Getting OHIP: who qualifies, what to bring and how to cover the gap

OHIP has no waiting period anymore, but you still have to qualify, show up in person with three original documents and wait for approval. Plan for the weeks in between.

The short version

• There's no longer a waiting period. If you're eligible, coverage starts once you're approved [1].
• Who qualifies: citizens, permanent residents, some PR applicants, and work permit holders working full-time for an Ontario employer for at least six months, plus their spouses and dependants [1].
• You must live here: be physically in Ontario 153 days in any 12-month period, including 153 of your first 183 days, and make Ontario your main home [1].
• Apply in person at ServiceOntario with the registration form and three original documents: status, Ontario residency and identity [1].
• Keep private or travel insurance until your card number is active. US plans and Medicare generally won't pay for routine care in Canada [3].

How OHIP differs from health insurance back home

The Ontario Health Insurance Plan is the province's public plan. There are no premiums, no deductibles and no network to check. When a service is medically necessary, OHIP pays the full cost of doctor visits, in person or by video or phone, and hospital care, including tests, nursing, in-patient drugs and a standard ward bed [2]. You'll never get an Explanation of Benefits in the mail.

The catch is what's left out. OHIP doesn't pay for [2]:

So most working Canadians have two layers: OHIP for doctors and hospitals, and an employer "extended health" plan for drugs, dental and vision. When you negotiate a Toronto job offer, ask about the benefits package the way you'd ask about a 401(k) match back home.

Who qualifies

You need to meet the residency rules and fall into one of the eligible groups [1].

The residency rules

• Be physically present in Ontario for at least 153 days in any 12-month period.
• Be physically present for at least 153 of the first 183 days after you settle here.
• Make Ontario your primary place of residence.

If you're outside Ontario for more than 212 days in any 12-month period, you may have to reapply [1]. That matters for snowbirds and for anyone who spends long summers at a family place in Michigan or Maine.

The eligible groups

That "Ontario employer" wording trips up some Americans. If you're a US company's employee working remotely from a condo on King Street, you probably don't fit the work permit category. A CUSMA professional hired by a Toronto firm usually does. If your situation is unusual, call ServiceOntario before you go in.

The three documents (and the form)

You apply in person, and photocopies aren't accepted [1]. Bring:

1. A completed Registration for Ontario Health Insurance Coverage form. You can fill it in ahead of time.
2. Proof of citizenship or OHIP-eligible immigration status. For most Americans that's a work permit or a PR card or Confirmation of Permanent Residence.
3. Proof of Ontario residency, such as a rental or lease agreement, a mortgage or an Ontario driver's license [1]. Your lease is usually the easiest one on day one.
4. Proof of identity, such as a passport or a credit card [1]. Your US passport works.

The province asks for three separate documents, so bring a spare in each category in case one isn't accepted. Work permit holders should also bring a letter from their employer confirming full-time work in Ontario; it isn't on the short list, but it heads off questions.

Step by step

1. Sign your lease and get settled at your Toronto address.
2. Book or walk into a ServiceOntario office that handles health cards. Downtown locations get busy; going early on a weekday helps.
3. Hand over the form and the documents. They'll take your photo and signature for the card.
4. Get your approval and paperwork. Keep any temporary document you're given.
5. Watch the mail for your photo health card, and don't move without updating your address.

When coverage starts, and the gap before it

Ontario removed the old three-month waiting period, and the province now says coverage starts once you're approved [1]. That's a big improvement over the old days, but there's still a gap:

• The days or weeks between landing and your ServiceOntario visit, while you find an apartment and a lease to prove residency.
• Anyone who isn't eligible yet, such as a spouse whose status is still in process or a remote worker on a visitor entry.
• Prescriptions, dental and vision, which OHIP never covers for most adults.

Covering the gap

• Buy newcomer or visitor health insurance that starts the day you land. Canadian insurers sell plans aimed at new arrivals; check whether pre-existing conditions are excluded.
• Check your US plan. Some employer plans cover emergencies abroad, but many don't cover routine care in Canada. Call and ask before you cancel anything stateside.
• Don't count on Medicare. Original Medicare usually doesn't cover care outside the US, with narrow exceptions like an emergency while driving through Canada between Alaska and another state [3]. Medigap plans may cover some emergency care abroad [3].
• Ask about employer benefits. Many Toronto employers enroll new hires in their group plan from the first day or after a short probation period.

Out-of-pocket hospital bills for uninsured visitors can be steep, so this isn't a place to save a few bucks.

After you get your card

• Find a family doctor. Register with Health Care Connect online or by calling 811; you'll need your health card number, and your mailing address must match the one on your card [4]. Matches can take a while in Toronto, so sign up right away.
• Use Health811 for free health advice and to find services in the meantime [4].
• Go to a walk-in clinic for minor issues; bring your health card.
• Keep your status and card in sync. If you're on a work permit, update ServiceOntario when you renew or change your permit, so your coverage doesn't lapse.

Keep your US options open

Many Americans keep one foot stateside. If you're nearing 65, decide whether to enroll in Medicare Part B even though it won't cover you here; delaying can mean a lifetime late penalty if you move back later. And if a family member is visiting from the States, remind them that OHIP won't cover them and that they need their own travel insurance [1].

Want to hear how other newcomers handled the gap? Ask in our community group for Americans in Canada.

Sources

1. Apply for OHIP and get a health card, Government of Ontario
2. What OHIP covers, Government of Ontario
3. Travel outside the US, Medicare.gov
4. Find a family doctor or nurse practitioner, Government of Ontario

Keep reading

• Healthcare and health insurance in Toronto
• Your first weeks in Toronto: SIN, phone and paperwork
• Working in Canada as an American: CUSMA permits and Express Entry
• Medicare when you live abroad