The Government of Ontario Health Insurance Plan (OHIP), also known as Assurance-Santé de l’Ontario, is a government-run health insurance plan for Ontario, which is one of the principal province of Canada.
The OHIP program is funded from the payroll of deductible tax by gainfully employed Canadian residents and citizens, from businesses operating in the province of Ontario, and by direct sponsored payments from the Government of Canada
Under this program, every citizen and resident living primarily and permanently in Ontario is entitled to access emergency and preventive care free of charge. Essentially every health centers and doctors practicing in the province are under this scheme, therefore, Ontario citizens and residents can engage their services any time they so wish or have need to, payment for any services rendered are billed through OHIP to the government.
Generally, OHIP does not cover prescription drugs outside of hospitals or dental care. However, there is another program called the Ontario Drug Benefit Program which pays for prescription drugs for seniors who are covered by OHIP. Another program designated the Trillium Drug Program covers households with high prescription drug costs. Prescription drugs for young adults and those under 25 years of age are covered by OHIP through OHIP+.
As stated above not everyone is eligible to be covered under the OHIP program, there are certain criteria that are required that enable you to participate in the program.
In this article
- Eligibility Requirement for OHIP Program
- Who Is Eligible For OHIP?
- Is OHIP Free?
- OHIP Open Work Permit Employment Letter Guidelines
- Open Work Permit Guidelines For Temporary Foreign Workers
- Documents Required for OHIP Application
- What Document Are Required For Family Members of Temporary Foreign Workers?
- How To Apply For OHIP?
- What Is Covered In The OHIP?
- How Is The OHIP Funded?
- Requesting a Review for OHIP
- How To Carry Out OHIP Appeals?
Eligibility Requirement for OHIP Program
- The first of this requirement is that a person normally must be a Canadian citizen or permanent resident or a holder of a work permit as set out in Ontario’s Health Insurance Act,
- The individual must have made the province of Ontario his or her permanent and principal home.
- The individual must be physically present in Ontario for 153 days in any 12-month period.
- Canadian citizens or permanent residents returning to Canada from another country normally are not covered by OHIP until they have been resident in Ontario for three months.
- If you are a applicants from outside Canada you will not be eligible for OHIP until you have completed the landing process and actually become a permanent resident, at which point the usual three-month waiting period begins. Private health insurance is often advised during this waiting period.
- For any Canadian citizen or permanent resident who is moving to Ontario from another province, the province of the previous residency will continue to cover them during the three-month waiting period.
Haven stated what OHIP means and what it takes to be a partaker of the program, it is becomes important to know who is eligible to apply for OHIP.
Who Is Eligible For OHIP?
- Anyone who is a Canadian citizen or permanent resident and who transfers from another province, territory, or country in the province of Ontario after 3 months of residence.
- Spouses of military officers or those of Crown Servants: gets Immediate inclusion regardless of origin
- Applicants for permanent residence from inside Canada: as long as it takes for AIP
- Applicants for permanent residence from outside Canada: as long as it takes for PR (15–24 months as of April 2014).
- Holders of Canada Work Permits
- You have applied for permanent residence, and Immigration, Refugees, and Citizenship Canada has confirmed that: you meet the eligibility requirements to apply and have not yet been denied.
Is OHIP Free?
All Ontario permanent resident who has his or her primary and permanent home in the province of Ontario is captured under the OHIP program to access emergency and preventive care free of charge. However, OHIP does not cover prescription drugs outside of hospitals or for dental care.
OHIP Open Work Permit Employment Letter Guidelines
- The letter must be on your employer’s company letterhead
- It must be signed and dated by the employer in pen [“in pen” is a must and its strictly enforced without which the letter will not be accepted, no digital signing, only signature signed with ink on the company’s letterhead paper is acceptable.
The letter must state:
- That the employee is working full-time
- State the title/position of the worker in the occupation
- State that the employee will be working for the company within Ontario (the company does not have to be located in Ontario. The letter may have the address or city where the employee will be working in Ontario)
- State the start date of employment
- State that the employee has been employed for a minimum of six (6) months duration.
