Ontario Health Insurance Plan

The Ontario Health Insurance Plan (French: Assurance-Santé de l'Ontario), commonly known in both official languages by the acronym OHIP (pronounced /ˈoʊhɪp/ 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, 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 care 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. OHIP does not generally cover prescription drugs outside of hospitals or dental care.[1] However, the Ontario Drug Benefit program pays for prescription drugs for seniors covered by OHIP[2] and the Trillium Drug Program covers households with high prescription drug costs.[3] As of 1 January 2018, prescription drugs for those under 25 years of age are covered by OHIP through OHIP+.[4]

In 2018, the Ontario Health Insurance Plan announced a new program designed to assist individuals struggling with food addiction.[5] As of 1 April 2019, the Ontario government will no longer offer free prescriptions to children and young adults with private coverage.[6]

Funding

While Ontario receives transfer payments from the 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. 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.[7]

Delisted care

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" (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).[8] 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. The 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).[9]

Eligibility

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 complete the landing process and actually become permanent residents, at which point the usual three-month waiting period begins. 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 the previous residency will continue to cover them during the three-month waiting period.[10]

Waiting period
  • 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
  • Applicants for permanent residence from outside Canada: as long as it takes for PR (15–24 months as of April 2014)

Precursors

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 the establishment of a national medicare plan. In 1972 the plan name was shortened to simply OHIP.[11]

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

References
  1. "What OHIP Covers". Ontario.ca. Queen's Printer for Ontario. Retrieved 11 February 2018.
  2. "Get coverage for prescription drugs". Ontario.ca. Queen's Printer for Ontario. Retrieved 11 February 2018.
  3. "Get help with high prescription drug costs". Ontario.ca. Queen's Printer for Ontario. Retrieved 11 February 2018.
  4. "Learn about OHIP+". Ontario.ca. Queen's Printer for Ontario. Retrieved 11 February 2018.
  5. "New program to help people struggling with food addiction". News-Medical-Life Sciences. June 6, 2018. Retrieved June 20, 2018.
  6. Gladysz, Kayla (2019-03-21). "OHIP+ free prescription drug benefit changes begin next month". Daily Hive. Retrieved 2019-03-21.
  7. Ontario Health Premium Rate Chart
  8. "OHIP Physiotherapy Clinics | pt Health OHIP Covered Physio". pt Health. Retrieved 2016-07-12.
  9. "OHIP Billing Software" (PDF).
  10. health.gov.on.ca
  11. Official website history
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