Ontario Health Insurance Plan (OHIP) Guide

The Ontario Health Insurance Plan (OHIP), also known as Assurance-Santé de l'Ontario, is the government-run health insurance plan for the province of Ontario, Canada. It ensures that residents have access to essential healthcare services without direct payment at the point of service.

Covered Services

Every Ontario resident who maintains their primary and permanent home in the province is entitled to free emergency and preventive care. Residents can visit participating doctors—which includes nearly every physician practicing in Ontario—and the services are billed directly to the government through OHIP.

Prescription Drugs

Generally, OHIP does not cover prescription drugs outside of hospital settings or dental care. However, there are specific programs to assist eligible residents:

• Ontario Drug Benefit (ODB): Provides coverage for prescription drugs for seniors.
• Trillium Drug Program: Assists households with high prescription drug costs.
• OHIP+: Launched on January 1, 2018, this program covers prescription drugs for those under 25 years of age (though free prescriptions for those with private coverage were phased out as of April 1, 2019).

Physiotherapy and Optometry

OHIP coverage for physiotherapy is restricted to specific groups, including those 65 years and older, those 19 and younger, residents of long-term care homes, individuals who have been hospitalized, and those on the Ontario Disability Support Program (ODSP), Family Benefits, or Ontario Works.

Regarding optometry, OHIP covers one major eye exam every 12 months for individuals 19 and younger or 65 and older. Adults aged 20 to 64 are covered if they have a specific medical condition affecting their eyes that requires regular monitoring.

Dental Care

OHIP provides free, routine dental services for low-income seniors (65+). For 2022, the income requirements were a net annual income of $22,200 or less for a single senior or $37,100 or less for a couple.

International Coverage

OHIP provides very limited coverage for emergency health services received while traveling outside of Canada. This includes doctor services (medical assessments, emergency surgery), emergency outpatient services (MRIs, CT scans), and emergency inpatient services (hospital stays, nursing services).

Funding and the Ontario Health Premium

OHIP is funded through a combination of general provincial tax revenues, transfer payments from the Government of Canada, and payroll taxes paid by employers and individuals. A key component is the Ontario Health Premium (OHP), which is part of the Personal Income Tax system. The premium is based on taxable income; for example, as of May 2010, the maximum premium was $900 for those with taxable incomes up to $200,600.

Eligibility Requirements

To be eligible for OHIP, an individual must typically be a Canadian citizen, permanent resident, or a holder of a valid work permit. They must have a permanent and principal home in Ontario and be physically present in the province for at least 153 days in any 12-month period.