What is Covered by the Ontario Health Insurance Program (OHIP)

Ontario Health Insurance Program (OHIP) is the public health care plan of the province of Ontario under which free healthcare services and benefits are provided to whoever possesses an OHIP card. As a newcomer to Ontario, the first step is to apply for the OHIP card by submitting an OHIP application at a ServiceOntario centre along with all the requested supporting documents. Once your application is approved and you deemed qualified for the OHIP, you will be granted a health card which you can use to access various health services and benefits. While the OHIP card covers a large multitude of health needs and care demands which are thus provided free for the card holders, there are some medical treatment services which are not covered. This article will give you a brief overview on the Ontario Health Insurance Program services summarizing what is covered by the OHIP card and which treatment sectors and medical services are not covered.  

What is covered by the Ontario Health Insurance Program?

Aa a resident in Ontario, and a holder of the OHIP card, you are entitled free healthcare covering a large multitude of medical services and treatment sectors. Overall, the Ontario Health Insurance Program covers the following, fully or partly:

• Doctor appointments and visits

The full cost of seeing or visiting a doctor is covered by OHIP, considering that the visit is medically necessary.

• Hospital visits and stays

OHIP covers the majority of your hospital stay costs including doctor and staff services, tests, medications, accommodation and meals.

• Medical or surgical abortions

OHIP covers the cost of medical or surgical abortions that take place in a hospital or clinic.

• Eligible dental surgery in hospital

OHIP only covers in-hospital dental surgeries, mainly surgeries which are complex and need close monitoring during and after the procedure. A list of the surgeries covered y OHIP is found here. 

• Services requiring ambulance intervention

In case you need to call an ambulance for a medical emergency, part of the associated costs will be covered by OHIP depending on the situation.

• Eligible optometry – eye-health services

If you are younger than 20 years of age or older than 64, then OHIP covers the cost of one major eye exam every 12 months in addition to any minor assessments you need. If you are between 19 and 65 years old, then OHIP will cover specific medical conditions listed here.

• Podiatry – foot-health services

OHIP covers between $7-16 of each visit to a registered podiatrist and up to $135 per patient per year, in addition to $30 for x-rays. The rest of the costs are to be paid by you. On the other hand, surgeries done by podiatrists are not covered at all. 

• Travel for health services if you live in northern Ontario

If you live in northern Ontario and you need to travel long distances to other areas or districts in Ontario for specialized medical treatment or follow-up on your health care, then there is a possibility that OHIP will help in covering your travel and accommodation through the Northern Health Travel Grant.

In all of the above, holding your OHIP card is enough as proof of your rights for fully or partly covered medical treatment and intervention. 

What is not covered by the Ontario Health Insurance Program?

While the majority of the healthcare services and medical treatment and interventions are covered to a large extent by the Ontario Health Insurance Plan, there are still certain types and services of medical treatment which are not covered by OHIP. This includes the following:

• Prescription drugs provided in non-hospital settings including antibiotics prescribed by a family doctor

• Consultation treatments with alternative medicines and treatment methods, such as Chinese medicine, homeopathy and Reiki 

• Chiropractor services 

• Dental services provided by a dentist

• Eyeglasses and contact lenses

• Laser eye surgery

• Cosmetic procedures and services that are not medically necessary

• Immunizations for travel including Hepatitis A, Hepatitis B, Twinrix and HPV

You as a patient need to pay for the above services and treatment yourself. Such services could be expensive and could come as a surprise. The recommendation is to choose and buy a private insurance plan which will then be able to cover part of all the additional medical expenses.

Additional Services for Seniors

Seniors who are aged 65 years old and over, and who are members of OHIP with a valid health card, will automatically qualify for the Ontario Drug Benefit (ODB) Program. The ODB program allows seniors to earn access to additional services and provide them with expanded coverage to make sure they have access to the healthcare they need at their age. Some of these additional benefits and health services for seniors include:

• Coverage for visits to the optometrist every two years 

• Coverage for most prescription medication