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 must pay the first $100 in prescription costs. Once this has been satisfied, seniors must pay the first $6.11 for each prescription. 
  • 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. 
Treatment category

Annual

quantity

limit

Managing diabetes with insulin 3,000
Managing diabetes with anti-diabetes medication with high risk of causing hypoglycemia 400
Managing diabetes using anti-diabetes medication with low risk of causing hypoglycemia 200
Managing diabetes through diet/lifestyle 200
 
  • 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.  Once this has been satisfied, households must pay up to $2.00 for each prescription
  • 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
  • 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+  

Ambulance

  • Coverage for in-province land and air ambulance when medically necessary. Patient is responsible for a $45 co-payment. Some exceptions apply.

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

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
  • Coverage for routine eye examinations once every two years for residents receiving assistance under the Ontario Disability Support Program, Ontario Works or the Family Benefits Program

Hospital

  • Coverage for standard ward rooms only

Paramedicals

  • No coverage for chiropractor, psychologist, massage therapy or naturopath services.
  • Coverage for podiatrist services up to an annual maximum of $135. An additional $30 per plan year is available for x-rays
  • Coverage for speech therapy services when performed in hospital only
  • Coverage for physiotherapy for seniors aged 65 and over, individuals age 19 and under and individuals of any age needing physiotherapy after being hospitalized

Hearing aids

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

Nursing benefits and home care

  • Some coverage based on need

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 of $2400 (paid out in units of $600, quarterly) is provided to approved individuals for related supplies 

Accidental death and dismemberment

  • No coverage.

Out of country

  • Coverage for emergencies only. In-patient services are covered up to $400 per day for higher-level hospital care and up to $200 for any other kind of medical care.

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: August 2019