OHIP Eligibility Criteria – Changes to Regulation 552

On April 1, 2009, changes to the OHIP eligibility rules under Regulation 552 under the Health Insurance Act became effective.   How do I know if I am affected by these changes?

The changes may impact your eligibility for OHIP coverage if you belong to one of the following groups:

• Temporary foreign workers with open work permits and their family members
• Participants in Citizenship and Immigration Canada’s Post-Graduation Work Permit Program and their family members
• Persons who have applied for a grant of citizenship under section 5.1 of the Citizenship Act (Canada) (i.e. children adopted internationally by Canadian citizens)
• Persons who have submitted an Application for Permanent Residence
• Persons who hold a Temporary Resident Permit issued by Citizenship and Immigration Canada
• Ontario residents pursuing educational opportunities outside of the province
• Interprovincial movers requiring admittance into a long-term care facility upon arrival in Ontario
• Charitable workers on out-of-country assignments and their family members
• Missionaries currently on out-of-country assignments and their family members

For more detailed information about OHIP eligibility and the changes to the OHIP eligibility rules:

• Refer to the fact sheet on OHIP Eligibility
• Refer to the Questions & Answers on OHIP
• Refer to Regulation 552 of Ontario’s Health Insurance Act (can be viewed online at www.e-laws.gov.on.ca)

If you have questions about your eligibility for OHIP coverage under the new policies, please contact INFOline at 1 800 268-1154 or visit your local Service Ontario – Health Card Services – OHIP office.

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Am I still eligible for OHIP if I temporarily leave Ontario?

You may be out of the province for up to 212 days in any 12-month period and still maintain your Ontario health insurance coverage provided that you continue to make Ontario your primary place of residence.

To maintain eligibility for OHIP coverage you must be an eligible resident of Ontario. This means that you must :

• have an OHIP-eligible citizenship/immigration status; and
• be physically present in Ontario for 153 days in any 12-month period; and
• be physically present in Ontario for at least 153 days of the first 183 days immediately after establishing residency in the province; and
• make your primary place of residence in Ontario.

If you will be out of the province for more than 212 days in any 12-month period, please refer to the Longer Absences from Ontario fact sheet.

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I am frequently away from Ontario, due to my job/studies; am I eligible for OHIP coverage?

If your job or studies require you to leave Ontario frequently and you are unable to be present for 153 days in any 12-month period, you may still be eligible for OHIP coverage as a mobile worker or mobile student. To maintain your OHIP coverage, you should:

• be able to provide acceptable documents that show that your work requires frequent travel in and out of Ontario or that your full-time academic program in Ontario requires travel outside of Ontario; and
• be able to provide acceptable documents to show how you make your primary place of residence in Ontario (refer to Ontario Health Coverage Document List).

New or returning residents to Ontario who qualify as a mobile worker or mobile student are exempt from having to meet the 153-day in the first 183-day physical presence requirement immediately after establishing residency in Ontario.

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Are open work permit holders and/or participants in Citizenship and Immigration Canada’s Post-Graduation Work Permit Program affected by the regulation change? 

Open work permit holders (including those in CIC’s Post-Graduation Work Permit Program) may be eligible for Ontario health insurance coverage provided they are employed full-time for an employer in Ontario for a minimum of six months, have a valid work permit during this time, and they:

• maintain their primary place of residence in Ontario; and are
• physically present in Ontario for at least 153 days in any 12-month period; and are
• physically present in Ontario for 153 of the first 183 days immediately after establishing residency in the province.

Further information on the changes concerning Temporary Foreign Workers can be found on a fact sheet entitled “Temporary Foreign Workers”.

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Are internationally adopted children exempt from the 3-month waiting period? 

Effective April 1, 2009, changes to Regulation 552 of the Health Insurance Act became effective and these apply to internationally adopted children and impact both their eligibility for OHIP coverage and their eligibility for an exemption to the 3-month waiting period.

