August 29, 2014

Ontario Provincial Health Plan - Fact Sheet

August 29, 2014

Your Ontario Health Insurance Plan Provides:Prescription Drugs:Coverage under the Ontario Drug Benefit Plan Program for seniors and SocialAssistance recipients only. Covers drugs listed on the Ontario drug formulary.Seniors must pay the first $100 in prescription costs. Once this has beenSatisfied, seniors must pay the first $6.11 for each prescription.Catastrophic coverage under the Trillium Drug Program after a deductible(paid in quarterly installments) has been satisfied. The deductible is based onfamily net income. Once this has been satisfied, households must pay up to$2.00 for each prescription.AmbulanceCoverage for in-province land and air ambulance when medically necessary.Patient is responsible for a $45 co-payment. Some exceptions apply.Dental benefitsNo coverage for routine or major services (i.e. cleanings, fillings, extractions,endodontics, periodontics, crowns, bridges, dentures, etc.).No coverage for treatment of accidental injury to teeth.Coverage for services provided by a dental surgeon, for specific proceduresperformed in hospital only.VisioncareNo coverage for glasses or contact lenses.Coverage for one eye exam every 12 months for residents under age 20 andunder and for residents aged 65 and over.Coverage for one major eye exam every 12 months for persons age 20 to 64Who have medical conditions requiring regular eye examinations.Coverage for routine eye examinations once every two years for residentsreceiving as assistance under the Ontario Disability Support Program, OntarioWorks or the Family Benefits Program.HospitalCoverage for standard ward rooms only.ParamedicalNo coverage for chiropractor, psychologist, massage therapy or naturopathservices.Coverage for podiatrist services up to an annual maximum of $135. Anadditional $30 per plan year is available for x-rays.Coverage for speech therapy services when performed in hospital only.Coverage for physiotherapy for seniors aged 65 and over, individuals age19 and under and individuals of any age needing physiotherapy after beinghospitalized.Hearing AidsCoverage under the Assistive Devices Program. Individual must apply forassistance.Nursing Benefits and Home CareSome coverage based on need.Medical SuppliesSome coverage under the Assistive Devices Program such as the cost ofinsulin pumps and related ongoing supplies for Type 1 diabetics who are18 years of age and under. Individual must apply for assistance.Coverage through The Assistive Devices Program (ADP) for the full cost ofinsulin pumps for adults who qualify and are age 19 and over. In addition, aannual grant of $2400 (paid out in units of $600, quarterly) is provided toapproved individuals for related supplies. Accidental Death & DismembermentNo coverageOut of CountryCoverage for emergencies only. In-patient services are covered up to $400per day for higher-level hospital care and up to $200 for any other kind ofmedical care.These highlights from the Ontario Health Insurance Plan are for general reference only and are subject to change, corrections and updates. Other government programs may also be available.For more information on the latest coverage details, please contact:The Ontario Health Insurance Plan:Phone: 416-314-5518Toll free in Ontario: 1-800-268-1154TTY: 1-800-387-5559Website: http://www.gov.on.ca

Your Ontario Health Insurance Plan Provides:Prescription Drugs:Coverage under the Ontario Drug Benefit Plan Program for seniors and SocialAssistance recipients only. Covers drugs listed on the Ontario drug formulary.Seniors must pay the first $100 in prescription costs. Once this has beenSatisfied, seniors must pay the first $6.11 for each prescription.Catastrophic coverage under the Trillium Drug Program after a deductible(paid in quarterly installments) has been satisfied. The deductible is based onfamily net income. Once this has been satisfied, households must pay up to$2.00 for each prescription.AmbulanceCoverage for in-province land and air ambulance when medically necessary.Patient is responsible for a $45 co-payment. Some exceptions apply.Dental benefitsNo coverage for routine or major services (i.e. cleanings, fillings, extractions,endodontics, periodontics, crowns, bridges, dentures, etc.).No coverage for treatment of accidental injury to teeth.Coverage for services provided by a dental surgeon, for specific proceduresperformed in hospital only.VisioncareNo coverage for glasses or contact lenses.Coverage for one eye exam every 12 months for residents under age 20 andunder and for residents aged 65 and over.Coverage for one major eye exam every 12 months for persons age 20 to 64Who have medical conditions requiring regular eye examinations.Coverage for routine eye examinations once every two years for residentsreceiving as assistance under the Ontario Disability Support Program, OntarioWorks or the Family Benefits Program.HospitalCoverage for standard ward rooms only.ParamedicalNo coverage for chiropractor, psychologist, massage therapy or naturopathservices.Coverage for podiatrist services up to an annual maximum of $135. Anadditional $30 per plan year is available for x-rays.Coverage for speech therapy services when performed in hospital only.Coverage for physiotherapy for seniors aged 65 and over, individuals age19 and under and individuals of any age needing physiotherapy after beinghospitalized.Hearing AidsCoverage under the Assistive Devices Program. Individual must apply forassistance.Nursing Benefits and Home CareSome coverage based on need.Medical SuppliesSome coverage under the Assistive Devices Program such as the cost ofinsulin pumps and related ongoing supplies for Type 1 diabetics who are18 years of age and under. Individual must apply for assistance.Coverage through The Assistive Devices Program (ADP) for the full cost ofinsulin pumps for adults who qualify and are age 19 and over. In addition, aannual grant of $2400 (paid out in units of $600, quarterly) is provided toapproved individuals for related supplies. Accidental Death & DismembermentNo coverageOut of CountryCoverage for emergencies only. In-patient services are covered up to $400per day for higher-level hospital care and up to $200 for any other kind ofmedical care.These highlights from the Ontario Health Insurance Plan are for general reference only and are subject to change, corrections and updates. Other government programs may also be available.For more information on the latest coverage details, please contact:The Ontario Health Insurance Plan:Phone: 416-314-5518Toll free in Ontario: 1-800-268-1154TTY: 1-800-387-5559Website: http://www.gov.on.ca

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