What Does OHIP Cover?

Posted on March 7, 2010 and updated December 4, 2018 in Canadian Life Insurance Companies, Critical Illness, Group Benefits, Life Insurance Canada News, Non-medical, Term Insurance 4 min read
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Every Ontario resident is entitled to OHIP for their medical care, but Canada’s “Free Healthcare” that so many envy doesn’t cover everything.

The following is a simple snapshot of the Health, Dental and paramedical services it does cover: (For more specifics you can contact them at 1.800.268.1154 www.gov.on.ca)

Medical Supplies: Some assistance through the Assistive Devices Program (ADP) for a variety of devices, including electric and manual wheelchairs to a maximum of 80%. The full amount of an insulin pump is covered every five years, as of September 1, 2008. Insulin pump supplies are covered annually up to a maximum of $2,400.

Podiatry: When performed in an approved facility, you get $135 maximum (plus $30 X-Ray) per benefit year ($16.40 for the initial visit and $11.45 for every subsequent visit).

Travel: In-patient services are coverd up to $400 a day and out-patient services are covered up to $50 a day for emergencies only.

Nursing and Home Care: Based on needs.

Hearing Aids: $500 per aid every three years.

Chiropractic: Not covered.

Physiotherapy: Allowed in OHIP approved clinics and long-term care facilities for ages 19 and under, as well as 65 and over to a maximum of $12.20 per visit for 100 visits a year. All others a maximum of $12.20 per visits for up to 50 visits a year if required due to overnight hospitalizations.

Osteopathy: $155 max benefit per year: $12 for initial visit, $9.50 for every subsequent visit and $25 for X-ray. Note: Very few OHIP approved practioners.

Speech Therapy: Only when performed in hospitals.

Dental: Only surgical procedures performed in hospitals.

Eye examination: One exam every 12 months for ages 19 and under, as well as 65 and over. Those receiving social assistance or with an approved medical condition are also eligible for an eye exam every 12 months.

Intraocular Lens: Standard hard/rigid and soft/foldable IOL’s are covered once per lifetime per eye.

Ambulance: $45 patient co-pay.

Accommodation: A standard ward = no charge. The daily rate for semi-private is $110 to $235 and a daily rate for a private room costs $200 to $325 (not legislated).

Lab and Diagnostic Tests: See OHIP list of eligible tests. PSA tests are covered as of January 1, 2009.

Prescription Drugs: The Ontario Drug Benefit Program covers seniors and social assistance recipients. Low income recepients and seniors are responsible for a $2 co-pay per prescription. Higher income seniors must satisfy a $100 deductable, followed by a co-payment of up to $6.11 per perscription. The Trillium Drug Program is available to all Ontario residents covered by OHIP with high drug costs in relation to your income. Eligibility requires that private insurance doesn’t cover 100% of their drug costs. Approved applicants are responsible for an income based deductable, in addition to a co-payment of up to $2 per perscription. ODB drugs can fall under the full benefit or be Limited Use Drugs, where the patient must meet specific medical criteria. As of January 2008, there is a new drug status called ‘Conditional Listings’. Drugs with this status are considered under the full benefit. In some cases, drugs not covered at all may be considered based on need as part of a clinical review. The benefit year falls between August 1 and July 31. The Special Drugs Program provides certain drugs at no cost to patients meeting certain clinical criteria. It is approved by a designated centre/physican for the drug. Conditions covered maybe Cystic Fibrosis, Thalassemia, HIV, end stage renal disease, growth hormone failure Schizophrenia, Gaucher’s Disease and some transplant patients. Cancer Care Ontario provides some cancer treatment drugs to patients meeting specific criteria.

Source: GreenShield Canada

Individual health and dental insurance is available to protect you and your family from items not covered Health and Dental Insurance. We also offer company benefit plans for small, mid size and large businesses – you can get more details here or a Group Insurance Quote here.

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Jane
Jane

Does OHIP cover Breast Reduction Surgery?