To be exempt from the 3-month waiting period, children who have been adopted outside Canada by a Canadian citizen must have received confirmation from Citizenship and Immigration Canada (CIC) that the child meets the eligibility requirements to apply for citizenship.  Provided this confirmation is received from CIC prior to the date the adoption is finalized, the child will be eligible for an exemption to the 3-month waiting period as of the date of the adoption. 

If the confirmation from CIC is received after the date of adoption, the child will be eligible for OHIP coverage as of the date CIC confirms that the child meets the eligibility requirements to apply for citizenship but will be subject to a 3-month waiting period from that date. 

Exemption to the Remainder of the Waiting Period
Adopted children can be considered exempt from the remainder of that waiting period if they are :

• already considered OHIP-eligible; and
• in their 3-month waiting period; and
• subsequently have their adoption finalized during that time 

Further information on the changes concerning adoptions can be found on a fact sheet entitled “Adoptions and OHIP Eligibility”.
The above is only a summary of the OHIP eligibility provisions of Regulation 552 for your reference.  You should consult the actual regulation for the specific requirements applicable to you.  The provisions in Regulation 552 prevail over this summary.

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On April 1, 2009 the changes to OHIP eligibility rules under Regulation 552 of the Health Insurance Act became effective.  You may be eligible for the Ontario Health Insurance Plan (OHIP) if you are included under one of the following categories :

• you are a Canadian citizen, permanent resident, landed immigrant or are registered as an Indian under the Indian Act;
• you have submitted an application for permanent residence in Canada, and Citizenship and Immigration Canada has confirmed that you meet the eligibility requirements to apply for permanent residence in Canada;
• you have applied for a grant of citizenship under section 5.1 of the Citizenship Act (Canada), and Citizenship and Immigration Canada has confirmed that you meet the eligibility requirements to apply for citizenship (i.e. children adopted internationally by Canadian citizens);
• you are a “protected person” - i.e. a Convention Refugee or a person in need of protection as referred to in the Immigration and Refugee Protection Act;
• you are a foreign worker who holds a work permit valid for at least 6-months which permits you to work in Canada, and you are working under a formal agreement in place to work full-time for an employer situated in Ontario which sets out the employer’s name, your occupation, and states that you will be working for no less than six consecutive months;
• you are a foreign clergy member who will be providing services to a religious congregation in Ontario for at least six months;
• you hold a Temporary Resident Permit with case type 80 (for adoption only), 86, 87, 88, 89, 90, 91, 92, 93, 94 or 95;
• you are the spouse, same sex partner, or dependent child (under 22 years old or 22 years and over if dependent due to a mental or physical disability) of an OHIP-eligible foreign clergy member or OHIP-eligible foreign worker;
• you hold a valid work permit under the federal Live-in Caregiver Program;
• you hold a valid work permit under the federal Seasonal Agricultural Worker Program;

AND, generally speaking

• you make your primary place of residence in Ontario;
• you are in Ontario for at least 153 days of the first 183 days immediately following the date you establish residence in Ontario (you cannot be absent for more than 30 days during the first 6 months of residence);
• you are in Ontario for at least 153 days in any 12-month period.

Tourists, transients or visitors are not eligible for OHIP coverage.

Your ongoing eligibility for Ontario health insurance coverage is based solely on you having one of the above OHIP-eligible citizenship or immigration statuses, and on you:

• making your primary place of residence in Ontario, and
• meeting the requirement of being physically present in Ontario for at least 153 days in any 12-month period.

The above is only a summary of the OHIP eligibility provisions of Regulation 552 for your reference.  You should consult the actual regulation for the specific requirements applicable to you.  The provisions in Regulation 552 prevail over this summary.

Everyone, including babies and children, must have their own health cards.  Always carry your health card with you. You should be ready to show it every time you need medical services.

If you have questions about when your OHIP coverage will begin, please contact INFOline at 1 800 268-1154 or visit your local ServiceOntario – Health Card Services – OHIP office.

