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Online Benefits Information
THE ONTARIO HEALTH INSURANCE PROGRAM
GENERAL PROGRAM DESCRIPTION
The Ontario Health Insurance Program (OHIP) is Ontario's provincially funded health insurance program. It covers a wide range of health services, such as doctor's visits, medical specialists, hospital stays, etc. A resident of Ontario must have an OHIP Health Card to show that he or she is entitled to health care services paid for by OHIP. You have to show your Health Card every time you see a doctor, medical specialists, etc. You are not eligible for OHIP coverage if you are a tourist, transient or visitor to Ontario. It takes 3 months to get an OHIP health card once you have established your residency in Ontario.
PROGRAM OVERVIEW
Only Ontario residents are eligible for Ontario's provincially funded health coverage (OHIP). To be eligible for Ontario health coverage (OHIP) you must:
- be a Canadian citizen, or have legal immigration status, and
- make your permanent and principal home in Ontario, and
- continue to be physically present in Ontario 153 days in any 12-month period.
OHIP covers a wide range of health services. It pays only for services that are medically necessary. (For more details regarding insured services, please contact your nearest Ministry of Health and Long-Term Care office, listed in the blue pages of your telephone directory under "Government of Ontario - Health Insurance.")
OHIP covers all your medically essential diagnostic and treatment services. Doctors may bill you for uninsured services. These include transferring files to another physician, telephone consultations, certificates of fitness to work, physical examinations for schools or camps, and cosmetic procedures. Physicians may also bill you for missed appointments. OHIP pays for optometry services every two years for persons 20 to 64 and once a year for those under 20 and age 65 and over. OHIP pays only part of the costs for the services of podiatrists, chiropractors and osteopaths. OHIP pays for some dental surgery when done in hospital.
OHIP also pays for physiotherapy services provided in:
- Hospitals
- Approved schedule 5 physiotherapy clinics
- Physicians offices that offer physiotherapy, and
- Community Care Access Centres (CCACs).
Prescription drug, ambulance services and longterm care services are not covered by OHIP.
Once you have an OHIP Health Card, most of your health coverage benefits can be used across Canada as a visitor. The province or territory you are visiting will usually bill Ontario for services. If you have to pay for health care you receive in another part of Canada, such as chiropractors, optometrists, podiatrists and osteopaths, or doctors' services in Quebec, you can submit your receipts to your local Ministry of Health and Long-Term Care office for repayment (within 12 months of the date of receipt).
For people traveling outside Canada, OHIP covers a set fee rate for emergency health services. If you travel out-of-country for elective medical services that are available in Ontario and/or can be planned ahead of time, you are not covered. It is important to consider buying private health insurance when you travel outside Canada, since not all services are fully covered or reimbursed by OHIP, some not at all. However, be aware that some private health insurance policies may have a "pre-existing" clause that may limit the amount and type of coverage and services you are eligible for.
APPLICATION PROCESS & DOCUMENTATION
You must register for a Health Card in person at your nearest Ministry of Health and Long-Term Care office. If there is no Ministry of Health and Long-Term Care office in your area, call the ministry office nearest you to ask about temporary outreach registration sites.
You are eligible for the Ontario Health Insurance Plan (OHIP) if:
- you are a Canadian citizen, landed immigrant or convention refugee, registered as an Indian under the Indian Act (plus other categories such as a foreign worker or Live-in Caregiver with employment authorization, have submitted an Application for Landing, hold a particular Minister's Permit) and
- you make your permanent and principal home in Ontario, and
- you are present in Ontario for at least 153 days in any 12month period.
To apply for a card, you must:
- go in person to your nearest Ministry of Health and Long-Term Care office, and
- fill in the Registration for Ontario Health Coverage form, and
- provide the necessary original documents
You must bring three original documents:
- To show your Canadian citizenship or immigration status, bring the original of one of these documents :
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- Birth Certificate from a Canadian province, territory or the Department of National Defence
- Certificate of Canadian Citizenship or Certificate of Naturalization (paper document or card, not commemorative issue)
- current Canadian Passport (or expired passport issued Feb. 15, 1977, or later)
- certified Statement of Live Birth from a Canadian province or territory
- Immigrant Visa and Record of Landing
- Canadian Immigration Identification card
- Convention Refugee Determination Division letter
- Minister's Permit (exceptions may apply)
-
To show you live in Ontario, bring a current original document with your name and home address on it, such as
- valid Ontario Driver's License or Temporary Driver's License
- Ontario motor vehicle permit (plate or vehicle portions)
- bank account statement (savings or chequing account, not automatic teller receipts)
- utility bill (telephone, cable TV, public utilities commission, hydro, gas, water)
- mortgage, rental or lease agreement
- employer record (pay stub or letter from employer)
- letter from Indian band administrator
- Statement of Direct Deposit from Ontario Disability Support Program (ODSP)
- letter from an administrator of an agency for convention refugees or for the homeless
- letter from an administrator of a publicly funded longterm care facility
-
To show you are the person you say you are, bring the original of a document with your name and signature, such as :
- Social Insurance Number card
- credit card or bank card
- current employee ID
- student ID card
- library card
- certified Statement of Marriage from the Registrar General of Ontario or a marriage certificate from anywhere else
- valid Ontario Driver's License or Temporary Driver's License
- Certificate of Canadian Citizenship (plastic card)
- Canadian Immigration Identification card
- Certificate of Indian Status (paper or plastic card)
You cannot use the same document twice. For example, if you use your driver's license for section 2, you cannot use it again for section 3. The ministry will not accept affidavits, statutory declarations or waive a document requirement.
