What is OHIP? All about the Ontario Health Insurance Plan in 2024

Did you know that public healthcare systems like the OHIP 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 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.

What is OHIP?

OHIP stands for the "Ontario Health Insurance Plan," the publicly funded health insurance program in Ontario. It provides coverage for a range of healthcare services, including doctor visits, hospital stays, tests, surgeries, and other essential 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 medical services covered.

What is 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?

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

What is OHIP coverage?

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?

• 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
• Blood tests (when medically necessary)

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.

What does OHIP not cover?

• 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
• Immunisations for travel (Hepatitis A, Hepatitis B, Twinrix, HPV)

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 customise your coverage and get quotes from Canada's best health insurances 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.

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 OHIP schedule of benefits?

Commonly referred to as the SOB, the OHIP schedule of benefits lists every medical service that doctors can 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.

This schedule serves as a reference for OHIP billing purposes and helps ensure a standardised system for healthcare billing and reimbursement in Ontario. Medical practitioners use the Schedule of Benefits to determine the appropriate OHIP billing codes and associated fees for the services they provide to patients.

Download the schedule of benefits below:

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.

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.

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 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.

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".

How is OHIP coverage for other common services?

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.

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 for the treatment of 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.

Are services by dermatologist covered by OHIP?

OHIP does cover some dermatology services, but the coverage is limited and specific to certain medical conditions. It typically covers dermatology services provided by a dermatologist for medically necessary procedures, such as the diagnosis and treatment of skin diseases or conditions that require medical attention.

Examples of dermatology services that may be covered include the diagnosis and treatment of skin conditions like psoriasis, eczema, skin infections, skin cancer, and other medically necessary procedures.

However, cosmetic procedures or treatments that are not deemed medically necessary, such as Botox injections for cosmetic purposes, generally would not be covered.

Is varicose veins 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.

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