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Am I eligible for OHIP right away or do I have to wait?

There may be a three-month waiting period for your OHIP coverage. 

Generally speaking, if you are a newcomer to Ontario, or a former resident returning here to live after being out of the country for more than seven months, the waiting period begins on the date you establish or re-establish residence in Ontario.  You may also be required to be present in Ontario for 153 days of the first 183 days immediately following the date residence is established in Ontario (you cannot be absent for more than 30 days during the first 6 months of residence).

If you are an eligible resident moving to Ontario from another part of Canada, the health insurance of your former province/territory may cover you during the waiting period for OHIP coverage.

If you are not covered by another province/territory, it is important to buy private health insurance to cover you until your Ontario health insurance coverage becomes effective.

Certain groups are exempt from the three-month waiting period; contact INFOline at 1 800 268-1154 or visit your local ServiceOntario – Health Card Services – OHIP office to find out if you may be exempt from the 3-month waiting period.

If you are a member of a military family, please refer to the Military Family Members fact sheet for more information.

If you are a Canadian citizen who is in the process of adopting a child, please refer to the fact sheet entitled Adoptions and OHIP Eligibility.

For more information:

• Refer to the OHIP Coverage Waiting Period fact sheet
• If you have questions about when your OHIP coverage will begin, contact INFOline at 1 800 268-1154 or visit your local ServiceOntario – Health Card Services – OHIP office.
• For private health insurance, contact a private insurance company directly or call the Canadian Life and Health Insurance Association Inc. at 1 800 268-8099.  In Toronto, call 416-777-2344.

How do I get an Ontario health card?

What documents should I bring when I register?

When applying for a new health card, you must bring three original documents to prove your OHIP-eligible citizenship/immigration status, your residence in Ontario, and your identity.

• See Health Card fact sheet for more information
• See Ontario Health Coverage Document List (PDF) for a list of documentation required to register

If you are a member of a military family, refer to the fact sheet Military Family Members and the Military Family Member Document List.

If you have questions about what documents to bring with you when you register for OHIP coverage, contact INFOline at 1 800 268-1154 or visit your local ServiceOntario – Health Card Services – OHIP office.

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What immigration documents must I present to confirm my immigration status as an Applicant for Permanent Residence (previously called an Applicant for Landing) when applying for Ontario health insurance coverage?

Please note:  As of April 1, 2009, changes to Regulation 552 of the Health Insurance Act became effective.  As a result of these changes, Applicants for Permanent Residence are no longer required to provide confirmation from CIC that they have passed their immigration medical in order to be eligible for OHIP.

If you are applying for Ontario health insurance coverage as an Applicant for Permanent Residence, you are required to present written confirmation from Citizenship and Immigration Canada (CIC) that you are eligible to apply for permanent residence in Canada, which may be one of the following :

• CIC Confirmation Letter – letter on CIC letterhead addressed to the Applicant for Permanent Residence that confirms that the applicant is eligible to apply for permanent residency in Canada;
• CIC Immigration document such as a Work Permit, Visitor Record, Temporary Resident Permit or Study Permit with note in the “Remarks Section” that indicates that you have applied for permanent residence; or
• A Work Permit case type 27, which are issued solely to individuals who have applied for permanent residence within Canada.

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How do I change my name on my health card to my married name?

How do I change my name on my health card upon dissolution of my marriage?

If I have had my name legally changed, how do I have my new name put on my health card?

What if my red and white health card is lost, stolen or damaged?

During business hours you should immediately call the ministry INFOline at 1-800-664-8988. For TTY service, call 1 800 387-5559.

After business hours, report your lost, stolen or damaged health card to the ministry health card Ontario inquiry system at 1 800 664-8988.

