Ontario Health Insurance Plan

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The Ontario Health Insurance Plan (in French: Assurance-Santé de l'Ontario, and commonly known in both languages by the acronym OHIP, pronounced /ˈhɪp/ OH-hip) is the government-run health insurance plan for the Canadian province of Ontario. OHIP is funded by a payroll deduction tax by residents who are gainfully employed, and by businesses in the Province of Ontario, and by transfer payments from the Government of Canada.

Every Ontario resident with his or her primary and permanent home in Ontario is entitled to access emergency and preventive medical care (although Bariatric surgery in many cases is not covered) under OHIP free of charge. Ontario residents may go to a participating doctor—essentially every doctor practising in the province—any time they wish (subject to the consent of the doctor) and the services are billed through OHIP to the government. It does not cover such areas as prescription drugs or dental care, although Ontario does have a drug insurance plan, for use as a "last resort", generically known as the Trillium Drug Program, or the Ontario Trillium Benefit (OTB) program.

Funding[edit]

While Ontario receives transfer payments from the federal government of Canada to partially fund health care, OHIP is also supported by general provincial tax revenues and premiums (taxes) paid by employers and individuals. Employers are charged a payroll health care tax (with an exemption for small businesses) and residents of the province pay a health premium (introduced in 2004) as part of their income taxes.

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 taxable income of $22,000, the premium doubles to $120; with taxable income of $23,000, the premium is $180; with 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.[1]

Delisted care[edit]

Until 2004, OHIP also paid for an eye examination every two years and limited chiropractic and physical therapy/physiotherapy services. The May 2004 budget, however, announced that most eye exams and all chiropractic and physical therapy would be "delisted", or removed from coverage, by the Liberal government of Dalton McGuinty. Physiotherapy ended up never being delisted from OHIP. Instead, effective April 1, 2005, OHIP coverage for physiotherapy was restricted to those 65 years of age and over, those 19 years of age and under, residents of long-term care homes (regardless of age), individuals who had been hospitalized (regardless of age) and individuals on the Ontario Disability Support Program, Family Benefits and Ontario Works (regardless of age). OHIP covers up to 50 visits per year post-hospitalization and up to 100 visits per year for residents of long-term care homes. The McGuinty government at the time promised to expand OHIP coverage for residents of long-term care homes and for residents of rural and remote areas. Provision continues to be made for free coverage to minors. Annual eye examinations are free for children (19 or younger), seniors (65 or older), adults ages 20–64 with certain ocular health conditions (including glaucoma, cataracts, and diabetes), as well as those receiving ODSP or Ontario Works (every two years).[2]

Eligibility[edit]

In order to be eligible for coverage under OHIP, 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, must make his or her permanent and principal home in Ontario, and must be physically present in Ontario 153 days in any 12-month period. Canadian citizens or permanent residents returning to Canada from another country are not normally covered by OHIP until they have been resident in Ontario for three months. In 2009 applicants for Permanent Residence from "Within Canada" were added to the plan following the "Approval In Principle"(AIP) stage of the process. Applicants from "Outside Canada" continue to be ineligible for OHIP until they receive their "Permanent Residence" card from CIC regardless of whether they enter Canada or not. It is recommended to obtain private health insurance to cover the waiting period. For those Canadian citizens or permanent residents moving to Ontario from another province, the province of previous residency will continue to cover them during the three-month waiting period.[2]

Waiting Period[edit]

  • Transfer from another Province, Territory or Country - 3 Months
  • Military Spouses - Immediate regardless of origin
  • Applicants for Permanent Residence from Inside Canada - as long as it takes for AIP (2-3 Months)
  • Applicants for Permanent Residence from Outside Canada - as long as it takes for PR (15-24 Months as of Apr 2014)

Precursors[edit]

Ontario's first government-run health plan was known as OMSIP (Ontario Medical Services Insurance Plan), established and enacted on 1 July 1966. On 1 October 1969, it was replaced by OHSIP, the Ontario Health Services Insurance Plan, as a provincially run and federally assisted plan under the federal Medical Care Insurance Act for establishment of a national medicare plan. In 1972 the plan name was shortened to simply OHIP.[3]

See also[edit]

Ministry of Health and Long-Term Care
Ontario
Health care in Canada

References[edit]

External links[edit]