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Ontario provincial health plan

What’s covered by the provincial government health plan?

The Ontario Health Insurance Plan (OHIP) is the provincial plan for all Ontario residents. It provides coverage for most of your basic healthcare services.

Are you covered?

To qualify, you must be a resident of Ontario for at least 5 months. Certain exceptions applyOpens a new website in a new window - Opens in a new window .

What’s covered with OHIP
Prescription drugs

Generally, the province doesn't pay for prescription medicine if you’re between the ages of 25 and 65. The Ontario Drug Benefit programOpens a new website in a new window - Opens in a new window covers seniors 65 years and older, recipients of social assistance and adults 24 years or youth younger who aren’t covered by a private insurance plan.

The provincial plan only covers drugs listed on the Ontario drug formularyOpens a new website in a new window - Opens in a new window .

Ambulance

You’re covered for in-province land and air ambulance when medically necessary and responsible for a copayment. Some exceptions apply.

Learn more about ambulance service billing information.Opens a new website in a new window - Opens in a new window
Dental benefits

You’re covered for some in-hospital dental surgeriesOpens a new website in a new window - Opens in a new window in Ontario.

There is no coverage for routine or major services such as cleanings, fillings, extractions, crowns, dentures, etc. You also aren’t covered for treatment of accidental injury to teeth.

Vision care

You’re covered for 1 major eye exam every 12 months if you are 19 years and younger, 65 years and older or 20-64 years old with medical conditions requiring regular eye exams.

You aren’t covered for prescription glasses or contact lenses.

Learn more about eye exam coverage.Opens a new website in a new window - Opens in a new window
Hospital You’re covered for standard ward rooms only. Learn more about hospital staysOpens a new website in a new window - Opens in a new window .
Paramedicals

You’re covered for podiatrist services up to an annual maximum of $135, with additional fees for x-rays.

You aren’t covered for chiropractor, psychologist, massage therapy or naturopath services.

Find out what podiatry services are available.Opens a new website in a new window - Opens in a new window
Assistive Devices Program (ADP) including hearing aids

The Assistive Devices Program (ADP)Opens a new website in a new window - Opens in a new window covers up to 75% of the cost for various customized equipment and supplies for people with long-term physical disabilities. You pay 25% of the cost when buying equipment and you are not covered for repairs or maintenance of equipment or supplies.

You need to qualify to be covered.

Nursing benefits and home care Home care coverage varies by need. If you qualify, the Ontario government provides coverage for a variety of services in your home and communityOpens a new website in a new window - Opens in a new window .
Accidental death and dismemberment OHIP does not provide any coverage for accidental death and dismemberment.
Out of country

Coverage for emergencies only through the Out-of-Country Travellers ProgramOpens a new website in a new window - Opens in a new window .

The province also covers out-of-country dialysis servicesOpens a new website in a new window - Opens in a new window , for Ontarians living with kidney failure.

How personal insurance can keep you covered

Personal health insurance can help supplement your coverage where you need it most.

  • Cover unexpected costs

    Though you’re covered, you still pay for some of your provincial health coverage. Personal health insurance can help make sure you aren't paying out of pocket for unexpected expenses.

  • Plan ahead

    Knowing the gaps in provincial plans and the workplace coverage you have can help make sure you have the coverage you and your family needs.

  • Help save money

    Taking care of your health now means avoiding serious illnesses or paying for expensive treatments later. Personal insurance can help you get the services and care you need without the big cost.

Talk to an advisor today

Government health coverage varies from province-to-province. Let’s build a plan so you and your family are protected.

These highlights from the Ontario Health Insurance Plan are for general reference only and are subject to change, corrections and updates. Other government programs may also be available. For more information on the latest coverage details, contact the Ontario Health Insurance Plan:

Phone: 416-314-5518
Toll free in Ontario: 1-800-376-5197
TTY: 1-800-387-5559
OntarioOpens a new website in a new window - Opens in a new window

 

Last updated: March 2021