1. Go in person to your local ministry office.
2. Complete a Registration for Ontario Health Coverage (form 0265-82).
3. Provide three original documents to prove citizenship/immigration status, residency in Ontario and identity. You may be asked for additional documents, for example, if your name has changed you may need to provide a marriage certificate or a change of name certificate.
• See Health Card fact sheet
• See Ontario Health Coverage Document List

If there is no ministry office in your area, you may require information about temporary Outreach Registration sites. For this information, call the ministry INFOline at 1-800-664-8988.

If you find your health card, keep it only until your new photo health card arrives and then destroy it because it will no longer be valid. Make sure you have your new photo health card before destroying the old health card.

What if my photo health card is lost, stolen or damaged?

During business hours you should immediately call the ministry INFOline at 1-800-664-8988. For TTY service, call 1 800 387-5559.

After business hours, report your lost, stolen or damaged health card to the ministry health card Ontario inquiry system at 1 800 664-8988.

If the card is a photo health card you will be sent a new one right away but if there are additional changes to your information, like an address change or name change, then you will need to visit a ministry office or Outreach site.

If there is no ministry office in your area, you may require information about temporary Outreach registration sites. For this information, call the ministry INFOline at 1-800-664-8988.

If you find your health card, keep it only until your new photo health card arrives and then destroy it because it will no longer be valid. Make sure you have your new photo health card before destroying the old health card.

My photo health card has expired. How do I renew my health card?

Your photo health card has an expiry date that is linked to your date of birth. The first time you apply for a photo health card, the expiry date can be anywhere from two to seven years in the future. When your photo health card is renewed, the renewal date will always be five years in the future and linked to your date of birth.

Renewal notices for photo health cards are mailed approximately two months prior to the expiry date shown on the front of the photo health card; however, if it is more convenient, you can renew up to six months prior to the date of expiry.

To learn more about renewing your Ontario photo health card, refer to the fact sheet Renewing Your Photo Health Card.

How do I renew my child's health card?

Children under the age of 15 ½ years have health cards that are exempt from both photo and signature.

Your child’s renewal notice will be mailed approximately two months prior to the expiry date shown on the front of his or her photo health card. In most cases, children under 15 ½ years of age can have their health card renewed by the custodial parent/guardian completing and signing the back of the child’s renewal notice and returning it to the ministry in the pre-addressed envelope. You will receive your child’s renewed health card in the mail within approximately six weeks following the receipt of the completed application. Your child’s existing health card should be shown when receiving insured health services until the new card arrives.

The child’s renewal notice will advise the parent/guardian if they must visit an OHIP office or Outreach site to provide their own proof of residency and identity to support the renewal of their child’s health card.

If your child’s health card is expiring around the time of his or her 16th birthday, he or she must visit a ministry office in person to have their photo and signature captured. Your child must bring acceptable original documents as listed on the Ontario Health Coverage document List (form 9998E-82).

I have a red and white health card. Do I need a photo health card?

A red-and-white card or a photo health card are both accepted as long as they are valid and belong to you.

If you register and receive a photo health card, you should destroy your red-and-white card if you still have it.

What if I forget to bring my health card when I go for health care?

You may be charged for a health service if you do not have a health card. The ministry requests that the provider reimburse you for the service if it was an OHIP insured service and you can later show that you were covered by OHIP at the time of the service.

Your health care provider may ask you to fill out a Health Number Release (form 1265-84) to indicate your consent to the ministry providing your health number to them.

What should I do if I move?

Why is it important for me to notify the ministry when I move?

What if I know of someone using a health card that is not theirs ?

It is against the law to receive insured health care when you are not an insured person.

If you know someone who is using a health card :

• which is not theirs, or
• after moving away permanently from Ontario.

You should inform the Ministry of Health and Long-Term Care Fraud Line at 1-888-781-5556.

You may make your report anonymously if you wish.

What services does OHIP cover?

OHIP covers a wide range of health services; however, it does not pay for services that are not medically necessary, such as cosmetic surgery. A brief description of insured services follows below. For more details, please contact your nearest ministry office.

