The Provincial Government of Ontario gives monetary assistance for medical and healthcare needs to its residents through the Ontario Health Insurance Plan. You will are mandated to apply for the insurance. Once the processing of your application is done and you are found eligible, you will receive an Ontario health card. This card works for you as proof. You can show it when you visit your doctor, an emergency clinic, take a medical test or receive a surgery.
What is covered by OHIP?
Listed below are the medical and healthcare services covered by this healthcare plan.
- You will receive coverage for your family doctor’s services.
- Your visit to walk-in clinics and other care providers is also covered in this plan.
- Emergency room visits are insured.
- Any medical tests or surgeries you receive are covered by OHIP.
For a medical procedure or test to be covered by OHIP, it must be medically necessary. Cosmetic surgeries are not covered by this plan.
Who qualifies for OHIP.
We have compiled a list of minimum requirements that you must satisfy to be eligible to apply for the Ontario Health Insurance Plan.
- You must be in Ontario for a minimum of 153 days in the last 12 months.
- After you start living in Ontario, you must be present in the province for a minimum of 153 days of the first 183 days.
- You must have made Ontario your primary residence location.
- You will also be required to meet a minimum of one additional requirement.
The additional requirements, of which you must qualify at least one, are listed below.
- You must be a Canadian citizen.
- You must be an indigenous person, who is registered under the federal Indian act.
- You can be an immigrant permanent resident.
- You must have applied for permanent residence through Immigration, Refugees Citizenship Canada.
- You must have all the qualifications necessary for applying for permanent residence.
- You must not have been denied a permanent residency in Canada.
- You must be in Ontario and have a valid work visa.
- You must have a full-time job in Ontario, under an employer from Ontario for a minimum of six months.
- Your spouse or partner and dependents must also qualify for permanent resident status.
- You could also have gained a valid work permit through the Live-in Caregivers program.
- You could be a refugee or in another protected category.
- In certain cases, you could also have temporary resident status.
- You could be a member of the clergy, ministering full-time in Ontario for a period of six months, and have legally entered Canada.
When your coverage starts
The Ontario Provincial Government has decided to do away with the three month waiting period of the Ontario Health Insurance Plan coverage. The cost of medical services required due to COVID-19 is also covered under this plan, even for those who are uninsured and not eligible for coverage through this program.
Who gets immediate coverage?
According to the OHIP guidelines, the following are qualifications for immediate coverage under this plan.
- Babies who are born in Ontario and are Canadian citizens.
- Internationally adopted children under the game of 16, adopted by Ontario residents.
- Refugees and other protected people, as is mentioned under the Immigration and Refugee Board Canada.
- Those who have moved to Ontario from another Canadian province or territory in the first three months of their arrival in Canada.
- Family members of military personnel who have the required documentation.
How to apply
You will be required to apply for the Ontario Health Insurance Plan in person by going to the Service Ontario centre. Given below are the needed supporting documents.
- You must have a completed Registration form for Ontario Health Insurance Plan.
- You must have the original copies of any three identification documents.
- One of the identification documents must prove that you are a citizen of Canada or have OHIP qualifying immigration status.
- You must have documents proving you live in the province of Ontario.
- You must have a document that supports your identity, like a credit card or passport.
Children who are below the age of 16 will not require a photograph or a signature because a parent or guardian can register on their behalf. Children older than 16 years of age are required to apply in person as they will be required to sign on their card.
Reapplying for OHIP
Those who have not been in Ontario for more than 212 days in the last 12 months will have to reapply for Ontario Health Insurance Plan. This can be done at a specialized Service Ontario centre which provides health and service cards. You will need the following documents.
- The completed application form.
- Three types of identification documents, their original copies.
Requesting a review
If you are informed that you no longer are eligible for OHIP, you are within your right to request a review of your decision. Here are some steps you can follow.
- Send the authorities a letter, fax or email.
- This should have the reason as to why you think you are eligible for coverage under the Ontario Health Insurance Plan.
- Any additional documents that show your eligibility must be attached.
- You must also give the authorities your contact information that is up-to-date.
Email to: [email protected]
Fax to: 613-548-6557
OHIP Eligibility Review Committee
Ministry of Health and Long-Term Care
49 Place d’Armes, 2nd floor
Kingston, ON K7L 5J3.
If you wish to appeal the decision of the OHIP Eligibility Review Committee, you will have to submit a written appeal to the Health Services Appeal and Review Board. This letter must be sent along with any other supporting documents, within 15 days of receiving the committee’s decision, to the following address.
Health Services Appeal and Review Board,
151 Bloor West Street, 9th Floor,
Toronto, ON M5S 2T5
OHIP for babies
A baby born in Ontario can apply for OHIP. The steps of application are different depending on whether the baby was born with birthing facilities in a hospital, under the care of a registered midwife or not.
If your baby was born with a registered midwife or in an Ontario birthing hospital with birthing facilities, these are steps you can follow.
- The registration form for Ontario Health Coverage Infant is not available online. It will be given to you by the hospital staff or the midwife.
- Complete the registration form.
- Give the details such as the baby’s name, the date they were born and the address to which the health care should be mailed.
- Mention the main residence of the baby in Ontario.
- Confirm that the baby will be physically in Ontario for a minimum of 153 days out of 12 months.
The form will be submitted by the registered midwife or the hospital to the authorities. The bottom section of the form must be kept with you till you get the baby’s health-care card. The bottom section of the form has the health number that is assigned to your baby. You will receive health care within eight weeks from when the firm is submitted.
If the baby is born outside a hospital or without a registered midwife, here are some steps you can follow.
- You are mandated to apply in person at the Service Ontario centre.
- If the day you apply is within 90 days of your baby’s birth, submit proof of your baby’s birth.
- If you apply after 90 days of your baby’s birth, you will have to submit proof of your child’s citizenship in Canada.
- You must also have a filled-out Registration form.
- Submitting proof of permanent residency and identity proof as well is must.
OHIP for adopted children
If you have an adopted child from another country, you can apply for OHIP coverage for them as soon as they arrive. Here are some steps you can follow.
- You are mandated to apply in person at the Service Ontario centre.
- You will have to bring proof of Canadian citizenship or OHIP qualifying Immigration status proof with you for your adopted child.
- You must have the approval from the director of the Ministry of Children and Youth Services, and proof of the same.
- You must also have documents of adoption or guardianship with you.
- You must have the completed registration form for Ontario Health Insurance Coverage.
- You must have proof of your residency in Ontario.
- You must also bring an identity proof such as a credit card or a valid passport.
If your adopted child is from Ontario itself, or any other Canadian province or territory, you must contact the Service Ontario centre to get a list of documents you will need to submit.
OHIP for military family members
If you are related to a member of the Canadian Force or someone who is currently deployed or inactive duty, as a spouse or dependent, you can get immediate coverage under OHIP.
- You are mandated to apply at the Service Ontario centre near you.
- You must have filled-out an Ontario Health Insurance Coverage form and brought it with you.
- You must have 3 forms of identification proofs, originals as photocopies of these documents will not be accepted.
- One must prove you are a citizen of Canada, another must show you have qualifying immigration status, and the third must show that you are physically living in Ontario.
- You must also have something to prove your identity such as your credit card or passport.
Visitors to Ontario
If you are visiting Ontario from another province or territory of Canada, you are not eligible to receive medical coverage under the Ontario Health Insurance Plan. You can find out about the insurance or healthcare plan of your province or territory, and apply for that before taking your trip to Ontario. It is also recommended that you buy private medical and healthcare insurance for the trip.