Syed Raza
Syed Raza

Hi Jane, Thank you for your question. In some cases this procedure can be covered by OHIP. Here is a good answer from Dr. Mitchell Brown on his website: Dr. Brown answers: “A breast reduction procedure may be performed for functional reasons (back pain, neck pain, shoulder grooving, rashes under the breast) or for non functional/aesthetic reasons including personal desire for smaller or lifted breasts, discomfort with exercise, problems with fitting clothes or an upper body that is out of proportion with the rest of the body. OHIP will consider coverage on a case by case basis when the indications… Read more »

Ron
Ron

Syed. Thank you for the information. Much appreciated.

Ron
Ron

Does OHIP cover any Medical cannabis and supplies which is physician approved with documentation for seniors. If anyone could direct me to any information would be appreciated

Syed Raza
Syed Raza

Hi Ron, Thanks for the question. Currently, medical marijuana and devices such as vapourizers are not covered under basic provincial health plans. It’s worth noting though, as of a recent change of policy medical marijuana now qualifies as a medical expense under CRA guidelines.

chrissie
chrissie

Does ohip cover a hysterectomy? Three kids later while on birth control and using condoms. I also have cysts on my ovaries.

Anna Sun
Anna Sun

Hi Missy,

I’m sorry to hear of the discomfort you are having. In regards to OHIP, you can view the link I have posted as it will contain the questions you are seeking: http://www.health.gov.on.ca/en/public/publications/pub_ohip.aspx

missy
missy

I have 3 children. After my third child I lost a lot of my breast and they went oddly shaped and now doesn’t fit properly in any of my existing bras. Esp when I lay down I now have to take the bra off due to extreme discomfort. Not only has this affected me physically but has emotionally and mentally. Is there anywhere in the system of ohip that I can find any coverage for breast implants? I would appreciate any advice in this embarrassing issue. Thank you kindly in advance.

pam
pam

If have a lump 5 cm, chemo happening, Dr recommend a lumpectomy but I want a double mastedctomy, with no family background of problems, will ohip cover a double mastectomy.

Charlie
Charlie

Wondering if a psychiatrist is covered after having brain surgeries?

Anna Sun
Anna Sun

Hi Charlie,

Psychiatric care is covered under OHIP in Ontario provided you get a referral by your family physician. Psychiatrists’ fees are covered by provincial and territorial health plans. If you want to get more information, please view this website: http://www.cmha.ca/

DIANE
DIANE

Is footcare done by a General Practioner (MD) covered by OHIP?

Sara
Sara

I am diabetic and can’t seem to lose any weight in my mid section I always look pregnant even though I don’t have my overuse anymore does OHIP cover tummy/surgery to help with lose this

Anna Sun
Anna Sun

Hi Sara,

Thanks for your comment! Unfortunately, OHIP does not cover services that are not medically required, such as cosmetic surgery.

Kerry
Kerry

Does OHIP cover private rehab centres for alcohol abuse and addiction or only the public ones?

p hagan
p hagan

does OHIP cover airlifting a person from one hospital to another thanks

Syed Raza
Syed Raza

Hi,

That’s a great question. I’ve looked into it a bit and cannot find any specific coverage for ‘hospital to hospital’. Your best bet is to contact the Emergency Health Services Branch or Ornge (formerly the Ontario Air Ambulance Services Co.) which is the Ontario Air Ambulance Program service provider. They should be able to tell you what is covered in specific situations.

Best of Luck!

zafar
zafar

My mother needs her hearing aid to be replace by new because the current one is no more working.she is above 70years and they are saying the original cost is $1500 and my mom has to pay $1000
Is there any way she can get some discount

Syed Raza
Syed Raza

Hi Zafar,

You can contact the Ontario Ministry of Health and Long-term care to see if your mother is eligible for the Assistive Devices Program for hearing aid funding.

Hope that helps, good luck!

Syed

Kristin Molnar
Kristin Molnar

Is gastric bypass covered?

Larry
Larry

Does OHIP cover the cost of hearing tests?

