Health Insurance in Ontario: Understanding OHIP, Group Plans, and Individual Coverage

In Ontario, the Ontario Health Insurance Plan —OHIP—offers basic medical coverage for all residents. For broader insurance, people often turn to either employer-sponsored group benefits or individual health insurance. 

This practical guide outlines the key differences between group and individual coverage, helping you make an informed decision based on your health needs and lifestyle.

 

1. OHIP: What Ontario’s Public Health Insurance Covers 

The Ontario Health Insurance Plan ensures access to essential medical services. Most Ontario residents are covered for: 

• Doctor visits 
• Hospital stays and emergency care 
• Medically necessary tests and procedures

 

However, OHIP does not cover many services people rely on regularly, including: 

• Prescription drugs (except for specific groups, such as seniors or those under 25 without private coverage) 
• Dental care 
• Eye exams and corrective lenses 
• Mental health therapy 
• Physiotherapy (with limited exceptions)

 

To access these types of care, individuals often turn to either group benefits through their employer or individual health insurance plans tailored to their needs. 

For more details on what OHIP does and doesn’t cover, see this article.

 

2. Group Benefits from Your Employer: What’s Typically Included 

Many workplaces in Ontario offer group health benefits. If your employer provides a plan, you're typically expected to enroll unless you're already covered under another group plan, such as your spouse’s.

Group benefits packages often include: 

• Prescription drug coverage 
• Dental and vision care 
• Access to a variety of health professionals (e.g., physiotherapists, chiropractors, psychologists)

 

You can usually add your spouse and children to your plan as well.

Keep in mind: If your group benefits do not meet all your needs, you may choose to supplement them with additional individual health insurance. 

 

3. Individual Health Insurance: When and Why to Consider It 

If you’re not eligible for a group benefits plan, individual health insurance can help cover services not included under OHIP. This is particularly useful for freelancers, retirees, students, or those between jobs. 

Plans like Blue Cross Health® give you the flexibility to tailor coverage to your priorities and budget. You can: 

• Select the services most relevant to you 
• Adjust reimbursement levels 
• Build a plan that supports your lifestyle and evolving needs

 

To qualify, you must be an Ontario resident and registered with OHIP. If you want drug coverage, you may need to meet additional eligibility criteria. 

Whether you’re supplementing OHIP or adding to limited group benefits, individual insurance can help close coverage gaps.

 

How to Choose the Right Health Insurance for You 

Start by assessing what you already have and where it may fall short. 

Ask yourself: 

• Do you have access to group benefits?
  If yes, participation is usually mandatory unless you're already covered under another comparable plan.
• What kinds of care do you regularly use? 
  Think about your ongoing needs—prescriptions, dental visits, eye exams, therapy, or physiotherapy. 
• Does your current coverage provide enough support? 
  If your current coverage is limited, individual insurance can help complete your plan and ensure you have access to the care you need. 

 

Flexible Coverage with Blue Cross Health®

At Blue Cross, we know that every person’s health journey is unique. That’s why we offer flexible, personalized health insurance plans designed to evolve with your needs. Whether you need essential coverage or a more comprehensive plan for your family, we offer options that fit your lifestyle. 

And because well-being is about more than just medical treatment, our plans also include wellness programs to support your physical and emotional health, at no extra cost.