What Your Provincial Health Plan Covers: Ontario

Posted on May 24, 2013 and updated June 6, 2013 in Life Insurance Canada News, Provincial Health Plan 3 min read
hospital2
OHIP covers emergency services
outside of Ontario on a limited basis.

Ontario’s Health Insurance Plan is known colloquially as OHIP.

In order to be eligible, you must be a Canadian citizen, permanent resident, or among one of the newcomer-to-Canada groups who are eligible for OHIP as set out in Ontario’s Health Insurance Act. Plus, you must be physically present in Ontario for 153 days in any 12-month period and be physically present in Ontario for at least 153 days. You are eligible following the first 183 days immediately after establishing residency in the province, and you must make your primary place of residence in Ontario.

What Does OHIP Cover?

OHIP covers most medically necessary surgeries and health services, including annual eye exams for those under 20 and over 65. Eye exams are also covered every 12 months for those between the ages of 20 and 64 who have medical conditions requiring regular eye exams.

What Doesn’t OHIP Cover?

  • Ambulance services
  • Regular annual eye exams for those 19 to 64
  • Physiotherapy may be partially covered or not covered at all, depending on the circumstances
  • Regular dental exams (only certain dental surgeries done in hospital are covered)
  • Pediatrists are only partially covered
  • Chiropractors
  • Necessary emergency surgery done outside of Canada is only partially covered on a very limited basis

Ontario Drug Benefit Plan

Prescription drugs are not covered under OHIP unless you meet some very specific requirements. You can receive coverage if you meet the following criteria:

  • You are 65 or older
  • You are on the Ontario Disability Support Program or Ontario Works
  • You live in a residential long-term care facility or another home for special care
  • You are receiving home care services

Trillium Drug Benefit

If you don’t fit in any of the categories above, you still may qualify for coverage through the Ontario Trillium Drug Benefit for people who have high drug costs in relation to their net income and have little to no private insurance coverage.

If you’re looking for health insurance to supplement your OHIP coverage, please call us at 1-866-899-4849. For more information on OHIP, please visit its website.

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