Services in Ontario

An eye examination is covered by OHIP for persons under 20 and for those 65 and over once a year. OHIP also covers a major eye examination once every 12 months for persons aged 20 - 64 who have medical conditions requiring regular eye examinations.

For more information refer to OHIP Bulletin 8089, fact sheets Changes to OHIP Coverage for Eye Care Services and Health Services.

You may be eligible for a Northern Health Travel Grant to help pay transportation costs if you live in northern Ontario and must travel long distances for specialty medical care.

Most of your Ontario health coverage benefits can be used across Canada. The province or territory you are visiting will usually bill Ontario directly. If you have to pay for health services you receive in another part of Canada, you can submit your receipts to your local ministry office to be considered for reimbursement. Prescription drugs from pharmacies, home care services, ambulance services and long-term care services provided in other provinces and territories are not covered.

For people travelling outside Canada, the ministry pays a set rate for emergency health services. Emergency health services are those given in connection with an acute, unexpected condition, illness, disease or injury that arises outside Canada and requires immediate treatment. Ambulance services are not covered. Ontario residents are encouraged to purchase supplementary insurance when traveling outside Canada as many emergency health services provided outside the country cost much more than OHIP may pay.

How do I submit my medical bills?

If you have purchased supplementary insurance, check with your insurance carrier about how you should submit your bills. Otherwise, it is required that you send your itemized bill to your nearest OHIP office within 12 months of receiving treatment. With your bill, send :

• an original, detailed statement, itemized on a fee-for-service basis
• your original receipt for payment
• your name and current Ontario address
• your health number
• a completed Out of Province/Out of Country Claims Submission (form 0951-84)

To avoid delays, do not hold your bills and receipts until you return to Ontario. Mail them to your insurance carrier or the ministry as soon as you receive them.

For more information : Travelling Outside Canada

My baby was born in hospital or at home attended by a registered midwife. How do I get a health card for my baby when he or she is born?

There is a special registration process for babies born in Ontario birthing hospitals (hospitals which have labour and delivery facilities) and for babies born at home attended by a registered midwife.

Immediately after the birth of your baby, hospital staff or a registered midwife will give you an Ontario Health Coverage Infant Registration form to complete. Babies born in an Ontario birthing hospital or at home and attended by a registered midwife will be provided with an infant registration form. Tourists, transients or visitors are not eligible for OHIP coverage.

This form requests information regarding your baby such as the baby’s name, birth date and mailing address. Information is also requested regarding the parent/guardian who is completing the form. You will be asked to confirm that :

• The child has a primary place of residence in Ontario.
• The child will be physically present in Ontario for at least 153 days in any twelve-month period to retain health coverage.

The bottom of the form is detachable and should be retained by you. It is pre-printed with a health number assigned to your baby. You should keep this record and use it until you receive the baby’s plastic Ontario health card.

A custodial parent may complete and sign the infant registration form. The completed form, minus the tear-off portion containing your baby’s Ontario health number, should be given back to the hospital or midwife before discharge. The midwife will forward the form to the hospital and the hospital will submit the completed top portion of the form to the ministry for processing.

What if my baby wasn’t born in hospital or attended at home by a registered midwife?

You will need to visit a ministry office to register your child for Ontario health coverage.

If you visit a ministry office within 90 days of the birth of your child you need to bring :

• confirmation of the baby’s birth, through either a letter from the hospital or attending physician, or a Certified Statement of Live Birth from a provincial office of the Registrar-General
• a completed Registration for Ontario Health Coverage (form 0265-82)
• your residency document
• your identity document

If you visit a ministry office more than 90 days after the birth of your child you need to bring :

• your child's citizenship document
• your residency document
• your identity document

Refer to the question "What documents should I bring when I register?" or to the Ontario Health Coverage Document List for a complete listing of approved documents.