The letter should not be:
- An employment acceptance or offer letter
- A photocopy, scan, email, or fax.
Open Work Permit Guidelines For Temporary Foreign Workers
- The worker must be employed full-time by an employer in the province of Ontario for a minimum of 6 months.
- The applicant must maintain the province of Ontario as his or her primary place of residence.
- The applicant must be physically present in Ontario for at least 153 days in any 12-month period.
- Be physically present in Ontario for 153 of the first 183 days immediately after establishing residency in the province.
Documents Required for OHIP Application
The following documents are required of a foreign worker applying for OHIP coverage: IRCC work permit and confirmation of full-time employment in Ontario for a period of at least 6 months. Additional document requirements may be necessary.
What Document Are Required For Family Members of Temporary Foreign Workers?
Family members of OHIP-eligible temporary foreign workers may be eligible for OHIP coverage (this includes family members of OHIP-eligible open work permit holders and OHIP-eligible closed work permit holders) provided they are legally entitled to stay in Canada.
Family members must provide the following documents required for OHIP Application:
- OHIP-eligible Foreign Worker’s Work Permit
and any one other document of the following:
- The eligible foreign worker’s Canadian Immigration document identifying the accompanying family member(s); or
- The individual family member’s immigration document as issued by CIC or
- Family member’s passport with an admission stamp cross-referenced to the foreign worker’s work permit.
How To Apply For OHIP?
You as the applicant must apply for your OHIP in person at a service Ontario centre.
You will need to bring these documents with you:
- A completed Registration for Ontario Health Insurance Coverage form.
- Three separate, original (not photocopies or printouts of electronic documents) identification documents:
- One that proves your Canadian citizenship or OHIP-eligible immigration status (e.g. Canadian birth certificate, Permanent Resident Card )
- One that proves you live in Ontario (e.g. Ontario Driver’s License, income tax assessment)
- One that supports your identity (e.g. credit card, passport from any country)
What Is Covered In The OHIP?
OHIP covers many health services you may need, such as:
- Appointments with your family doctor
- Visits to walk-in clinics and some other health care providers
- Visits to an emergency room
- Medical tests and surgeries
NOTE: To be covered by OHIP, you must have a medical reason to receive a service or treatment. Cosmetic surgery, for example, is not covered.
How Is The OHIP Funded?
Ontario as amongst other provinces in Canada receives support funding from the Government of Canada to partially fund health care. OHIP is one of the health care schemes being funded by the government, the OHIP alongside the government is also supported by general provincial tax revenues and premiums (taxes) being paid by employers and individuals.
Employers are charged a payroll health care tax (with an exemption for small businesses), also residents of the province of Ontario pay a health premium (introduced in 2004) as part of their income taxes. Similarly, Ontario publicly funds hospitals.
The Ontario Health Premium (OHP) is a component of Ontario’s Personal Income Tax system. The OHP is based on taxable income for a taxation year.
As of May 2010, an Ontario resident with taxable income (i.e., income after subtracting allowable deductions) of $21,000 pays $60 per year. With a taxable income of $22,000, the premium doubles to $120. With a taxable income of $23,000, the premium is $180.
With a taxable income of $24,000, the premium is $240. The premium increases at a decreasing rate thereafter for taxable incomes up to $200,600 at which point the maximum premium of $900 is reached.
Requesting a Review for OHIP
If you have been denied before or told that you do not – or no longer – qualify for OHIP, you can request a review of the decision by:
Send OHIP a letter, fax or email stating:
- The reason(s) why you believe you qualify for OHIP
- Send additional information or documents to show you qualify
- Ensure to include an up-to-date contact information
How To Carry Out OHIP Appeals?
If your OHIP application was denied on the grounds of your eligibility and you want to appeal the decision of the OHIP Eligibility Review Committee, you can write to the Health Services Appeal and Review Board.
This, however, must be done within 15 days of receiving the written decision from the OHIP Eligibility Review Committee.
For more information on what to do should you encounter a set back in the application for OHIP, do check OHIP website.