In the province of Ontario, public health coverage for citizens, permanent residents, and (under certain conditions) temporary residents is provided through the government-run health insurance program known as OHIP (Ontario Health Insurance Plan). This program covers the most basic medical services—such as family doctor visits, hospital stays, and some emergency services—free of charge and funded by the government.
Registration in this program is required in order to receive an Ontario Health Card.
Below is an overview of healthcare services covered under the Ontario Health Insurance Plan (OHIP) for eligible residents:
Prescription Drugs
- Ontario Drug Benefit Plan (ODB) is available for seniors aged 65 and older, or individuals receiving social assistance. In this plan, only drugs listed on the Ontario Drug Formulary are covered.
- Seniors may have to pay a portion of the cost depending on their annual income and marital status.
- Trillium Drug Program (Catastrophic Coverage) provides coverage after a deductible, based on family net income is met. After this, most prescriptions are available at up to $2.00 per drug.
Ambulance Services
- Partial or full cost of ambulance services for medical emergencies is covered depending on the circumstances and medical necessity.
Dental Benefits
- No coverage for routine dental care.
- Coverage applies only to dental surgeries when performed in hospital settings.
- Canadian Dental Care Plan (CDCP) is a federal program and may provide additional support.
Eye Care Services
- Children (19 and under): One eye exam per 12 months.
- Seniors (65 and over): One eye exam every 18 months.
- Adults (20–64): One eye exam per 12 months for those with eligible medical conditions affecting vision.
Hospital Coverage
- Covers standard ward rooms in public hospitals.
Hearing Aids
- Assistive Devices Program (ADP) covers 75% of the cost, up to a maximum of $500 for one hearing aid (if eligible).
Medical Equipment & Supplies
- Assistive Devices Program (ADP) provides partial funding for approved medical equipment and supplies (eligibility required).
Nursing and Home Care
- Some coverage is provided based on assessed medical need.
Paramedical Services
- Not covered: Chiropractor, Psychologist, Massage therapy, Naturopath services.
- Podiatrist visits: $7–$16 per visit, up to $135 per patient per year.
- Physiotherapy is Covered for:
– Seniors (65+)
– Children and youth (under 19)
– Individuals requiring treatment after hospitalization
Out-of-Country Emergency Coverage
- Limited emergency coverage while outside Canada:
- Up to $400 CAD/day for care in: Operating rooms, Coronary care units, Intensive care units, Neonatal/pediatric special care units
- Up to $200 CAD/day for other hospital care
However, it’s important to note that Ontario Health Insurance Plan (OHIP) does not cover all health-related expenses. Another major drawback of the public healthcare system is the long wait times for certain procedures, especially non-emergency surgeries. As a result, many patients are forced to turn to private options or use complementary insurance that allows for quicker access to specialists and healthcare services.
In such cases, having a valid complementary insurance policy tailored to your personal or family health needs not only brings greater peace of mind but also provides crucial financial support when facing unexpected medical costs or specialized care.
At Rahimian Insurance, we rely on our specialized knowledge in the insurance field and years of experience in the Canadian market to carefully assess your situation and offer the most suitable options with the clearest terms. All you need to do is to complete and submit the form below.
