5 Things You Need to know About OHIP

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Ontario Premier Doug Ford announced today that most of the Greater Toronto and Halton Area will be designated as a red zone for COVID-19 restrictions. We hope and pray that the new restrictions help curb the spread of COVID-19. If the disease spread and the future modelling predictions come to fruition, our healthcare system will be stressed.

If you are new to Canada, you might have some questions about the Canadian healthcare system. In this blog post, we specifically explore the ins and outs of the Ontario Health Insurance Plan. In Canada, the federal and provincial governments work together to ensure access to basic health care for all those who live in the country—provided that they meet the eligibility requirements. In the province of Ontario, this government funded program operates under the banner of the Ontario Health Insurance Plan, or OHIP for short. 

Here are 5 things you need to know about OHIP to make sure you and your family are covered for all of life’s bumps and scrapes.

  1. OHIP covers a wide range of health care services—but it doesn’t pay for everything.

Under OHIP, most basic medical and emergency services—including ambulance rides and visits to your family doctor—are covered in full. Many services, however, are only partially covered. These include: some services provided by family doctors, podiatrists, chiropractors and osteopaths; physiotherapy appointments; in-hospital dental services; and eye tests. It does not cover services deemed medically unnecessary, such as cosmetic surgery.

For more information regarding specific services, call the Ontario Ministry of Health’s INFOline:

                In Ontario: 1-866-532-3161

                In Toronto: 416-314-5518

  • There is a 3 month waiting period for OHIP coverage.

New residents and former residents returning to Ontario must wait three months before they are eligible for OHIP coverage. There are a few exceptions, however. Newborn babies, and OHIP-eligible adopted children under the age of 16 are immediately eligible for OHIP coverage; as are convention refugees, protected persons and people from another province who move directly into a long-term care facility in Ontario. 

If you are moving to Ontario from another country, the waiting period begins on the date you establish residence in Ontario. For example, if you establish residence on January 15th, then your OHIP coverage would begin on April 15th. If you are moving to Ontario from another province or territory, however, your OHIP coverage will begin on the first day of the third month after established residence in Ontario. In other words, if you establish residence on January 15th, your OHIP coverage will begin  April 1st.

  • You do not need Permanent Residence Status or Canadian Citizenship to be eligible for OHIP.

It is a common misconception, but you do not need to wait for PR or citizenship status to secure OHIP coverage. Official Applicants for Permanent Residence (previously known as Applicants for Landing) are already eligible for OHIP with written confirmation from CIC that you meet eligibility requirements. This written confirmation can come in the form of either an official CIC letter or a CIC immigration document (ie. Work permit, visitor record, temporary resident permit or study permit) with an added note in the “remarks section.”

Temporary foreign workers, Live-in caregivers, and seasonal agricultural workers who hold valid work permits and can provide proof of secured employment for a minimum of six consecutive months are also eligible for OHIP coverage—as are their spouses and dependents. Students on a full-time study permit are similarly covered.

If your work or studies cause you to frequently travel outside of Ontario, you may still be eligible for OHIP, provided that you have one of the above mentioned OHIP-eligible immigration statuses, make Ontario your primary place of residence and are physically present in Ontario for 153 days in any 12 month period.

  • You—and every member of your family— must have an Ontario Health Card.

An Ontario Health Card proves your eligibility for health services in Ontario. It is vital therefore that you apply for a card by first completing the application form (which you find online here or at your local Service Ontario OHIP office) and submitting it to your local Service Ontario OHIP office along with the all other necessary documentation proving citizenship, permanent residence or your current immigration status (click here for a complete list http://settlement.org/ontario/health/ohip-and-health-insurance/health-ohip-card/what-documents-do-i-need-to-apply-for-a-health-card-ohip/). And while you must wait three months to be eligible for coverage, Service Ontario recommends that you submit your application for coverage as soon as you have your documentation ready.

Remember: you are required to show your card every time you need medical services. It is therefore recommended that you carry your card at all times. All members of your family—including infants and children—are required to have their own card.

  • OHIP does not fully cover medical services accessed outside the province of Ontario.

While the federal government is involved in ensuring that all Canadians have access to health care, it is the provinces—not the federal government— that actually provide universal health coverage. As a result, it is possible that, if you become sick or injured while traveling outside of Ontario, not all of your medical expenses will be covered by OHIP. For a standard doctor’s visit, it is at the discretion of the physician whether they will charge the Ontario Ministry of Health directly or require the patient to pay for services out of pocket. If the patient is billed directly, they can seek reimbursement by submitting all original receipts to the ministry upon their return to Ontario.

Most basic public hospital services are covered by reciprocal billing agreements between provinces. However, to avoid any nasty surprises, the Ontario Ministry of Health does recommend securing private travel insurance for your time out of province.

For updated information, we recommend to check the Ontario website: https://www.ontario.ca/page/ohip-coverage-while-outside-canada#:~:text=Starting%20January%201%2C%202020%20Ontario,are%20travelling%20outside%20of%20Canada.

If you have an OHIP card, we hope you will not have to use it, at least for COVID-19 related purposes!  Stay safe, be cautious and take care!

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