Provincial Health Care Guides – Ontario In Canada, public health insurance is available to eligible residents.
Canadian citizens and permanent residents can apply for provincial health insurance. Eligibility Requirements You are eligible for OHIP if:
• A child born in Ontario.
• Your main residence is in Ontario
• You were in Ontario for at least 153 days in 12 months
• You are a Canadian citizen or permanent resident
• You are a “protected person”
• You are registered as an Aboriginal Person
• You applied for permanent residence and the IRCC confirmed that you meet the requirements to have a permanent residence in Canada.
When living in Canada you are not covered by a federal health program. Each province and Canadian territory operate their provincial health system that is funded by the Provincial and Federal governments. Coverage can be different from province to province. Although each program covers certain programs or procedures you can not hop from province to province some requirements must be met to acquire coverage.
You can only apply in person, and you can only use a document once. So, for example, if you use your passport as proof of citizenship, you cannot use it as a Support of Identity document.
What is OHIP?
OHIP stands for the Ontario Health Insurance Plan. It is a government-run health plan that pays for many health care services, including visits to your family doctor and various specialists. OHIP provides Ontario residents with medical and emergency care that’s free of charge. The costs of OHIP are covered through taxes. All Ontario residents pay for OHIP through their income tax. Getting an OHIP Card To apply for OHIP, you have to fill out a form that you can find online or at your local ServiceOntario.
You will also need to show three more documents:
• Proof of citizenship or OHIP eligibility- birth certificate, passport, Temporary Confirmation of Registration Document, etc.
• Proof of Residency – Employer record, income tax assessment, property tax bill, mortgage or rental agreement, etc.
• Support of Identity – Credit card, employee ID, passport, student ID, driver’s license, etc.
OHIP Coverage Dental
OHIP usually doesn’t cover dental services. However, OHIP may cover some dental surgery if it’s done in a hospital.
Prescription Drugs OHIP does not pay for prescription medicine if you’re older than 25. Your private insurance plan may also cover part of your costs.
Dental surgery in hospital
Some 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
- tumour removal
- reconstructive surgeries
- medically necessary tooth removal (prior approval by OHIP is required)
Some of your Expenses for Prescription Medicine
The Ontario Ministry of Health has some programs that can cover some of your expenses for prescription medicine:
• Ontario Drug Benefit Program (ODB) – ODB covers some costs with prescription medicine for those over 65 who get social assistance and for long-term care patients
• Trillium Drug Program – The Trillium drug program helps those who have high drug costs compared to their family income pay for their prescription drugs.
• Special Drugs Program – This program helps those who suffer from HIV, schizophrenia and other conditions pay for their drugs.
• The New Drug Funding Program – This program covers the costs of certain intravenous cancer treatments
• Exceptional Access Program – This program covers some drugs that are not included in the OBD, but only in some cases.
• Respiratory Syncytial Virus Prophylaxis for High-Risk Infants Program – This program covers the full cost of treatment for infants suffering from RSV.
If you do not qualify for any of the above programs, you can purchase private health insurance.
Extended Health Care People who have high health costs but have an income that’s too high for them to be included in the Ontario Disability Support Program may be eligible for the Extended Health Benefit.
The Extended Health Benefit
The Extended Health Benefit may help with the cost of:
• Medical supplies, such as those for diabetes or incontinence
• Assistive devices, such as hearing aids
• Prescription drugs
• Vision care
• Dental care, if the recipient is 18 years or younger
• Transportation to and from medical appointments Travel, and Out of Province Coverage. If you plan to travel outside of Canada for some time longer than seven months in a year, your OHIP coverage will still be available for up to two years if you have a valid health card and you lived in Ontario for at least 153 days per year for the two years before your leaving.
OHIP will cover a limited amount of the treatment costs if you receive treatment outside of Canada.
If you receive treatment in another Canadian province or territory, OHIP will cover some of the costs for physician and hospital services.
Students & Seniors Students and seniors are covered by special programs, such as the OHIP+.
OHIP+ covers the costs for more than 5,000 prescription drugs for anyone younger than 24 who is not covered by a private plan.
Seniors who need long-term care are eligible for the Ontario Disability Support Program and will maintain their benefits through the ODB program without pay regardless of whether they also have a private plan or not.
What OHIP Does Not Cover Cosmetic surgery
- Dental services are performed in a dentist’s office
- Eye exams for people between the ages of 20 and 64, except for those suffering from specific conditions
- Care services provided by non-licensed facilities
- Some physiotherapy services
Preferred hospital accommodation, unless specifically prescribed by a physician Private duty nursing Prescription renewals done over the phone Completion of forms and certificates you may need for school, work, insurance, etc.
Remember, there’s a 153-day waiting period for your coverage to become active.
In the meantime, if you are settling here in Ontario, be sure to invest in Super Visa insurance from Insurdinary. It will protect you in the event you become sick or injured.