What is OHIP
The Ontario Health Insurance Plan (OHIP) is the public health insurance program for Ontario residents. OHIP pays for many of the health services you receive when you visit a doctor, hospital, or other approved provider. The goal of OHIP is to ensure that medically necessary care is available to residents without direct cost at the time of treatment. When you present your health card at a clinic, hospital, or pharmacy for an eligible service, the government pays the provider directly.
See also: How to Register for a Health Card in Ontario
How Do You Access OHIP?
You access OHIP by applying through ServiceOntario and receiving a photo health card. This card confirms your eligibility and must be shown whenever you use covered health services. You should carry it with you when you visit a doctor, hospital, walk-in clinic, or lab. OHIP is not automatic—residents need to apply and update their information if they move or change status. Renewals happen every five years, and you must keep your address and personal information current to avoid losing coverage.
Who Is Eligible for OHIP?
Eligibility for OHIP depends on your legal status and residence in Ontario. You are eligible if you are a Canadian citizen, permanent resident, or certain categories of temporary resident who makes Ontario your primary home. You must be physically present in Ontario for at least 153 days in a 12-month period and make Ontario your main place of residence. New residents often wait three months before coverage begins, although some exceptions exist. If you are an international student, temporary foreign worker, or refugee claimant, you may or may not qualify, depending on your specific circumstances.
What Does OHIP Cover in Ontario?
OHIP covers a wide range of medically necessary services. Coverage is grouped into categories such as physician services, hospital care, diagnostics, and specific procedures. These services are available whether you visit a family doctor, a walk-in clinic, or an emergency department, provided the care is medically necessary.
Physician and clinic services
- Visits to family doctors, walk-in clinics, and other general practitioners for medically necessary reasons
- Telehealth and virtual visits when medically required
- Referrals to specialists made by a primary care doctor or walk-in physician
Hospital services
- Emergency room visits, inpatient stays, and outpatient treatments
- Diagnostic tests like blood work, ultrasounds, and X-rays ordered by a doctor
- Standard ward hospital rooms, nursing services, and meals during admission
Laboratory and diagnostic services
- Blood tests, urine tests, and other lab work ordered by a physician or nurse practitioner
- Imaging such as X-rays, CT scans, and MRIs when medically necessary
Specific procedures and treatments
- Medically necessary surgeries, including certain dental surgeries done in hospitals
- Abortions, whether surgical or medication-based
- Eligible podiatry services for foot health, though coverage is limited
- Eye exams for people under 20, over 65, or adults with specific medical conditions such as diabetes, glaucoma, or cataracts
- Ambulance services when medically necessary and deemed urgent by a physician
These covered services demonstrate that OHIP focuses on medically required care. When you visit a walk-in clinic for an illness or injury, most assessments and necessary tests fall within OHIP coverage.
What Does OHIP NOT Cover?
OHIP does not cover all health services, especially those considered elective or outside the scope of medically necessary care. Understanding these gaps helps you plan for private insurance or out-of-pocket costs.
Dental care
- Routine cleanings, checkups, fillings, crowns, and dentures
- Dental procedures performed in a dentist’s office, unless the surgery requires hospital care
Vision care
- Eye exams for adults aged 20–64 without a qualifying medical condition
- Glasses, contact lenses, and laser eye surgery
Prescription drugs
- Medications prescribed outside of a hospital setting, unless you qualify for a specific drug program like OHIP+ (for children and youth), the Ontario Drug Benefit (for seniors), or assistance programs for low-income residents
Cosmetic and elective procedures
- Cosmetic surgery such as liposuction, botox, or procedures done solely for appearance
- Some forms of physiotherapy, chiropractic care, and massage therapy unless prescribed and performed in approved facilities
Hospital and other services
- Private or semi-private hospital rooms unless medically required
- Travel vaccinations, sick notes for work, and most forms requested by employers or insurance companies
These exclusions mean that even though OHIP provides broad coverage, you may face additional costs for routine or elective services. Walk-in clinics often charge for forms, travel medicine consultations, or procedures that fall outside OHIP.
What Happens If You Leave the Province?
If you leave Ontario temporarily, OHIP continues to cover you for short trips within Canada or abroad, but the coverage has limits. Within Canada, OHIP pays for doctor and hospital services at Ontario rates, but you may need to pay upfront and seek reimbursement. Outside Canada, OHIP pays very limited amounts, and private travel insurance is strongly recommended. For students studying elsewhere, workers on short-term contracts, or snowbirds, special rules may extend coverage for up to two years with proper paperwork. However, out-of-country care almost never covers the full cost, and many people choose supplemental insurance.
What If You’re Not Covered?
If you are not covered by OHIP, you are responsible for paying for medical services or obtaining private insurance. International students often buy health coverage through their schools. Refugee claimants may qualify for the Interim Federal Health Program, but its scope is narrower than OHIP. Some community health centres provide basic care regardless of coverage, but services are limited. For people without OHIP, walk-in clinics may still see you, but they will usually require payment upfront. Blood tests, X-rays, and prescriptions also carry additional costs if not covered.
Book a Same-Day Walk-in Clinic Appointment at Infinity Health
Walk-in clinics play an important role when you cannot see your family doctor. Infinity Health offers same-day walk-in appointments in Toronto and Oakville, providing access to physicians, diagnostic testing, and referrals. With OHIP, your visit is covered if the care is medically necessary. Without OHIP, you can still access services, but you should expect to pay out-of-pocket.
Infinity Health Locations
Toronto: 39 Lower Simcoe Street, Toronto, ON M5J 3A6
Oakville (Bronte Village): 2441 Lakeshore Rd W, Oakville, ON L6L 5V5