Ontario provincial health care plan (OHIP)

Eligibility and coverage details for Ontario

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GHIP

Who is covered by the Ontario provincial government health care plan?

The Ontario Health Insurance Plan (OHIP) provides coverage for all Ontario residents. It includes essential healthcare services such as doctor visits, hospital stays, and some surgeries. Residents must apply to receive OHIP coverage.

GHIP

Are you eligible?

To qualify for the Ontario Health Insurance Plan (OHIP), you must reside in Ontario for at least 5 months out of the year. Certain exceptions apply.

What's covered

Coverage details for the Ontario provincial Health Care Plan (OHIP)

Benefit
Coverage details
Prescription Drugs

The Ontario Drug Benefit (ODB) program provides coverage for residents aged 65 and older, individuals receiving social assistance, and adults or youth who do not have private insurance coverage. The ODB program covers drugs listed on the Ontario drug formulary, and participants pay a co-payment depending on their income level. The Biosimilars Initiative in Ontario ensures that only biosimilar versions of eligible drugs are covered under the provincial plan.

Ambulance

Ambulance services in Ontario are covered when medically necessary, both for land and air ambulance transportation within the province. However, residents are required to pay a copayment for these services, unless they meet specific exemptions. Some exceptions apply, such as for seniors, those with social assistance, or hospital-to-hospital transfers. Learn more about ambulance service billing in Ontario.

Dental benefits

In-hospital dental surgeries are covered when medically necessary, but routine dental services, such as cleanings, fillings, extractions, crowns, and dentures, are not covered under the Ontario Health Insurance Plan (OHIP). The plan also does not cover dental treatment for accidental injuries to teeth, leaving residents responsible for most dental care costs.

Vision care

The Ontario Health Insurance Plan (OHIP) covers one major eye exam every 12 months for residents aged 19 and younger, 65 and older, and for those aged 20 to 64 with medical conditions requiring regular eye exams. Prescription glasses and contact lenses are not included. Learn more about eye exam coverage.

Hospital

The Ontario Health Insurance Plan (OHIP) covers standard ward room accommodations and medically necessary services during hospital stays. Private and semi-private rooms are not included in the coverage and will require an additional fee. Learn more about hospital stays.

Paramedicals

Ontario Health Insurance Plan (OHIP) provides limited coverage for podiatrist services, up to an annual maximum of $135, with additional fees for x-rays. Chiropractor, psychologist, massage therapy, and naturopath services are not covered under OHIP. Learn more about what podiatry services are available under the provincial plan.

Hearing aids

Ontario’s Assistive Devices Program (ADP) covers up to 75% of the cost for hearing aids and other customized equipment for individuals with long-term physical disabilities. Residents are responsible for the remaining 25% of the cost. However, ADP does not cover maintenance, repairs, or replacement of hearing devices. Eligibility is determined based on the individual’s condition and long-term need for the equipment.

Medical equipment & supplies

The Assistive Devices Program (ADP) in Ontario covers up to 75% of the cost for various customized equipment and medical supplies for residents with long-term physical disabilities. Individuals are responsible for 25% of the cost. However, repairs and maintenance of equipment and supplies are not covered. Eligibility is based on medical need and the type of device required.

Paramedicals

Ontario Health Insurance Plan (OHIP) provides limited coverage for podiatrist services, up to an annual maximum of $135, with additional fees for x-rays. Chiropractor, psychologist, massage therapy, and naturopath services are not covered under OHIP. Learn more about what podiatry services are available under the provincial plan.

Nursing benefits and home care

Ontario’s home care services are based on need and offer support such as personal care, nursing, rehabilitation, and home support services. The provincial government provides coverage if you qualify, ensuring care can be administered in the home or community for those with assessed medical requirements.

Accidental death and dismemberment

The Ontario Health Insurance Plan (OHIP) does not provide coverage for accidental death and dismemberment. Private insurance options are available for residents who require this type of protection.

Out of country

Ontario’s Out-of-Country Travellers Program provides coverage for emergencies only, reimbursing services at Ontario rates. The province also offers coverage for out-of-country dialysis services for Ontarians living with kidney failure. All other non-emergency or non-hospital services are not covered, and residents are responsible for any costs beyond provincial rates.

Disclaimer

The information provided on this page is intended for general informational purposes only and may be subject to change. While every effort is made to ensure accuracy, provincial and territorial health coverage details can vary and are regularly updated. We recommend contacting your respective GHIP or consulting a legal, tax, or insurance advisor for advice tailored to your specific situation.

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Extended Health Care

How Personal Health & Dental Insurance Complements Your Provincial Plan

While your provincial or territorial health plan covers many essential medical services, there are important areas where personal health insurance can help extend your coverage, giving you broader protection and peace of mind.

Bridge the Gaps in Coverage

Provincial health plans often leave gaps, such as prescription drugs, dental visits, and vision care. Personal health insurance can bridge these gaps by covering expenses your government plan doesn’t, ensuring you’re not left with unexpected out-of-pocket costs.

Be Ready for Life’s Health Changes

Even with your government health coverage, there are still costs that can catch you off guard, like prescription drugs, dental care, and vision expenses. A personal health plan can step in to cover these out-of-pocket expenses, making sure you’re protected from financial surprises.

Secure Your Health & Financial Future

Investing in personal health insurance today can save you from paying high costs for treatments or services down the road. By taking a proactive approach, you can ensure you get the care you need now, avoiding bigger health issues—and bigger bills—later on.

Get in touch

Talk to an advisor who can understand your situation, answer your questions and help you build an insurance plan appropriate for you and your family.

How to contact your GHIP

For more information on the latest coverage details, please contact the Ontario provincial health care plan directly at:

Ontario Health Insurance Plan (OHIP)
Phone: 416-314-5518
Toll-free: 1-800-376-5197
TTY: 1-800-387-5559
Email: [email protected]

Website: Ontario Health Insurance Plan (OHIP)