How to Get an Ontario Health Card: Applying for OHIP

Introduction to OHIP and its Importance for Newcomers

Eligibility Criteria for New Immigrants

To qualify for OHIP, new immigrants must meet specific criteria. These include having a permanent resident status, having applied for immigration status, and residing in Ontario for at least 153 days in any 12-month period.

Who is Not Eligible for OHIP?

The Ontario Health Insurance Plan (OHIP) is not accessible to everyone. Those who typically don’t qualify include tourists, visitors, some temporary workers, foreign students (with specific exceptions), Canadian citizens who don’t primarily live in Ontario or have been out of Canada for more than 212 days in a year, and individuals with expired or illegal immigration status. Refugee claimants may also be ineligible, depending on their specific circumstances.

Required Documentation

Applicants need to prepare certain documents for the OHIP application. This includes proof of identity (such as a passport), proof of residency status (like a Permanent Resident card), and proof of residency in Ontario (such as a rental agreement or utility bill). It’s important to check the latest requirements on the Ontario government’s website, as the required documents may change.

Application Process

To apply for OHIP, newcomers must visit a ServiceOntario center in person. It’s advisable to book an appointment or check the walk-in hours. During the visit, you’ll need to complete an application form and submit it along with your documents. The staff at ServiceOntario will verify your documents and process your application.

After Submitting the Application

After submitting your application, there’s typically a waiting period before your coverage begins. This period usually lasts up to three months. During this time, it’s wise to consider temporary health insurance to cover any necessary medical expenses.

Using Your OHIP Card

Once you receive your OHIP card, you can use it to access a wide range of health services, including visits to doctors, hospital stays, and certain medical tests.

What Happens if You Forget Your OHIP Card at the Doctor’s?

If you forget your OHIP card when visiting the doctor, you may still be admitted for treatment, especially if the office has your details on file.

What is Covered by the OHIP?

The Ontario Health Insurance Plan (OHIP) provides coverage for a wide range of health services to eligible Ontario residents. Here’s a summary of what is typically covered:

• Doctor Visits: Consultations, examinations, and some treatments provided by a family doctor or a specialist are covered.
• Hospital Services: This includes stays in a hospital, necessary diagnostic tests, and surgeries.
• Medical Tests and Surgeries: Necessary diagnostic services, such as blood tests, X-rays, and surgeries that are required for medical reasons. MRI scans are also covered by OHIP but only if they are medically necessary and prescribed by a licensed physician. This coverage applies to scans conducted in hospitals and certain OHIP-certified private clinics.
• Emergency Health Services: Coverage for emergency medical services, particularly in situations where immediate medical attention is needed.
• Dental Surgery: OHIP covers some dental surgeries, but this is limited to procedures that must be done in a hospital.
• Optometry (Eye Health Services): Eye examinations are covered for individuals under 20 and over 65 years of age and those with specific health conditions.
• Podiatry (Foot Health): Limited coverage for podiatric services, excluding routine foot care.
• Ambulance Services: OHIP partially covers the cost of ambulance services in cases of medical emergency.

What is Not Covered by the OHIP?

• Prescription Medications: For most people under 65, prescription drugs outside hospitals are not covered.
• Routine Dental Services: Basic dental care is not included, except for specific surgical procedures that must be performed in a hospital.
• Eye Exams for Certain Age Groups: Routine eye exams for adults aged 20 to 64 are not covered, except for individuals with specific medical conditions.
• Cosmetic Surgery: Procedures that are deemed cosmetic and not medically necessary are not covered.
• Out-of-Country Medical Services: OHIP provides very limited coverage for medical services received outside Canada.
• Ambulance Services: While partially covered, there is usually a co-payment for ambulance services, except under certain conditions.
• Private Rooms in Hospitals: If you choose a private room in a hospital, the additional cost is not covered.
• Alternative Therapies: Services such as acupuncture, chiropractic, naturopathy, and others are typically not covered.
• Hearing Aids and Glasses: OHIP does not cover hearing aids, eyeglasses, and contact lenses.

Does OHIP Cover You Outside of Ontario?

OHIP offers limited medical coverage outside Ontario.

Renewal and Updates

OHIP cards need to be renewed periodically. Ensure to keep track of the expiry date on your card and follow the renewal process, which may involve providing updated documentation and visiting a ServiceOntario center. Also, inform ServiceOntario about any changes in your address or immigration status.

Conclusion

Successfully obtaining an OHIP card is a crucial step in settling in Ontario as a new immigrant. It ensures access to healthcare services and contributes to a smoother transition into your new life in Canada. By following the outlined steps and utilizing available resources, the process can be straightforward and manageable.