A Guide to the Ontario Health Insurance Plan (OHIP)

Applying for OHIP

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.

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.

Eligibility Requirements

You are eligible for OHIP if:

Getting an OHIP Card

To get an Ontario Health Card, you have to visit your local Service Ontario Centre with the original documents confirming your eligibility. In some cases, you may have to provide additional documents. For example, you may be required to provide a marriage certificate if you changed your name, and so on.

Renewing or Replacing Your OHIP Card

If you’re applying for a replacement health card because your last one expired, you have to bring the three original documents that prove your eligibility to your local Service Ontario.

If you want to replace your health card because the last one was damaged, lost, or stolen, you can make your request by phone or in writing if the information shown on the card (such as your name, address, etc) has not changed and your card is still valid.

OHIP Coverage

OHIP covers many health care services, including visits to your family doctor, diagnostic services, treatment for illnesses or injuries, hospital and emergency care.

OHIP does not cover dental care, eye care, prescription drugs for people aged 25 or older, and services that are not medical necessities, such as cosmetic surgery.

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. And 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 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.

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 may help with the cost of

• Medical supplies, such as those for diabetic or incontinence
• Assistive devices, such as hearing aids
• Prescription drugs
• Vision care
• Dental care, if the recipient 17 years or younger
• Transportation to and from medical appointments

Travel, and Out of Province Coverage

If you plan to travel outside of Canada for a period of 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 prior to 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.

Coverage for Subgroups

The Ontario Government covers both military and aboriginal groups in their healthcare programs. Both have free access to medically necessary care as required by a licensed physician.

Aboriginals

Aboriginal peoples are insured by OHIP. The government assists aboriginals by providing public health services and health promotion programs.

Military

Regular Force personnel are eligible for OHIP coverage during specified periods, based on their duty status.