Health Plan Fact Sheet

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 $6.1 1 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.
• Covorage for one eye exam every 12 months for residents age 20 and under and for residents aged 65 and over.
• Coverage for routine eye examinations once every two years for residents receiving assistance under the Ontario Disability Support Program, Ontario Works or the Family Benefits Program.

Hospital

• Coverage for standard ward rooms only.

Paramedicals

• 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.

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 onlly and are subject to change, corrections andupdates. Other government programs may also be available. For more information on the latest 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: Click Here