Most Canadians are proud of their universal healthcare system, but there are limitations as to which services the government provides coverage for in each province. Many people in Ontario are surprised to learn what services OHIP does and does not cover. Know which services OHIP doesn’t cover before you book an appointment for counselling, physiotherapy, or osteopathy in Guelph.
Services OHIP Covers
The following services are covered by OHIP in almost all circumstances:
- Prescription drugs inside a hospital
- Hospital visits and stays (including meals and accommodation)
- Medical or surgical abortions
- Travel costs for Northern Ontario residents who must travel for speciality care
Services OHIP Does not Cover
OHIP does not provide coverage for the following, but many private insurers do:
- Prescription drugs outside of a hospital
OHIP does cover drugs administered inside of a hospital. However, prescription drugs to be taken at home are only covered for Ontarians over the age of 65. Children and youth under 25 can get limited coverage after they have exhausted any private insurance coverage.
- Anti-smoking/Smoking cessation treatment
Patches, pills, nicotine gum, and other medications designed to help people stop smoking must be paid for out-of-pocket. In rare cases, private insurance may cover these treatments.
- Alternative medicine
Traditional Chinese medicine, homeopathy, acupuncture, Reiki, and other unscientific methods are not covered by OHIP.
- Cosmetic Surgery
Elective surgical procedures that are cosmetic do not fall under OHIP coverage. This category includes cryotherapy for warts and circumcision.
- Mental Health Treatment
OHIP only covers treatment by a psychiatrist, psychotherapist, or physician. Services of therapists, counsellors, and social workers are not covered.
- Chiropractic Care
OHIP covers spinal care when it is performed by a doctor, but not the services of a chiropractor.
- Osteopathic Care
Although you can access osteopathy in Guelph, osteopathic treatment is rarely covered by OHIP.
Services OHIP Covers Only Partially
Certain services receive partial coverage from OHIP under certain circumstances:
Physiotherapy is covered for people under the age of 20 and over the age of 65, but young and middle-age adults usually pay for physio out-of-pocket.
- Dental Care
Unless you are on social assistance, OHIP does not cover dental care. However, dental surgery performed in a hospital is covered.
- Eye care
OHIP covers one eye exam per year for people under 19 and over 65. For people between the age of 20 and 64, eye care is only covered if the individual has one of the following medical conditions: diabetes, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent uveitis, or optic pathway disease.
- Ambulance services
Ambulance services are covered if the individual is an Ontario resident with a valid health card who needs transportation from a hospital in Ontario to another hospital, and a physician deems the ambulance service necessary.