What OHIP covers
Find out what services you can get through OHIP.
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Services covered by OHIP
OHIP covers part or all of the following services:
- visits to doctors
- hospital visits and stays
- laboratory testing in community labs or hospitals
- medical or surgical abortions
- eligible dental surgery in hospital
- eligible optometry (eye-health services)
- podiatry (foot-health services)
- ambulance services
- travel for health services if you live in northern Ontario
Whether you visit your doctor, or if you see one in a walk-in clinic, OHIP covers the full cost of your services – as long as they’re medically necessary.
Learn about the services doctors provide.
If you need to go to the hospital, OHIP covers:
- doctor and nursing services
- services to diagnose what’s wrong (such as blood tests and x-rays)
- medications for in patients (once a patient is discharged, prescribed medications are not covered)
- some medications for out patients (certain limited medications are provided to out-patients for home use)
- accommodation and meals if you have to stay
- if you want a private or semi-private room, you or your private insurance will have to pay some or all of those hospital fees
OHIP covers lab tests taken in hospitals that are medically necessary.
Hospital patients should have their tests taken at the hospital to avoid any possible out-of-pocket charges.
OHIP also covers medically necessary lab tests taken in non-hospital settings, such as community labs. Read the full list of covered tests in the community setting.
Non-hospital patients should have their test done in a community lab if they have a lab order from a clinical provider such as a licensed physician, midwife or nurse practitioner.
Before you have your laboratory testing done, speak to your health care provider about:
- OHIP coverage to avoid unexpected costs
- where to get lab testing done if you are unsure
See below for community lab providers that offer laboratory services in Ontario:
What is not covered by OHIP
OHIP does not cover some specialized, non-routine tests. For other tests, OHIP will only cover them if you meet certain eligibility criteria and a particular health care provider (physician, midwife, nurse practitioner) ordered the test. A few examples of tests that are not covered by OHIP except under specific circumstances include:
Prostate-specific antigen (PSA) is covered by OHIP if either of the following apply to you:
- you have been diagnosed with prostate cancer and are receiving treatment or following up after receiving treatment for the disease
- a healthcare provider (for example, physician) suspects prostate cancer because of your history and/or the results of your physical examination (including digital rectal examination)
For all other scenarios, you will need to pay for PSA.
Aspartate aminotransferase test (AST) is covered by OHIP if ordered by a physician who specializes in liver diseases.
For all other scenarios, you will need to pay for AST.
25-hydroxy vitamin D test is covered by OHIP if you have any of the following conditions:
- malabsorption syndromes
- renal disease
- drugs that affect vitamin D metabolism
For all other scenarios, you will need to pay for a vitamin D test.
OHIP covers the cost of:
- surgical abortions that take place in a hospital or clinic
- Mifegymiso (a pill that induces an abortion in early pregnancy), if you have a prescription from your doctor
Contact an abortion clinic near you for more information about ending a pregnancy.
Some dental surgeries need to be performed in a hospital because they are complex and/or you have another medical condition that needs monitoring during the procedure.
OHIP covers in-hospital dental surgeries such as:
- fracture repair
- tumor removal
- reconstructive surgeries
- medically necessary tooth removal (prior approval by OHIP is required)
Children and youth 19 years old or younger are eligible for the following OHIP covered services:
- 1 major eye exam (for vision and general eye health) every 12 months
- any minor assessments needed
If you are 20 to 64 years old, and you have an eligible medical condition affecting your eyes, OHIP will cover:
- 1 major eye exam for you once every 12 months
- 2 additional follow-up minor assessments
Eligible medical conditions are:
- diabetes mellitus
- glaucoma requiring or having had treatment with medication, laser (excluding prophylactic laser peripheral iridotomy), or surgery
- cataracts / posterior capsular opacification with a visual acuity of 20/40 or worse in the best corrected eye, or when a surgery referral is made
- retinal disease that is acute, or is chronically progressive
- corneal disease that is acute, or is chronically progressive
- uveitis that is acute or chronic during episodes of active inflammation
- optic pathway disease that is acute, or is chronically progressive
- acquired cranial nerve palsy resulting in strabismus during the acute phase or until the condition resolves or stabilizes
- ocular drug toxicity screening for patients taking hydroxychloroquine, chloroquine, ethambutol or tamoxifen
If you are 65 years and older and you do not have an eligible medical condition affecting your eyes, OHIP will cover:
- 1 major eye exam for you once every 18 months and 2 additional follow-up minor assessments.
OHIP covers between $7-16 of each visit to a registered podiatrist up to $135 per patient per year, plus $30 for x-rays. You will need to pay for the remainder of the cost of each visit.
Surgeries performed by podiatrists are not covered by OHIP.
If you need an ambulance for a medical emergency, OHIP covers part or all the costs depending on the circumstances.
If you have to travel long distance for specialized medical care and live in one of the following areas, OHIP might help pay for your travel and accommodation through the Northern Health Travel Grant:
- Parry Sound
- Rainy River
- Thunder Bay
Find out if you qualify and how to apply to the Northern Health Travel Grant.
Services not covered by OHIP
OHIP does not cover:
- prescription drugs provided in non-hospital settings (such as antibiotics prescribed by your family doctor)
- dental services provided in a dentist’s office
- eyeglasses, contact lenses
- laser eye surgery
- cosmetic surgery
Protect your health card number
Only share your health card number with health care professionals who are entitled to have it, such as:
- nurse practitioners
You can use your health card as a form of identification for other reasons, but no one else can record or copy your health card number. If your health card number falls into the wrong hands, it could be used to access to your personal health information or for OHIP fraud.
Help prevent OHIP fraud
You can help stop someone who:
- knowingly uses an Ontario health card that is not theirs
- receives health services covered by OHIP but is not an Ontario resident
- knowingly gives false information to get OHIP when they know they are not eligible
To report suspected cases of OHIP abuse or fraud:
- call us anonymously at 1-888-781-5556
- send us an e-mail
We investigate every report and will cancel OHIP coverage if someone cannot prove they qualify for OHIP. We also refer suspected fraud to the Ontario Provincial Police for investigation and possible prosecution.