One of the benefits for young people moving to Canada is access to funded health care, which has a reputation for being world-class. Health care is provided in all provinces and territories of Canada. In Ontario, it is known as OHIP (Ontario Health Insurance Program). Here’s what you need to know about OHIP coverage and how to apply.
Access to health care in Ontario
OHIP provides free health care that is free of charge, as the cost of these services is taxable by the state. You will need to carry an OHIP card, issued by the provincial government. This card shows that you are eligible for free health care in the province. Each eligible person is given a card, including children. You will be asked to show a valid OHIP card every time you see a doctor, have a medical examination or treatment at a hospital.
What is covered under OHIP?
OHIP covers the full cost of the following:
1. A visit to a family doctor or a travel clinic
2. Staying in a hospital
3. Doctor’s fee, diagnostic tests (such as x-rays), medication when you stay in the hospital, the cost of your hospital stay including meals (excluding private rooms)
4. One eye test every 12 months for anyone younger than 19 years and older than 65 years of age.
5. One eye test for anyone between the ages of 20-64 if they have a medical condition, such as glaucoma or diabetes mellitus
6. Dental surgery that needs to be performed in a hospital
7. Travel expenses to access health services if you live in northern Ontario
OHIP covers the partial costs of the following:
1. Ambulance services, with the exception of a $45 CAD co-payment for citizens with a valid OHIP card
2. Costs for podiatry services, up to $135 CAD per year in consultation with a registered podiatrist, and $30 CAD for x-rays.
Do you need an OHIP card to go to the hospital or ER?
The hospital would treat you without an official OHIP card. However, in order for your medical expenses to be paid by the Ontario Health Insurance Plan, you must submit an official OHIP card or provide a health insurance plan number.
What is not covered under OHIP?
Generally, OHIP will only consider basic medical care services, such as visiting your doctor or hospital. There are a number of important things Ontario’s health system does not cover, including:
1. Cost of prescription drugs for anyone under 65 years of age
2. Dental care
3. Eye examination for anyone between the ages of 20-64 and the cost for glasses
4. Compatible or alternative therapies, such as chiropractor, physiotherapy, massage, acupuncture, or reflexology
5. Private psychotherapy or counseling
6. Sticks or lumps
7. Medications required for travel
8. Cost of non-missed appointments and medical notes
9. Medical examination of the application for permanent residency
Who is eligible for OHIP?
To qualify for OHIP, you need to meet the following conditions:
1. You are already a Canadian citizen, permanent resident, or immigrant
2. You have applied for citizenship or permanent residence in Canada, and you are meeting the requirements for state eligibility
3. You are a foreign worker with legal status to work legally in Canada (including the Live-in Caregiver Program and the Seasonal Agricultural Worker Program)
For your OHIP coverage to remain effective, you will also need to make Ontario your main residence and be physically present in the province for at least 153 days in any 12-month period.
How long can you stay outside Ontario and be covered under OHIP?
You can be outside Ontario or Canada temporarily for up to 212 days in any 12-month period and continue to be covered, as long as your main residence remains in Ontario.
When does OHIP start?
Prior to March 19, 2020, OHIP coverage was not available to newcomers in the province until a three-month wait. However, in response to the COVID-19 epidemic, the provincial government has taken steps to protect the health of everyone living in Ontario. As a result, the Department of Health and Long-Term Care has now lifted the three-month waiting period.
Visacrunch strongly recommends you to visit the Ontario government website for up-to-date information when applying for OHIP, as this decision may be reversed or changed in the future.
What documents are required to obtain an Ontario health card?
To apply for an OHIP card, you will need the following:
1. Proof of Canadian citizenship or immigration status (e.g. permanent card, work permit)
2. Proof of residency in Ontario (eg Ontario driver’s license, credit card, lease agreement, or pay stub)
3. Proof of identity (eg passport, credit card)
4. A completed Ontario Health Insurance Coverage registration form
How to apply for an OHIP card?
OHIP applications must be completed in person at the ServiceOntario Center. See the ServiceOntario Center website to find the nearest location or call 416-326-1234 or 1-866-532-3161 from Monday to Friday from 8:30 a.m. to 5 p.m. for more details.
Before visiting the ServiceOntario Center, you can download and complete the required Ontario Health Insurance Coverage form. English and French version of the form is available. Alternatively, take a copy to the Ontario Service Center and fill out the form there. However, with the limit of services during the current pandemic, Visacrunch recommends that you download and complete the form ahead of time. Each person in your family will need a different form.
Collect your three pieces of ID that prove your eligibility to live in Canada, proof that you live in Ontario, and verification of your identity. If you are not sure what is acceptable, the Ontario government has provided a complete list of documents you need to get a health card. ServiceOntario will not accept copies of documents.
Visit the ServiceOntario Center with your completed form and three real ID forms. The ServiceOntario Center can advise you on their busiest times to avoid overcrowding. Often, the early mornings are a little busier than during the day, especially at lunchtime. If you have children or dependents aged 15 and a half or under, you can apply on behalf of your children at the same time. Older children must apply in person, as they will need to sign their form and have their photographs taken. The Services Clerk will process your request and take a photo of you.
Your card will be mailed to you and will take one to two weeks to arrive. Currently, there is no waiting period to apply for OHIP due to COVID-19. However, this may change in the future, and if so, ServiceCentre staff will check your documents to check when your three-month waiting period begins. Your OHIP card will be sent to you later that day.