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Changes To Schedule of Benefits - Understanding Changes to Sleep Studies

Sleep studies are used to diagnose and treat sleep disorders such as sleep apnea, insomnia and narcolepsy.

What is changing?

OHIP coverage for overnight sleep studies is currently limited to a maximum of two per 12 month period. Beginning on July 1st, 2010, diagnostic sleep studies are limited to one per 12 month period, while therapeutic sleep studies are limited to one every 24 months.

What is not changing?

OHIP coverage for overnight sleep studies for children or adults in specialized facilities remains limited to a maximum of two per 12 month period.

What are specialized facilities?

For children, these services are in paediatric hospitals with a Neonatal intensive care unit.
For adults, these services are provided in a chronic care hospital for adults in respiratory failure.

Why the change?

Medical experts recommended this change to the Ministry of Health and Long-Term Care, based on the College of Physicians and Surgeons clinical guidelines for sleep studies which are based on the best available medical evidence . The ministry made this change after consulting with the Ontario Medical Association and other key partners.

What if a test is recommended and the limits are exceeded?

If a test is recommended to you by a physician practicing sleep medicine and you have already reached the limit, the physician can apply to OHIP for approval of an additional sleep study before the test is done. If approved, the test is covered by OHIP. As with all medical tests that may not be covered by OHIP, we encourage Ontarians to consult with their physician or the Ministry of Health and Long-Term Care before proceeding with the test.

Where can I get more information on these changes?

To obtain more information on these changes, you are encouraged to call ServiceOntario at 1-866-532-3161.

For More Information

Call ServiceOntario, Infoline at 1-866-532-3161
In Toronto, 416-314-5518
TTY 1-800-387-5559
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm