How to Get Health Insurance in Ontario (OHIP)

By Taxiarchos228 [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], from Wikimedia Commons

This should be easy. After all the paperwork you’ve filled out to get accepted and to receive an Invitation to Apply, and then having obtained your Permanent Residence, getting your OHIP card is relatively straightforward now that you’re here in Canada and living in Toronto. You just head to the Ontario government’s website that tells you how to apply and click on the link that says: Registration for Ontario Health Insurance Coverage form. Follow the links to here and download the form. It’s quite a simple document but read the instructions carefully and make sure you fill out the appropriate sections depending on your immigration status. Then print it out and sign it.

Now you just have to remember where exactly to take your application to register with the Ontario Health Insurance Program. You look for the nearest Service Ontario centre on your laptop and then get ready to head out and apply. You’ve only been in Canada for a short while, and you know how important it is to apply for health insurance which is public and much of it is free. (Well, not exactly “free” as OHIP is funded by the taxpayers’ money.) But not all. So many questions in your head as you head downstairs and out your buildings’ front door.

You also have to remember to bring 3 types of documents when you take your completed form along with your documents to the Service Ontario centre. You will need 3 types of documents:

  • Proof of Citizenship or Proof of Immigration Status and Eligibility for OHIP. They can include:
    • A valid passport
    • A Canadian Citizenship card or certificate
    • Temporary Confirmation of Registration Document
    • Certificate of Naturalization
    • Permanent Resident Card (even one that has expired for less than 5 years)
    • Confirmation of Permanent Residence (IMM5292 or IMM5688)
    • Record of Landing (IMM1000)
    • Letter confirming Protected Person or Refugee status
    • Protected Person Status document
    • Written confirmation from IRCC that you are eligible to apply for permanent residence or that you are eligible to apply for citizenship
  • Proof of Residency. This shows that you are currently residing in the province of Ontario and can include:
    • Employer record on company letterhead or a paystub
    • Income tax assessment
    • Insurance policy
    • Mortgage contract or lease or rental contract
    • Monthly mailed bank account statements
    • Ontario Motor Vehicle Permit
    • Statement of Employment Insurance benefits
    • Utility Bill
    • Valid Ontario Driver’s license
    • Valid Ontario photo card
  • Support of Identity. This is a document that has both your name and your signature on it. This could include:
    • Canadian Immigration ID card
    • Canadian Citizenship card
    • Confirmation of Permanent Residence (IMM5292 – only if signature is displayed)\Permanent Resident Card (only if signature is displayed)
    • Passport
    • Current Employee ID card
    • Student card
    • Valid Ontario Driver’s license
    • Valid Ontario photo card

With your 3 documents (one from each of the 3 groups listed above) and your completed form you head to the Service Ontario centre at 777 Bay Street, right at the intersection with College Street. You take the 506 Carlton streetcar (College street becomes Carlton street after you cross Yonge street and keep heading East - but you knew that right?) and get off at Bay street.

Yes, it’s busy and there’s a line up but you get processed reasonably quickly and are back out on Bay street with your OHIP card in hand, right??

Wrong. You now have a 4 to 6 week wait before your OHIP card gets sent to you and you also have a 3 month wait before you are eligible to start using your OHIP card at hospitals, clinics, and doctor’s offices. You knew that, right? Which means you had better have bought private insurance – best to do it with a Canadian company like Ontario Blue Cross, for example – to cover the waiting period. If you don’t have private insurance and you become ill or injure yourself before you become eligible for OHIP, you may have to pay the full cost of your hospitalization and any other healthcare you receive.

But that’s not the only type of insurance that you should consider when thinking of healthcare in Canada. Even when you have your health card, there are several services that are not covered by OHIP and which you have to pay for out of your own pocket. As you head back West down College on the 506 Carlton streetcar, you glance through the pamphlets you picked up at the Service Ontario centre and read about what OHIP doesn’t cover:

  • Prescription drugs that are prescribed in a non-hospital setting. In other words, any sort of medication that your family doctor, or the doctor you see in a clinic rather than a hospital setting, is NOT covered by OHIP.
  • Most dental services are NOT covered by OHIP. The only dental services OHIP covers are those performed in a hospital because of things like complexity or the patient’s medical condition and the need for monitoring. This includes medically necessary tooth removal in a hospital setting.
  • Psychiatrists that prescribe medication and work out of a hospital setting are covered but most mental health professionals are NOT covered by OHIP. This means that:
  • Psychologists are NOT covered by OHIP
  • Mental Health Counsellors are NOT covered by OHIP
  • If you are an out-patient leaving the hospital after surgery or some other treatment, OHIP may not cover all your costs of any medication that has been prescribed.
  • A private or semi-private hospital room is NOT covered by OHIP.
  • If you are 20 to 64 years old, OHIP will only cover 1 eye exam per year IF you have one of the following conditions:
    • diabetes mellitus
    • glaucoma
    • cataract
    • retinal disease
    • amblyopia
    • visual field defects
    • corneal disease
    • strabismus
    • recurrent uveitis
    • optic pathway disease
  • Surgeries performed by Podiatrists in a non-hospital setting are NOT covered by OHIP.
  • Your Ambulance Services are NOT fully covered by OHIP except in very specified circumstances, generally when you are on some sort of social assistance program or participate in Ontario Works, or are part of a disability program. You generally have to pay $45 per ride or up to $250 per ride. You may even have to pay the full cost of your ambulance services in certain circumstances.
  • Eye glasses or contact lenses are NOT covered by OHIP. Neither is laser eye surgery.
  • Cosmetic surgery is NOT covered by OHIP.
  • Physiotherapy for people aged 20 to 64 years of age are NOT covered unless in very specified circumstances.
  • Alternative medicine treatments are NOT covered by OHIP.

You stare out the window of the streetcar as an ambulance rushes North on Bathurst Street and wonder: do they have coverage or will they have to pay? As the ambulance siren slowly fades away, you start to think about what is called supplemental insurance, that is private insurance plans that cover what OHIP doesn’t. As you can see from above, it’s a fairly long list of things that OHIP doesn’t cover. Plus, you get the option of getting coverage for when you travel abroad. For example, travel medical insurance means you’re covered no matter where you travel.

As you reach your stop further west on College street, you realize you need to do what you should have done before you even booked your flight to Canada. You need to buy supplemental insurance both to see you through your 3-month waiting period until you become eligible, and to supplement your OHIP plan once you start using your OHIP health card. Canada’s public health care system is an excellent public service, but it does not cover all your needs. Why risk having to pay large healthcare expenses out of pocket when you can purchase quite reasonable health insurance that, when combined with OHIP, will cover all the bases?

You unlock your front door, and head inside. Time to open up your laptop and do a little investigating about supplemental health insurance plans. An ounce of prevention is worth a pound of cure, as Benjamin Franklin wisely advised us all.

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