LSM Insurance
LSM Insurance

Hi Larry, Behind the ear hearing aids are covered as well in the ear haring aids. Things like batteries are not covered

Sue
Sue

Many thanks Syed….will do as you suggest.

I find it very dishearting when a professional advises you that you wont have to pay for the medication due to OHIP. You then get discharged and there is no medication available because everywhere is closed. We did find one open a Rexall however they wouldnt fulfill one part of the prescription without the other ( and you guessed it, it was a specialised drug they didnt hold lol) You really couldnt make this up.

Sue
Sue

Hi, I’ve just been discharged from hospital after having a total hip replacement. Not only was the hospital pharmacy closed Rexall and Shoppers refused to fill the prescription as it was a specialised medication. In the meantime I’ve had to survive on Tylenol….btw going back to the ward was pointless they must have known the pharmacy was closed even though the nurse on duty told me otherwise. My husband was made redundant over 6 months ago and has just started a very much lower paid job to keep us ticking over. My main beef is having to pay out $300… Read more »

Syed Raza
Syed Raza

Hi Sue,

I am sorry to hear about your situation. You can always contact the Ontario Ombudsman to see if they can help you out. You can find their details here:

http://www.ombudsman.on.ca/Make-A-Complaint.aspx

Best of luck,
Syed

Crissy
Crissy

I have had the gastric bypass and it was and it was covered by Ohip. I am now onl 30 pounds awa from my highest weight. I didn’t lose as much as most and I’ve gained quite a bit back. Does ohip cover a revision?

Syed Raza
Syed Raza

Hi Crissy,

I was able to do some research for you but was not able to confirm whether or not OHIP will cover a repeat procedure. You can find more info at the link below:

http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/j_diagth.pdf

Hopefully that helps out.

Regards,
Syed

Wendy
Wendy

I was wondering if anybody knows if Ohip will cover Breast implants along with surgery to have loose skin tighten. ? After having gastric bypass to loose weight for medical reasons

Syed Raza
Syed Raza

Hi Wendy, Thanks for the great questions and congratulations to you on your road to better health. I am not an expert on the subject but was able to do some research for you. OHIP will cover breast implants surgery for breast reconstruction after a mastectomy resulting from breast cancer and for cases of extreme congenital disorders. I was not able to find any other situations where OHIP coverage would be applicable for breast augmentation procedures. Regarding the removal of excess skin, Pannilectomy surgeries are usually not covered under OHIP. However, OHIP has covered this procedure in some cases of… Read more »

Bill
Bill

Does OHIP cover private rehab centres for alcohol abuse and addiction or only the public ones?

Joel Cadesky
Joel Cadesky

Mary:I am not positive this is covered.The best person to contact would be your podiatrist who should be able for sure to tell you if covered or not.

Mary MacVittie
Mary MacVittie

I have a bone spur, facitis and would like to know if I am covered for orthopedic shoes

Vincent
Vincent

I am a senior citizen aged 75, living in the province of Ontario. I have a cavity in a tooth. Am I covered by OHIP towards treatment by a dentist or Hospital?
I live with my daughter who has sponsored me and my wife to live in Canada.

LSM Insurance
LSM Insurance

Thanks for the note Bella – it is hard to say if you need Critical Illness insurance without doing a needs analysis. Critical Illness insurance provides valuable protection which pays out a lump sum if the insured is diagnosed with an illness such as cancer stroke or heart attack.

Bella
Bella

Do I need critical insurance?

LSM Insurance
LSM Insurance

See Greenshelds Canada quick reference: Prescription Drugs: The Ontario Drug Benefit Program covers seniors and social assistance recipients. Low income recepients and seniors are responsible for a $2 co-pay per prescription. Higher income seniors must satisfy a $100 deductable, followed by a co-payment of up to $6.11 per perscription. The Trillium Drug Program is available to all Ontario residents covered by OHIP with high drug costs in relation to your income. Eligibility requires that private insurance doesn’t cover 100% of their drug costs. Approved applicants are responsible for an income based deductable, in addition to a co-payment of up to… Read more »

Dora
Dora

Does ohip cover crestor?