Canada offers its residents quality healthcare with well-designed Ontario health insurance plan and health cards. Most of these free medical services are a result of the income tax system of the country. However, the plans and services differ across the provinces. If you are a Canadian citizen residing in Ontario and looking for medical coverage, we have you covered.
This article outlines the details of Ontario health card coverage that can be beneficial to you.
What is an Ontario Health Card Plan?
The Ontario Health Insurance Plan implies excellent healthcare services for all. It is managed directly by the Canadian government and is available to residents of Ontario. This plan is popularly known as the OHIP. The taxes citizens pay are used to provide funding and reimbursement for OHIP. OHIP covers numerous medical treatments after the determination of a medical condition. It covers most essential and urgent medical services, including regular check-ups and specialised treatments.
Services Under Ontario Health Insurance Plan
Each citizen of Ontario with a primary residency has the right to cost-free treatment for urgent and wellness services through OHIP. OHIP card covers a wide range of medical treatments and facilities considered necessary for a resident. OHIP is financed by regular provincial tax income and surcharge taxes provided by companies and individuals. Additionally, Ontario obtains transfer funds from the federal government to finance medical services.
OHIP covers the following services in whole or sometimes partially.
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Visits to the Doctor
As long as the treatments are clinically essential, OHIP will pay the entire cost of the treatment. You can visit your family doctor or consult any clinic of your choice.
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Being Admitted to a Hospital
Prescribed medications in a hospital for people younger than 25 have been protected by the Ontario health card plan. If your medical situation calls for treatment at a hospital, your OHIP card will cover the following expenses:
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- Fees of the physicians and nurses
- All required diagnosis tests like blood, urine, scanning, etc
- All the medications that the patients use during their stay in the hospital. However, OHIP does not cover the medicine charges once the patient is discharged. Only a few special medicines are paid for outgoing patients.
- OHIP covers Food and lodging expenses. However, the insurance company will bear the cost if you require a private accommodation option.
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Ambulance Facilities
In case of a medical crisis or emergency situation, the Ontario health insurance plan coverage pays for your ambulance expenses.
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Dental Treatments
This plan is preferably designed for low-income senior citizens. At times a few dental surgeries must be carried out in a hospital owing to the complexity and pre-existing health conditions that may require special attention during dental surgeries. Your OHIP card will cover hospital charges if you undergo a tooth fracture, tumour surgery or other teeth repair services. However, a beforehand approval of funding is required by OHIP in these situations.
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Eye Related Treatments
OHIP considers optometry services under the following conditions:
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- Only those below 19 years or above 65 years of age are covered by OHIP for the expenses of an annual main eye check-up. This is conducted for vision and general eye health. Additionally, Minor eye tests are also covered by the Ontario Health Card Plan.
- If you are between 20 and 64 years old and have an eye-related chronic health issue that necessitates routine evaluation, OHIP will pay for an extensive eye checkup once a year and any necessary subsequent visits. These chronic conditions include visual field defects, Glaucoma, disease of the Cornea, Cataracts, Diabetes Mellitus and retinal disease.
- If your healthcare provider requests an important eye test for specific purposes and provides you with an authorisation form, OHIP might additionally pay for it.
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Abortion
OHIP card covers the costs associated with a surgical abortion performed in a clinic or hospital. It also pays for the medicines, but only with a valid prescription from a medical practitioner.
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Podiatric Services
A licenced podiatrist’s office visit costs between $7 and $16 and is covered by OHIP up to $135 per person annually. Additionally, X-rays costing $30 are also covered. However, the balance of every appointment’s price is your responsibility.
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Psychotherapy
If a citizen seeks counselling, it can be reimbursed by OHIP. It will probably be approved if your family practitioner is qualified in psychotherapy. However, the majority of family doctors would suggest that you visit a psychiatrist or other particular mental health professional. Working with a licenced psychologist, a licenced social specialist, or a licenced therapist may be cost-free if government centres or hospitals employ them.
It is doubtful that Ontario Health Card Plan will pay for the service if you don’t have an immediate family physician or if they do not provide psychotherapy services. This means that any therapy you receive from a licenced psychologist, a licenced social worker, or a licenced psychotherapist who is not a member of a publicly financed institution will cost you money.