My baby was born in an Ontario hospital but we are only visiting Ontario for a short period. Can we use the Ontario Health Coverage Infant Registration form to register our baby for Ontario health coverage while we are here?

No. Tourists, transients or visitors are not eligible for OHIP coverage. For a child born in Ontario to be eligible for Ontario health insurance coverage they must make their primary place of residence in Ontario, and be physically present in Ontario for at least 153 days in any 12-month period to retain OHIP coverage.

If you are visiting Ontario from another province or territory in Canada, contact your home province/territory regarding health insurance coverage for your baby and any insured services received while visiting Ontario.

I don’t live in Ontario. Can my newborn/baby be registered through this process?

No. Only residents who have a permanent and principal home in Ontario can register using this process.

OHIP pre-approved payment for my medical treatment in the United States and during that time I gave birth. How do I register my child for OHIP?

Please contact INFOline at 1 800 268-1154 to find out how to register your child.

What should I do if I need to take my baby to the doctor but haven't received his or her health card ?

The infant registration form contains a convenient tear-off record of your baby's Ontario health number. Keep and present this record for any required medical services until you receive your child's plastic Ontario health card.

If you do not have the tear-off record and you have paid for medical services for your child while awaiting his or her health card, your health care provider can reimburse you in full when you show the health card as proof of your child's eligibility.

It usually takes 6 weeks from registration for the ministry to process and mail your child's health card.

Do I need to notify the ministry if my baby and I are leaving the province?

You should contact the Ministry of Health and Long-Term Care with any change of address for both you and your baby. If you move to a location outside Ontario, you should inform the ministry of your new address and the date of the move as soon as possible. To inform the ministry of your move, you can either :

• Obtain a Change of Information (form 0280-82) for you and your baby. Complete and sign the form and return it by mail. Forms are available from your local OHIP office or from Forms Online.

or

• Send a letter to your local ministry office. You must include your names, health numbers, telephone number, current address, new address including postal code, and the effective date of the move for yourself and child(ren).

Do I need to cancel my OHIP coverage if I plan to move to a location outside Ontario?

You should contact the Ministry of Health and Long-Term Care with any change of address. If you move to a location outside Ontario, you should inform the ministry of your new address and the date of your move as soon as possible. To inform the ministry of your move, you can either :

• Obtain a "Change of Information" form and return it by mail. Forms are available from your local OHIP office or from the Forms Online

or

• Send a letter to your local OHIP office. You must include your name, health card number, telephone number, current address and new address including postal code.

The ministry will end your OHIP coverage based on the information that you provide.

Do I need to do anything with a deceased person's health card or health coverage ?

The health card of a deceased person must be returned to the Ministry of Health and Long-Term Care. You will need to complete a Change of Information (form 280-82) and then mail it with the health card of the deceased person to the ministry. You should include a copy of the death certificate. Copies of this form are available by :

• Contacting your local ministry office and requesting that one be forwarded to you.
• Printing a copy of the form through Forms Online.

Alternately, you can send a letter to your local ministry office providing the deceased person's name, date of birth, sex and health number. Enclose a photocopy of the death certificate and the actual health card.

Doesn't the government already know about this death ?   A death certificate has been issued.

It is important to notify the ministry as soon as possible when an insured person dies. The attending physician forwards this information to the ministry but this may take some time and the doctor is not responsible for the collection and return of the health card. The person who is looking after the affairs of the deceased must return the health card to the ministry.

Can I just throw a deceased person's health card away ?

No. The health card is actually the property of the government. It should be returned to the ministry for proper action and disposal.

Here is a list of local ministry offices.

Should I tell a deceased person's health care providers about the death (e.g., family doctor, specialists, optometrist, dentist) ?

As a courtesy, you could advise the deceased person's various health providers but you are under no obligation to do so.

What should I do if I have a question or concern about extra billing or queue jumping?

You may call the Ministry of Health and Long-Term Care at any of the following numbers :

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