Ontario Health Insurance

Under the Canada Health Act, Ontario is required to fund necessary hospital and medical or primary care (i.e., physician) services. But we go beyond those legal obligations to provide a wide range of other health services. Ontario health insurance also pays for:

• a variety of  community services, such as home care and other support services that help people manage chronic illnesses and live independently
• community mental health services for people with mental health problems
• a portion of the cost of care provided by long-term care homes that provide residential care for people who are no longer able to live independently
• most of the cost of prescription drugs for seniors (age 65 and over), people on social assistance, and Ontario residents who face high drug costs

Specific details of insurance coverage are broken down according to hospital insurance and medical insurance as follows:

Hospital Insurance Plan
Insured in-patient hospital services include accommodation and meals at the standard ward level; necessary nursing services; laboratory, radiological and other diagnostic procedures; drugs, biologicals and related preparations; use of operating rooms, obstetrical delivery room and anaesthetic facilities.

Insured out-patient services include laboratory, radiological and other diagnostic procedures; use of radiotherapy, occupational therapy, physiotherapy and speech therapy facilities, where available; use of diet counselling services; use of home renal dialysis and home hyperalimentation equipment, supplies and medication; provision of equipment, supplies and medication to haemophiliac patients for use at home, (including Cyclosporin to transplant patients, AZT to AIDS patients, biosynthetic human growth hormone, rabies vaccines, and drugs for treatment of cystic fibrosis and thalassemia).

In addition to the insured hospital benefits, Ontario provides mental health services; the residential component of the Homes for Special Care Program; ambulance services (air and land) with a patient co-payment component; dental treatments for patients with cleft lip/palate registered at a designated clinic; and funding for a Breast Screening Program.

Medical Care Plan
Insured medical services include all prescribed medically necessary services provided by physicians. Insured physician services in facilities, physicians' offices or in a patient's home include diagnosis and treatment of medical disabilities and conditions; medical examinations and tests; surgical procedures; maternity care; anaesthesia; radiology and laboratory services in approved facilities; and immunizations, injections and tests.

Insured hospital surgical-dental services include repair of traumatic injuries; surgical incisions; excision of tumors and cysts; treatment of fractures; homeografts; implants; and alloplastic reconstructions and other specified dental procedures where it is medically necessary that they be rendered in hospital.

In addition to the basic insured health services, the Ministry of Health and Long-Term Care also provides funding for oculo-visual assessments by optometrists once a year for persons under 20 and those 65 and over. The Ministry also covers a major eye exam once every 12 months for persons aged 20–64 who have medical conditions requiring regular visits as well as a drug benefit program for persons who are legally entitled to remain in Canada and reside in Ontario, and who belong to one of the following groups:

• people 65 years of age and older  
• residents of long-term care homes  
• residents of Homes for Special Care  
• people receiving professional services under the Home Care Program  
•  people receiving social assistance

The government also provides:

• the Trillium Drug Program for those people who spend a large part of their income on prescription drugs
• a Special Drugs Program administered by hospitals that covers the cost of expensive out-patient drugs used on a long-term basis
• an Assistive Devices Program that provides such items as home oxygen, artificial limbs, hearing aids, communication and visual aids, wheelchairs, respiratory equipment and supplies
• an annual grant for needles and syringes for insulin-dependent senior diabetics
• a Northern Health Travel Grant program
• with some limitations, the services of midwives and physiotherapy in approved facilities

For more information go to www.health.gov.on.ca