a medical doctor. If your family doctor has training in psychotherapy, then treatment will likely be covered. However, most family doctors will refer you to a psychiatrist or specific mental health provider. If you work with a registered psychologist, registered social worker or registered psychotherapist, they may also be free if they work in government-funded hospitals or clinics.

If you do not have a family doctor or if they do not offer psychotherapy services, then it is unlikely OHIP will cover the service. This means that you will have to pay for any treatment you receive from a registered psychologist, registered social worker or registered psychotherapist who is not part of a government-funded hospital. 

If you have an employer-provided or private health insurance plan, it may cover part or all of your expenses for therapy.

Am I eligible for OHIP?

To be eligible for OHIP, you must meet all of the minimum qualifications listed below plus at least one of the additional requirements.

The minimum qualifications you must meet in order to qualify are:

  • Be physically in Ontario for 153 days in any 12 months
  • Be physically in Ontario for at least 153 days of the first 183 days immediately after you began living in the province
  • Make Ontario your primary residence

There are several other additional requirements you must meet to be eligible to apply for OHIP. See our in-depth OHIP guide for more information. 

How do I apply for OHIP?

If you fulfill the eligibility requirements for OHIP, you can apply in person by visiting a ServiceOntario Centre and bringing your completed Registration for Ontario Health Insurance Coverage form.

You will also be responsible for bringing along several types of original documentation (photocopies will not be accepted) to submit with your application. These include proof of

  1. Identity
  2. Citizenship or residency in Ontario
  3. Your address in Ontario

See a complete OHIP accepted documents list.

Do I need an OHIP card?

Yes, you need an OHIP card to access public health services. Once you have applied to OHIP and been accepted, you will receive your Ontario health card. Your health card will prove that you are covered by OHIP. You will need to show it every time you see your doctor, go to the emergency room or undergo medical tests or surgery. 

How does private health insurance work in Ontario?

Similar to car insurance or life insurance, with private insurance you pay a monthly premium to an insurance company in exchange for extra coverage for certain health care costs. Private health care covers a broader range of services and typically has high limits on the amount they will cover. Even if you qualify for OHIP, you can use private insurance to pay for some services that OHIP does not cover.

If you want coverage beyond the scope of what OHIP covers, private health insurance is right for you. Check out our comparison tool to see what options are available to you.

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