安省OHIP医疗保险计划简要
Ontario Health Insurance Plan (OHIP)
以下是有关安大略省(安省)政府OHIP健康保险计划的简介，引自安省健康厅网页，仅供参考。更详细和更新的资讯请浏览健康厅的网站。 For more detailed and updated information about the provincial health plan in Ontario, please refer to the Government of Ontario Web site: www.health.gov.on.ca
What does your provincial plan cover?
Registration OHIP登记申请
Ontario Health Insurance Plan
For more information, contact Registration OHIP coverage:
Coverage is not compulsory. Participation is on an individual basis and there are no premiums.
For more information, please refer to the Ontario Ministry of Health and Long-Term Care Web site: www.health.gov.on.ca/english/public/pub/ohip/services.html
Eligibility OHIP申请资格You are eligible for Ontario Health Insurance if:
- you are a Canadian citizen, landed immigrant or convention refugee,
- you make your permanent and principal home in Ontario,
- you are present in Ontario for at least 153 days in any 12-month period.
Note: Tourists, transients and visitors, members of the RCMP and Canadian Armed Forces, inmates of federal penitentiaries, temporary residents, primarily international students and their families are not eligible and will not be covered (with exception).
Exception: People who come to Ontario for the primary purpose of working temporarily are eligible for OHIP coverage if, before coming to Canada, they are issued an Employment Authorization allowing them to work for an Ontario employer, at a specific job, for a limited time (minimum six months). Family members are covered if foreign worker is to be employed in Ontario for at least three consecutive years.
Effective dates of coverage OHIP生效日期OHIP coverage normally becomes effective three months after the date you establish residency in Ontario. The ministry strongly encourages new and returning residents to purchase private health insurance in case you become ill during the OHIP waiting period.
The day a permanent resident ceases to be :
- a serving member of the Canadian Armed Forces
- a serving member of the RCMP
- an inmate of a federal penitentiary
The day a non-resident becomes:
- a recipient of social assistance
- a ward of the Children's Aid Society
Under certain circumstances, residents may apply to continue Ontario coverage while living temporarily outside of Ontario.
Coverage termination OHIP保险终止Three months following departure for Ontario residents who establish residence outside Canada.
The last day of the second month for Ontario residents who establish residence elsewhere in Canada.
The day resident becomes
- a serving member of the RCMP or Canadian Armed Forces
- an inmate of a federal penitentiary
The day that a non-resident's social assistance is terminated or the day a non-resident is no longer a ward of the Children's Aid Society.
The end of the month following the month of expiry of a document issues by Employment and Immigration Canada.
Dental services 牙齿OHIP covers only a few specific dental services when performed in a hospital. These include: the cost of extracting a tooth if it is medically necessary to perform the procedure in a hospital and prior approval is obtained from OHIP; the cost of procedures related to cleft lip repair, neurological procedures, and tumors; osteotomy surgery and one post-operative (office) visit. If the dentist's charges for removing a tooth is covered by OHIP, general Anaesthesia will also be covered.
Coverage for children (JK to Grade 8) and seniors not covered by group insurance or eligible for dental care under provincial social assistance programs. Individual or parent must sign a declaration stating that the treatment represents a financial hardship.
Emergency treatment provided for those receiving Mother's Allowance. Basic treatment provided for children.
Basic care provided for mentally and physically handicapped individuals between 18 and 65, receiving family benefits, and not covered by a group insurance plan.
Disability 伤残Employment Insurance Sickness Benefit
Effective December 31, 2000 a person must have worked and paid Employment Insurance
premiums for a minimum of 600 hours to be eligible for benefits. Benefit max remains
at $413.00 per week.
For more information, please refer to the Human Resources Development Canada (HRDC) Web site:
www.hrdc-drhc.gc.ca/ae-ei/employment_insurance.shtml
Canada Pension Plan (CPP)
To be eligible for disability benefits, workers must contribute to the CPP for four of the last six years. During that period, earnings will have to be at least 10% of the year's maximum pensionable earnings (YMPE). In 2003, the YMPE is $39,900. The YMPE changes each year.
Disability pension payments stop:
- when the individual is no longer disabled according to Canada Pension Plan legislation; or
- at age 65 when the Canada Pension Plan retirement pension begins (or between ages 60-65 if early retirement is taken); or
- upon death.
