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Ontario Provincial Health Plan – Fact Sheet

Your Ontario Health Insurance Plan Provides:

Prescription Drugs:

Coverage under the Ontario Drug Benefit Plan Program for seniors 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.

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.

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.

Visioncare

No coverage for glasses or contact lenses.

Coverage for one eye exam every 12 months for residents under age 20 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 as assistance under the Ontario Disability Support Program, Ontario
Works or the Family Benefits Program.

Hospital

Coverage for standard ward rooms only.

Paramedical

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

 Accidental Death & 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, please contact:

The Ontario Health Insurance Plan:
Phone: 416-314-5518
Toll free in Ontario: 1-800-268-1154
TTY: 1-800-387-5559
Website: http://www.gov.on.ca