If your children are 15 1/2 years or younger, apply for their health coverage at the same time you apply for your own. The children do not have to go with you because they will not have a photo or signature on their card. You will need three original documents for each child. The document from list 1 above showing their citizenship status must be in their own name. The documents from lists 2 and 3 can be in the name of the parent who is registering them. Children older than 15 1/2 years must register in person because they will have a photo and signature on their card. They will need three original documents in their name -- one each from lists 1, 2, and 3, shown in the above question.
WAITING TIMES
OHIP coverage normally becomes effective three months after the date you establish residency in Ontario. The ministry strongly encourages new and returning residents to purchase private health insurance in case you become ill during the OHIP waiting period.
If you are a newcomer to Ontario, or a former resident returning here to live after being away for more than seven months, the waiting period begins on the date you establish or re-establish residence in Ontario. If you are an eligible resident moving to Ontario from another part of Canada, your former province's health insurance will cover you for up to three months. And likewise, should you relocate from Ontario to another province, your Ontario Health Insurance will cover you for the first 3 months in your new province.
DOCUMENTATION TO BE COMPLETED
You must go in person to your nearest Ministry of Health and Long-Term Care office, and fill in the Registration for Ontario Health Coverage form, and provide the necessary original documents.
PROCESS FOR LEAVING THE PROGRAM
If you are eligible for Ontario health coverage and choose to withdraw your participation in OHIP, you may not obtain coverage through any other insurer. You can request cancellation of your OHIP coverage at any time by submitting a written request to the Ministry of Health and Long-Term Care. Written requests for cancellation of OHIP coverage for insured persons under 16 years of age must be provided by a parent or legal guardian.
If you move to a location outside Ontario, you should inform the ministry of your new address and the date of your move as soon as possible. The ministry may end your OHIP coverage based on the information that you provide or continue to provide coverage for up to 3 months if moving within Canada. To inform the ministry of your move, you can either:
- Obtain a "Change of Information" form and return it by mail. Forms are available from your local OHIP office or from the Forms Online, or
- Send a letter to your local OHIP office. You must include your name, health card number, telephone number, current address and new address including postal code.
PAYMENT & RESPONSIBILITIES
It is illegal to knowingly use someone else's Ontario Health card, or to allow someone else to use your Health Card. If your Health Card is lost, stolen or damaged you should immediately call the Ministry of Health and Long-Term Care at 1-800-268-1154 (Toll-free in Ontario only). In Toronto, call 416-314-5518, TTY 1-800-387-5559 If you have purchased supplementary insurance, check with your insurance carrier about how you should submit your bills. Otherwise, submit your itemized bill to your nearest Ministry of Health and Long-Term Care office within six months of receiving treatment. With your bill, send :
- details of your treatment
- your original receipt for payment
- your name and current Ontario address
- your Health Number.
To avoid delays, do not hold your bills and receipts until you return to Ontario. Mail them to your insurance carrier or to the ministry as soon as you receive them.
FREQUENTLY ASKED QUESTIONS
Q: What if I don't have a Health Card when I go for health care?
Even if you do not have a Health Card, physicians and hospitals must provide you with emergency health care services. You may be charged for health care if you do not have a Health Card. The provider will reimburse you for the service if you can later show that you were covered by OHIP at the time of the service.
Q: Is anyone exempt from the waiting period?
Ministry staff will help you determine if you are exempt. Several groups are exempt from the waiting period. These include:
- newborn babies born in Ontario,
- discharged Canadian forces and RCMP personnel making their residence in Ontario,
- people from other provinces who immediately become residents of approved charitable homes, homes for the aged or nursing homes in Ontario.
Q: What is the difference between the old and new Ontario Health Cards?
The old Health Cards are red and white, with just your name and Health Card number on it. The new cards have your picture, date of birth, address, and period that your card is valid for (note that your card has an expiry date). The green card also has a phone number for contacting OHIP if you change addresses. Your signature is also laminated on the card. If you have ever had your Health Card replaced (due to it being lost, stolen or re-issued) your Card will have a Version Code - 2 letters following your Card number. It is your responsibility to notify the Ministry of Health and Long Term Care when you move, and to update your Card prior to the expiry date.
Q: What if I use a Health Card that is not mine?
It is against the law to receive insured health care when you are not an insured person. People who use a card which is not theirs can face criminal prosecution.
Q: Does OHIP pay for medications?
No, OHIP doesn't pay for medications except during hospital stays. You will need to obtain drug coverage from another source. See our chapters on the TRILLIUM Drug Plan, and also Ontario Works, and Ontario Disability Support Program.
Q: I am planning on leaving the country on a trip. Will OHIP pay for my medical or emergency needs while I am away?
Your Ontario Health Insurance does not cover all medical services when you are out of Canada. They will cover some emergency medical services, with limits. OHIP encourages you to purchase further coverage when you are leaving the country. You may purchase special Out of Country travel insurance that covers you for things not covered by OHIP. But be sure to carefully review the contract - some have clauses that won't cover pre-existing conditions, have limits on services that are covered, or may require you to pay up-front for costs and seek reimbursement later. The best tip is to read the contract carefully and ask questions.
LINKS
For further information, call the ministry INFOline at 1-800-268-1154 (Toll-free in Ontario only); In Toronto, call 416-314-5518; TTY: 1-800-387-5559
For online information about the OHIP program,
http://www.gov.on.ca/health/english/program/ohip/ohip_mn.html
For services covered by OHIP,
http://www.gov.on.ca/health/english/pub/ohip/services.html
For Frequently Asked Questions at OHIP,
http://www.gov.on.ca/health/english/program/ohip/ohipfaq_dt.html#Q3
Also, you should visit our sections on:
We hope this information provided by the Ontario AIDS Network answers all your questions. If the section does not answer all your questions, and you have HIV/AIDS or are an individual or organization supporting someone living with HIV/AIDS, let our Benefits Expert answer your question. All responses are confidential. Click HERE to send your question.
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