Understanding the limitations of OHIP coverage

The Ontario Health Insurance Plan (OHIP) is the provincially run health insurance program for Ontario residents. It provides Ontario residents with access to emergency care and preventative health care free of charge.

While the program is available to all residents who have permanent residency in the province, there are some limitations. The project provides coverage for basic care needs, it does not cover many forms of treatment, including most prescription drugs and dental care, among other things. For a full list of what is and is not covered under OHIP, visit the Ministry of Health and Long-Term Care.

Eligibility limitations

To qualify for OHIP, you must meet the following criteria:

• You must be a Canadian citizen or permanent resident
• Your principal home must be in Ontario
• You must physically reside in the province for a minimum of 153 days in any 12-month period
• You can also qualify if you have a work permit (as outlined in Ontario’s Health Insurance Act)

Most Ontarians qualify under these eligibility limitations. However, residents who are away from the province for an extended period of time or those who are new to the province will have to apply for coverage.

Waiting period for new Ontario residents

New residents are not automatically granted provincial health insurance coverage when they move to Ontario. Whether you are moving from another province or territory within Canada, or from another country, you are subject to a 3-month waiting period before you have access to health care coverage, a limitation of OHIP that is often overlooked.

Many Canadians and new immigrants assume they will receive government health care when they move to the country, only to find out they have to wait to receive their permanent resident card. If you find yourself in this situation, the good news is that visitors to Canada plans are available.

Other limitations

Whether you have lived in Ontario your entire life, are a Canadian citizen, or a new immigrant to the province, there are limitations of OHIP coverage that you need to be aware of. Because of these limitations, an increasing number of Canadians are opting for supplementary health insurance to help them cover the additional costs.

Here are some of the limitations:

• Prescription drugs are not covered for individuals under the age of 65
• Services that are deemed to be medically unnecessary or cosmetic in nature are not covered
• Services from a podiatrist are only partially covered
• Only some types of dental surgery are covered
• Dental care is not covered
• Services offered by other health care providers, such as physiotherapists, chiropractors, massage therapists and other practitioners, are only partially covered or not covered at all
• Eye care exams are not covered for individuals 20 to 64 years old unless they have medical conditions that require regular exams

Learn more about supplemental health insurance for OHIP and the costs that OHIP doesn’t cover.

For more information about the limitations of OHIP coverage, contact the Ministry of Health and Long Term Care.