One of Canada’s most well-known attributes is its history of universal healthcare. The idea that most healthcare-related services are free for nearly anyone who needs them has become a core value shared by many Canadians and is a great representation of our community-oriented spirit. Understanding your Ontario health insurance options is an important step for newcomers.
Today, we’ll delve into the intricate landscape of healthcare in Ontario, Canada, and how newcomers can navigate the system to access quality healthcare in the event of illness, accidents, or unexpected events. We will emphasize the critical role of private health insurance during the initial waiting period for Ontario Health Insurance Plan (OHIP) coverage, providing a comprehensive overview to help newcomers make informed decisions about their healthcare needs.
The Ontario Health Insurance Plan (OHIP)
In Canada, each province administers its own health insurance, which is publicly funded. Once an individual is signed up for this public health insurance, the province pays for most of their required health services. In Ontario, this public health insurance is known as the Ontario Health Insurance Plan (OHIP).
OHIP Coverage Details
For newcomers (and even some long-time residents of Ontario), it can be challenging to determine what OHIP may cover and in what situations. Essentially, it boils down to one question – do you have a medical reason for receiving that service or treatment? If not, you will likely have to pay out-of-pocket or use private insurance.
OHIP covers many services, but it does place limits on some benefits. For example, OHIP will cover the cost of one major eye exam every 12 months, but only for OHIP cardholders who are under the age of 19 or 65 and older. If you’re between the ages of 20 and 64, you must pay that expense out of pocket.
OHIP also does not cover:
- Prescription drugs in a non-hospital setting.
- Dental services.
- Eyeglasses.
- Cosmetic surgery.
Additionally, coverage for some services is discretionary. For example, taking an ambulance may or may not be covered, depending on the circumstances. To ensure you understand what OHIP covers, you can verify the specific services on the OHIP website.
Newcomer Eligibility for Ontario Health Insurance
Typically, newcomers to Canada must be present in Ontario for three months before being covered under OHIP. They must also plan to make Ontario their primary residence. To get a bit more technical about it, they are required to be physically present in the province for at least 153 days of their first 183 days in Canada.
Moreover, newcomers must fall into one of the following categories to be eligible for OHIP:
- Have applied for permanent residency.
- Already be a permanent resident.
Have a valid work permit and be working in Ontario full-time for at least 6 months (or be a spouse or dependent of this person).
- Have a Temporary Resident Permit.
- Be a convention refugee or other protected person.
Temporary Waiver due to COVID-19
During the COVID-19 pandemic, Ontario temporarily waived the traditional three-month waiting period for OHIP coverage for newcomers and recent immigrants. While this waiver has been in effect, newcomers who entered Canada after March 19th, 2020, and settled in Ontario should have immediate access to OHIP. However, it’s essential to stay informed about any policy changes, as this waiver may be reinstated in the future.
Applying for an Ontario Health Card as an Immigrant
Applying for an Ontario health card is a straightforward process, but it does require an in-person visit to a ServiceOntario center. When you visit, you will need to bring specific documents, including:
- A completed OHIP registration form.
- A document that proves your eligibility for OHIP (typically, your immigration documents).
- A document that provides proof of Ontario residency (like a driver’s license).
- A document that proves your identity.
A comprehensive list of valid documents can be found on the official ServiceOntario website. For children under the age of 16, a parent or guardian can register on their behalf without them being present.
Challenges During the Waiting Period
Even with the waiting period for Ontario health care currently waived for newcomers due to the COVID-19 pandemic, there may still be weeks or even months where you are uninsured. It can take a while to receive a bill, pay stub, or official document that offers adequate proof of residency, which you can use to apply for OHIP. During that time, you will be uninsured unless you have purchased private insurance before your arrival in Canada.
The Importance of Private Health Insurance
It may not seem like a significant concern to go a few weeks or months without insurance, but it’s a substantial risk. An injury or sudden illness can happen in an instant, and if you need to seek medical care, that cost will have to come out of your pocket. This can be a significant financial burden, especially as you’re settling in a new place far from home.
Purchasing private insurance is a prudent way to ensure that you’re protected during your first few months in Canada, before you are eligible to apply for OHIP. Through an insurance company like Blue Cross, you can apply and get approved in minutes, and only pay for as much insurance as you need. Here are some reasons why private health insurance is crucial for newcomers:
Immediate Coverage: Private health insurance provides immediate coverage from the moment you arrive in Canada, ensuring that you have access to healthcare services in case of emergencies or health concerns. You should get health insurance quotes for many carrier to compare prices.
Comprehensive Coverage: Private insurance plans can offer comprehensive coverage, including services that OHIP does not cover, such as prescription drugs, dental services, eyeglasses, and more. This comprehensive coverage provides peace of mind, knowing that you won’t face unexpected expenses.
Flexibility: Private insurance plans are customizable, allowing you to tailor coverage to your specific needs and budget. You can choose a plan that suits your circumstances, whether you’re an individual or a family.
Protection against Financial Burden: Medical expenses can be significant, and without insurance, these costs can quickly add up. Private insurance ensures that you won’t face the financial burden of paying for medical services out of pocket.
Easy Application Process: Applying for private health insurance is a straightforward process, often available online, and can be completed before your arrival in Canada or shortly after. It provides newcomers with a sense of security during the initial transition period.
Conclusion
Navigating the healthcare system as a newcomer in Ontario, Canada, can be complex, with waiting periods and coverage limitations under OHIP. While Canada’s healthcare system is known for its universality, newcomers should be aware of the initial waiting period and consider the importance of private health insurance.