For more information, please refer to the Human Resources Development Canada (HRDC) Web site:
www.hrdc-drhc.gc.ca/isp/common/cpptoc_e.shtml
Veterans Affairs Canada
Veterans may also be eligible for disability pensions from Veterans Affairs Canada, paid through the Canadian Pension Commission.
For more information, please refer to the Veterans Affairs Canada Web site: www.vac-acc.gc.ca
Workplace Safety & Insurance Board
In January 1, 1998 the Workers' Compensation Board of Ontario changed its name to the Workplace Safety & Insurance Board. The Ontario workplace safety and insurance system provides no-fault workplace insurance to workers who are injured on the job or who contract an occupational disease. This system is governed by the Workplace Safety and Insurance Act.
For more information, please refer to the Ontario Ministry of Health and Long-Term Care Web site: www.wsib.on.ca
Equipment, services and suppliesFor more information, contact Assistive Devices (ADP) & Home Oxygen Programs (HOP):
1-800-268-6021 (toll-free in Ontario only) or 416-327-8804 (in Toronto)
The objective of the ADP and HOP is to financially assist Ontario residents with long term physical disabilities to obtain basic, competitively priced, personalized assistive devices appropriate for the individual's needs and essential for independent living.
Please note that coverage is provided to a maximum amount. Additional coverage may apply to those individuals receiving social assistance under Ontario Works (OW), Ontario Disability Supports Program (ODSP) or Assistance to Children with Severe Disabilities (ACSD).
For more information, please refer to the Ontario Ministry of Health and Long-Term Care Web site: www.health.gov.on.ca/english/public/pub/pub_menus/pub_adp.html
Dental - ADP covers part of the approved cost for selected extra-oral and intra-oral maxillofacial prostheses. Individuals will be billed for at least 25 per cent of approved costs.
Colostomy supplies - ADP covers 75 per cent of the cost of ostomy supplies for individuals with a permanent ostomy up to $600 per year.
If you are receiving social assistance under Ontario Works (OW), Ontario Disability Supports Program (ODSP) or Assistance to Children with Severe Disabilities (ACSD), you may be eligible to receive $800 per ostomy.
Residents of long term care facilities are eligible for $800 per ostomy.
Durable equipment - ADP pays 75 per cent up to a maximum amount of the cost of wheelchairs, walkers (with wheels), scooters, powerchairs and cushions.
ADP may contribute to the cost of a new mobility aid if:
| • | Your functional ability or body size has changed |
| • | Your old device has worn out |
ADP provides coverage for compressors, drainage boards, suction machines, percussors, tracheostomy equipment, ventilators, recesitator and nasal continuous positive airway apnea pressure. Coverage at 75 per cent is provided for rental of an apnea monitor for infants who meet specific medical criteria. Coverage of enteral feeding supplies is provided for individuals with a chronic disability.
Hearing aids - For children 18 and under, ADP covers 75 per cent of the cost of a hearing aid, earmold (must be purchased with hearing aid), options/accessories listed with ADP and the dispensing fee up to a maximum of $500. If hearing aids are needed for both ears, ADP will cover 75 per cent to a maximum of $1,000 of the cost of two hearing aids, two earmolds (must be purchased with hearing aids), options/accessories listed with ADP and two dispensing fees.
The program also covers 75 per cent of the cost for an FM system to a maximum of $1,350.
A new hearing aid is allowed every three years unless medically necessary at an earlier date.
For adults over 18, ADP covers $500 toward the cost of a hearing aid, earmold (must be purchased with hearing aid), options/accessories listed with ADP and the dispensing fee.
A new hearing aid is allowed every three years.
If hearing aids are required for both ears, ADP will cover 75 per cent to a maximum of $1,000 of the cost of two hearing aids, two earmolds (must be purchased with hearing aids), options/accessories listed with ADP and two dispensing fees.
Orthopedic shoes - No coverage.
Oxygen - Home Oxygen Program covers 100 per cent of the costs for oxygen and related supplies for seniors over 65 years and social assistance recipients and 75 per cent of costs for all others.
Orthotics - ADP covers 75 per cent of the approved cost of orthotic devices including custom made braces and splints. Orthotic devices may be replaced if medically necessary or the device no longer meets the needs of the individual.
