Ontario provincial health plan fact sheet

Your Ontario Health Insurance Plan provides:

Prescription drugs

  • Coverage under the Ontario Drug Benefit Plan Program for seniors aged 65 and older and Social Assistance recipients only.
    • Covers drugs listed on the Ontario drug formulary.
    • Seniors are responsible for a plan year deductible. Once this has been satisfied seniors must pay a copayment on each prescription.

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  • Catastrophic coverage under the Trillium Drug Program after a deductible (paid in quarterly installments) has been satisfied.
    • The deductible is based on family net income and once this has been satisfied, households pay a minimal copayment per prescription

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  • Full coverage for Injectable Cancer drugs and other serious conditions, such as cystic fibrosis, transplant drugs, etc.; is available through the New Drug Funding program if an individual qualifies

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  • Effective August 1, 2013 an annual quantity limit for blood glucose test strips has been implemented based on the diabetes treatment the patient is receiving.

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  • Effective January 1, 2018 Ontario introduced OHIP+. Coverage under OHIP+ is automatic for children and youth under the age of 25. OHIP+ is first payer for eligible medications under the Ontario Drug Benefit (ODB) formulary for residents without private drug coverage
  • Effective April 1, 2019, Ontario children and youth under the age of 25 with private plan coverage will be required to submit prescription drug claims directly to their private plan as coverage will no longer be available through OHIP+

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Ambulance

  • Coverage for in-province land and air ambulance when medically necessary. Patient is responsible for a copayment. Some exceptions apply.

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Dental benefits

  • No coverage for routine or major services (i.e. cleanings, fillings, extractions, endodontics, periodontics, crowns, bridges, dentures, etc.)
  • No coverage for treatment of accidental injury to teeth
  • Coverage for services provided by a dental surgeon, for specific procedures performed in hospital only

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Vision care

  • No coverage for glasses or contact lenses
  • Coverage for one eye exam every 12 months for residents 19 years and under and for residents aged 65 and over
  • Coverage for one major eye exam every 12 months for persons age 20 to 64 who have medical conditions requiring regular eye examinations

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Hospital

  • Coverage for standard ward rooms only

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Paramedicals

  • No coverage for chiropractor, psychologist, massage therapy or naturopath services.
  • Coverage for podiatrist services up to an annual maximum plus an additional amount per plan year is available for x-rays

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Hearing aids

  • Coverage under the Assistive Devices Program. Individual must apply for assistance

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Nursing benefits and home care

  • Some coverage based on need

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Medical supplies

  • Some coverage under the Assistive Devices Program such as the cost of insulin pumps and related ongoing supplies for Type 1 diabetics who are 18 years of age and under.  Individual must apply for assistance
  • Coverage through The Assistive Devices Program (ADP) for the full cost of insulin pumps for adults who qualify and are age 19 and over. In addition, an annual grant is provided to approved individuals for related supplies 

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Accidental death and dismemberment

  • No coverage.

Out of country

  • Out-of-Country Hemodialysis Reimbursement Program. 

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These highlights from the Ontario Health Insurance Plan are for general reference only and are subject to change, corrections and updates. Other government programs may also be available. For more information on the latest coverage details, contact the Ontario Health Insurance Plan:

Phone: 416-314-5518

Toll free in Ontario: 1-800-376-5197

TTY: 1-800-387-5559

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Updated: October 2020