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Physiotherapy
OHIP provides coverage for physical therapy treatments provided at government-sponsored physiotherapy clinics. A physiotherapist will offer evaluation and therapy facilities, such as recovery from a trauma or hospitalisation. However, you can avail of physiotherapy under the OHIP card only if you are under 19 years or above 60 or a recipient of the Ontario Works or the Ontario Disability Support Program.
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Special Travel facilities for North Ontario Residents
If you need to travel for specialised medical care and reside in one of the following regions, OHIP may offer financial assistance via the Northern Health Travel Grant to cover your travel and lodging costs:
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- Algoma
- Thunder Bay
- Manitoulin
- Kenora
- Nipissing
- Parry Sound
- Rainy River
- Sudbury
- Cochrane
- Timiskaming
Services Not Covered Under OHIP
There are several medical services that OHIP does not cover. This could compel you to pay a hefty charge. Services not covered by OHIP include
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- Prescribed medications given outside of hospitals, such as antibiotics supplied by a family physician
- Cosmetic treatments
- Dental treatments in a private dental clinic
- Contact lenses and power glasses
- Eye laser surgeries
Additionally, certain specialised and unconventional tests are not covered by OHIP. OHIP will pay for them only when you fulfil specific qualifying requirements, and the test has been recommended by a specific healthcare professional. The following are some instances of testing that the OHIP cannot address unless certain conditions apply:
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- Prostate-specific antigen (PSA) is covered by OHIP only in situations of prostate cancer
- Aspartate aminotransferase test (AST) can be treated under the Ontario health insurance plan only when treated by a liver specialist
- 25-hydroxy vitamin D test is covered when you are dealing with diseases like osteoporosis, rickets, renal disease, malabsorption syndromes, etc.
Tips to Avail of Maximum Benefits of Your OHIP Card
OHIP card covers most of the medical requirements in Ontario. However, knowing the essential details of the plan can be an extensive process as it includes many exceptions and maintenance procedures. Here are a few tips you need to keep in mind to make the most out of your Ontario Health Insurance Plan
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- You must always keep track of your OHIP card validity period. You need to renew your OHIP card every 5 years. This renewal process can be done either online or in person. Failing to renew your OHIP card on time may lead to a crisis during medical emergencies.
- You must always maintain a list of the medical services covered under the OHIP card to make full use of them. Sometimes there are certain exceptional guidelines for children and senior citizens. Knowing each specific service in detail will help you at the time of requirement.
- You must update your address on the OHIP card in case of any relocation within the province. You will be more likely to get crucial information about your OHIP card and health insurance if you ensure your address is up to date.
Everyday Myths About the OHIP Card in Canada
It is a widely accepted notion in Canada that the OHIP card only bears the medical expenses of residents inside Ontario. However, the Ontario Health Insurance Plan (OHIP) also covers certain medical services received outside of Canada. Even while the OHIP card only covers a small number of medical services overseas and only pays a portion of the bill, many people find it helpful to get some of their travel expenditures reimbursed. The OHIP card is also accessible to temporary citizens who come to Ontario due to emergency situations. This service is provided solely on humanitarian grounds.
To Sum Up
Until recently, newcomers had to wait up to three months for OHIP coverage provided they met the requirements for instant insurance. However, this waiting time has been eliminated because of the COVID-19 epidemic. Citizens of Ontario can avail of full medical coverage using the OHIP card.
According to Ontario’s Health Insurance Act, an individual must typically be a Canadian citizen, a permanent resident of the province, or possess an employment authorisation to qualify for coverage under OHIP. One can even opt for private insurance plans to cover additional medical charges not included in the Ontario health insurance plan coverage.
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Frequently Asked Question (FAQs)
Hospitals will initiate your treatment in a critical situation without checking your card. However, if you want the Ontario Health Insurance Plan (OHIP) to cover your medical fees, you must present your card afterwards.
The OHIP can cover someone with insurance for a maximum of 12 months after departing from Ontario for travel or work briefly inside Canada.
Your OHIP coverage can take up to three months to start after your application, and the Transaction Record will indicate when it does.
The government sponsors OHIP, which is free of cost for the residents of Ontario.
After submitting the application, Ontario citizens who qualify for OHIP will get their OHIP card in four to six weeks. Do you need an OHIP card for the hospital or Emergency room?
How long can you stay out of Ontario and still be covered under OHIP?
When does OHIP coverage start?
How much does an OHIP card cost?
How long does it take to get an OHIP card?
