To get public
medical coverage under OHIP (the Ontario Health Insurance Plan), you must be a
"resident" of Ontario. You must also be living in this province when you apply
There is no "family coverage" under OHIP. A separate
application must be made for everyone, including newborn babies. If you
qualify, you receive a numbered Health Card with your photo on it. You must
show this Card whenever you need medical care.
OHIP only pays for services that are medically
necessary. It covers hospital care and the diagnosis and treatment of disease
by physicians. It also covers the cost of a bed in a "standard" ward, but not
in a private or semi-private room. It does not cover telephone consultations
or medical reports for an employer or a legal proceeding. Doctors can bill you
for these services, just as they can for missed appointments.
Who qualifies for OHIP?
To qualify for OHIP, you
must be "ordinarily resident" in this province. That is, your principal
home must be in Ontario. You must also be one of the following:
- a Canadian citizen or landed immigrant,
- a status Indian,
- a Convention refugee,
- an applicant for "landing" (permanent
resident status) who has met the medical admissibility requirements,
- someone on a work permit that is valid for
at least six months, that names the Canadian employer, and that
specifies the worker's occupation,
- the worker's spouse or dependent child,
provided that the Canadian employer states in writing that he or she
intends to employ the worker for three years,
- a visiting cleric (clergyman or clergywoman)
with employment in Ontario for at least six months,
- the cleric's spouse or dependent child,
provided that the employer states in writing that he or she intends to
employ the cleric for three years,
- a foreign domestic worker who is in Ontario
as a live-in caregiver,
- someone on a Minister's Permit, provided
that his or her Minister's Permit "case type" is number 86, 87, 88, or
89 (in other words, that he or she is an "early admission case," a
Minister's Permit holder being processed for permanent residence), or
- a child whose Minister's Pen-nit case type
is number 80, if he or she is being adopted by someone covered by OHIP.
What about seasonal agricultural workers who come to Ontario from other
countries? Can they get OHIP coverage?
It depends. OHIP has a
special provision for people who come with employment authorizations
issued by Canada Immigration under the Caribbean Commonwealth and Mexican
Seasonal Agricultural Workers Programme. These people are eligible for
OHIP right away and without being "ordinarily resident" in Ontario.
What about refugee claimants?
Medical care for refugee
claimants is provided by the Interim Federal Health (IFH) program, not
OHIP. If you make a refugee claim, Canada Immigration gives you documents
showing you are entitled to IFH coverage. The IFH program provides
essential health services for the prevention or treatment of serious
medical and dental conditions, as well as contraception, prenatal, and
obstetrical care. It does not cover all routine medical or dental
services. For more information, contact Citizenship and Immigration
Is there a waiting period for OHIP?
Usually, yes. Most people
have to wait three months after applying for OHIP. They are not insured
during this period unless:
- they are seasonal agricultural workers
exempt from the waiting period,
- they are children under 16 who are adopted
by someone who is insured,
- they are newborns born in Ontario to someone
who is insured,
- they can prove they have lived in Ontario at
least three months before their application for OHIP,
- they are found to be Convention refugees, or
- they are among those with Minister's Permits
who qualify for OHIP.
Under some circumstances, other people may also
be exempt from the three month waiting period; for example, members of the
Canadian Forces or Royal Canadian Mounted Police, diplo- mats, released
prisoners, and people who move to a nursing home or home for the aged in
Ontario from a province where they were covered by that province's health
Note: Anyone who
moves to Ontario from a province where they were covered by that
province's health insurance plan, is covered by that plan during their
first three months in Ontario. To avoid a gap in coverage, however, you
must apply for OHIP as soon as you arrive in Ontario.
What about newborn babies?
The rules that apply to older applicants apply to
newborn babies. For example, a baby born in Ontario may qualify for OHIP
as a Canadian citizen who lives in Ontario and intends to make his or her
principal home in this province.
Babies born in Ontario are exempt from the three
month waiting period if at least one of their parents is covered by OHIP.
What happens to my coverage if I leave Ontario for a while?
In the first 183 days (six
months) after your OHIP application, you must spend at least 153 days in
Ontario. To keep your coverage after that, you must spend at least 183
days in Ontario in any 12-month period.
How do apply for OHIP?
Application forms are available from your nearest
Ministry of Health office, listed in the blue pages of your telephone
book. Some doctors' offices and hospitals also have OHIP applications.
It's a good idea to submit an application even if
you are told that you may not qualify for OHIP. Mail or deliver the
completed form to the nearest Ministry of Health office. Include all the
other documents requested on the application form.
If you give birth in a hospital, staff will give
you an OHIP application form for your baby.
What if my application is turned down?
If OHIP turns you down, you should receive a
written explanation for this decision. If you do not receive a written
decision, contact the office where you applied and ask for it. Or ask a
community legal clinic to help get the decision. You need a written
decision before you can appeal the refusal.
Once you receive the written decision, you have
15 days to appeal to the provincial Health Services Appeal Board. You must
appeal in writing, submitting your letter of appeal by mail or in person
to the Health Services Appeal Board, with a copy to the General Manager of
the Ontario Health Insurance Plan.
Health Services Appeal Board
151 Bloor Street West 9th Floor
Toronto, Ontario M5S 2T5
Tel.: (416) 327-8512
General Manager OHIP
49 Place d'Armes 2nd Floor
Kingston, Ontario K7L 5J3
If 15 days have passed since you received the
written decision, you can still try to appeal. Ask for an extension (more
time) in your letter of appeal.
OHIP appeals are heard before a panel of the
Health Services Appeal Board. The Board's decisions can be appealed to the
Ontario Divisional Court.
If you are turned down for OHIP and want to
appeal, it's a good idea to get help. Community legal clinics can provide
free legal advice and, in some cases, legal representation at appeals.
What if I can't get OHIP but need medical care?
Many towns and cities in
Ontario have community health centres where you may not need to show an
OHIP card. Contact the centre nearest you and explain your situation. If
you don't know where the centre is, ask for its address from your
community information centre or public health office.
IMPORTANT TELEPHONE NUMBERS
College of Physicians & Surgeons:
Ontario Ministry of Health - Information Centre:
Ontario Health Insurance Plan (OHIP):
Ontario Medical Association (OMA):