OHIP Coverage: What It Pays For, and What It Leaves to You

Current as of October 2026. Government programs, tax rules and prices change. Check the official sources listed at the end of this page before making a decision, and confirm details with a licensed advisor.

What OHIP is, in plain terms

The Ontario Health Insurance Plan (OHIP) is the province's public health insurance. The federal Canada Health Act sets conditions provinces must meet to receive federal health funding, and the insured services it describes include medically necessary hospital, physician and certain surgical-dental services. OHIP is how Ontario delivers that coverage to eligible residents.

As of October 2026, the Ontario government states there is no longer a waiting period for OHIP coverage, and newcomers can apply as soon as they arrive. To qualify, a person generally needs to make Ontario their primary residence, be physically present in the province for at least 153 days in any 12-month period (and at least 153 of their first 183 days after settling here), and meet one of the listed status requirements, such as being a Canadian citizen, a permanent resident or certain work permit holders.

For employers, this matters because OHIP sits underneath every workplace plan. A good extended health benefits plan is built around what OHIP already pays for, not on top of it.

What OHIP covers (as of October 2026)

According to the Ontario government's own summary of what OHIP covers, the core services include the following. Rules can change, so treat this as a snapshot as of October 2026 and check ontario.ca for current details.

• Doctor services: the full cost of medically necessary physician services, including virtual visits by video or phone.
• Hospital care: doctor and nursing services, diagnostic tests, medication while you are an inpatient, some outpatient medications for home use, and standard ward accommodation and meals.
• Eye exams for some ages and conditions: one major eye exam every 12 months for people 19 and under; one major exam every 18 months, plus follow-up assessments, for people 65 and older; and yearly exams for adults 20 to 64 with certain medical conditions such as diabetes, glaucoma or cataracts.
• Some dental surgery in hospital: for example, fracture repair, tumour removal, reconstructive surgery and medically necessary tooth removal (with prior OHIP approval).
• Partial podiatry coverage: a set portion of each visit to a registered podiatrist, up to an annual limit per patient (check ontario.ca for the current amounts).
• Ambulance: some ambulance services, with coverage depending on the circumstances.

What OHIP does not cover

The province lists several common costs that OHIP does not pay for. These are the bills that show up in real life: the pharmacy counter after a family doctor visit, the six-month cleaning, the new pair of glasses after a prescription change. For a deeper look, see our guide on what OHIP does not cover.

• Prescription drugs outside of hospital, such as antibiotics from your family doctor (some groups qualify for separate provincial drug programs).
• Dental services in a dentist's office, like cleanings, fillings and checkups.
• Eyeglasses and contact lenses.
• Laser or other eye surgery to correct vision.
• Cosmetic surgery and experimental treatments.
• Private or semi-private hospital rooms (the province notes you or your private insurance pay some or all of that cost).

Other provincial programs that fill some gaps

OHIP is not the only public program. Ontario runs separate programs for specific groups, and each has its own rules as of October 2026:

OHIP+ covers thousands of prescription medications for people 24 and under who have OHIP and are not covered by a private plan. If a young employee or an employee's child is on a workplace drug plan, the private plan pays first and OHIP+ does not apply. Learn more on our OHIP+ page.

The Ontario Drug Benefit generally begins at age 65 and also covers some people under 65, such as long-term care residents and Ontario Works or ODSP recipients.

Government-funded physiotherapy at community clinics is available to people 65 or older, people 19 or under, people of any age after an overnight hospital stay or day surgery in the last 12 months for a condition needing physio, and Ontario Works or ODSP recipients. Most working-age adults with a sore back or a running injury fall outside these groups.

The gaps employer benefits commonly fill

Put the two lists side by side and a pattern appears: working-age adults and their families pay for a lot of routine care themselves. That is the space a group plan is designed for. Depending on the plan, an employer package can help with:

• Prescription drugs filled at the pharmacy, through a group drug plan.
• Dental care such as cleanings, checkups, fillings and sometimes major work, through group dental coverage.
• Vision care like glasses, contacts and eye exams for adults who do not qualify for OHIP-insured exams.
• Paramedical services such as physiotherapy, massage therapy and chiropractic care, plus mental health support from eligible practitioners.
• Travel medical insurance, which matters because OHIP's out-of-country emergency coverage is limited (see below).
• Private or semi-private hospital rooms, which some extended health plans help pay for.

Travelling? OHIP coverage outside Canada is limited

This is one of the biggest surprises for employees. As of October 2026, the Ontario government says OHIP pays only limited amounts for emergency care outside Canada: for outpatient emergency services, up to $50 (Canadian) per day or the amount billed, whichever is less; for inpatient emergency services, up to $400 (Canadian) per day for higher levels of care (such as an operating room or intensive care unit) and up to $200 (Canadian) per day for lower levels of care. OHIP also does not cover the cost of a transfer to an Ontario hospital for ongoing care.

The province's own advice is that it is essential to buy travel medical insurance before leaving the country, ideally one that covers getting you home if you fall ill. Many group plans include group travel medical insurance, which is a meaningful perk for anyone heading south for March break or visiting family abroad.

How employers can use this when designing a plan

Knowing where OHIP stops helps you spend benefit dollars where your people actually feel them. A workforce of younger staff might lean on dental, vision and mental health support. A team with older employees might care more about drug coverage and paramedical care before they reach provincial program ages. Some employers add a health spending account so staff can direct funds to the gaps that matter most to them.

A licensed benefits advisor can walk you through how a specific plan coordinates with OHIP and other provincial programs. When you are ready, get matched with a licensed benefits advisor who works with Ontario employers.

Common questions

Is there a waiting period for OHIP in 2026?

As of October 2026, the Ontario government says there is no longer a waiting period. Eligible residents have coverage as soon as they are approved, and they can apply as soon as they arrive in Ontario. Check ontario.ca for the current eligibility rules.

Does OHIP cover dental cleanings or glasses?

No. The province lists dental services in a dentist's office, eyeglasses and contact lenses among the things OHIP does not cover. Some federal and provincial programs help specific groups, and employer dental and vision benefits are a common way working adults get help with these costs.

Can my child use OHIP+ if they are on my work drug plan?

No. As of October 2026, OHIP+ is only for people 24 and under who have OHIP and are not covered by a private plan. If your child is covered under your group drug plan, that plan pays for eligible prescriptions instead.

Does OHIP cover physiotherapy?

Only for certain groups at government-funded community clinics, such as people 65 or older, people 19 or under, people recovering from a recent hospital stay or day surgery, and Ontario Works or ODSP recipients. Most working-age adults pay privately or use paramedical coverage through a workplace plan.

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