Prosthetics - ADP coverage varies for prosthetics based upon the device required. A written estimate from the vendor will provide the amount that can be billed to ADP for prosthetic devices (generally 75 per cent).
Pressure modification devices - ADP will provide 75 per cent coverage for custom-made burn orthoses (once a year), burnscar pressure garments (three sets of two outfits per year), vascular compression garments (three sets of two outfits per year), and extremity pumps (once every five years; two year replacement for boots and sleeves for the pumps).
Health servicesAmbulance - Coverage for medically necessary air and land ambulance after patient pays $45. No coverage for out-of-province ambulance service.
For more information, please refer to the Ontario Ministry of Health and Long-Term Care Web site: www.health.gov.on.ca/english/public/pub/ohip/amb.html
Laboratory and X-rays - Coverage for lab services and x-rays, excluding dental x-rays.
Hospital - Ward coverage. Coverage for normal hospital in-patient services, as well as certain hospital out-patient services
For more information, please refer to the Ontario Ministry of Health and Long-Term Care Web site: www.health.gov.on.ca/
Chronic care patients - Effective Sept 1, 2002, chronic care patients must pay $47.53 per day to the hospital to cover room, board and basic necessities. The previous payment amount was $44.51 per day. The co-payment is charged to a patient whose doctor has determined that the patient requires chronic care and is permanently resident in the hospital or awaiting placement in a chronic care hospital/unit or nursing home. A full exemption from the co-payment is available for patients who are under 18; on social assistance; have a monthly income below a certain level; or have a third party (ie. Workers Compensation, insurance benefits, government benefits, etc.) that pays either the total hospital cost or the co-payment.
A partial exemption is available depending upon the monthly income of the patient and his/her dependents and the number of dependents.
Home careCommunity Care Access Centres (CCACs) provide in-home health care services and homemaking with referral of a doctor. Clients must have valid Ontario Health insurance to be assessed for service. Services include nursing, physiotherapy, occupational therapy, speech therapy, dressings, medical supplies, homemaking, palliative care, dietetic services and social work. School health support services provided for students with special health care needs.
For more information, please refer to the Ontario Ministry of Health and Long-Term Care Web site: www.health.gov.on.ca
There is no charge for up to 2 months rental of equipment (wheelchair, commode, pain pump, walker). Ontario Drug Benefits (ODB) is provided automatically for those receiving Home Care Service.
Respite care is also available according to need.
Nursing homeEffective July 1, 2001 - Short-stay payment is $30.24 per day. Effective Sept 1, 2002, coverage for long-stay nursing home care after payment of $47.53 per day for basic accommodation. The previous amount was $44.51 per day. Additional $8 charge for semi-private accommodation and an additional $18 for private accommodation.
Paramedical practitioner servicesChiropractor - Effective February 12, 1999, the maximum annual benefit per patient payable by OHIP is reduced to $150 (including $40 for x-rays) from current level of $220.
The rates are as follows:
- $11.75 for the initial visit;
- $9.65 for each subsequent visit;
- $12 for a home visit.
The benefit year remains unchanged and runs from April 1 to March 31. If the patient has received payment for more than $150 before February 12, all claims for services after February 12, but before April 1 are paid at $0.
Massage - No coverage.
Naturopath - No coverage.
Nurse practitioners - Nurse practitioners are registered nurses who hold an extended certificate of registration to provide, with members of other health professions, primary health care services.
Effective February 18, 1998, under the Expanded Nursing Services for Patients Act, nurse practitioners in Ontario will have the legal authority to:
- prescribe and administer treatments and medications;
- order certain ultrasounds and basic X-rays;
- order basic lab tests.
A physician's signature is no longer necessary, allowing both nurse practitioners and family physicians to more effectively and co-operatively provide care to patients.
Osteopath - Maximum $155 per year (including $25 for x-rays) at the following rates: $12 for the initial visit; $9.50 for each subsequent visit; $15 for a home visit. Benefit year from April 1 to March 31.
Physiotherapist - Coverage when service provided in an approved physiotherapy clinic, hospitals, physicians offices that offer physiotherapy and Community Care Access Centres.
Podiatrist - Maximum $135 per person per year (including x-rays) at following rates: $16.40 for the initial visit; $11.45 for each subsequent visit; $7 for an institution visit. Maximum of $30 per year for x-ray. Benefit year is April 1 to March 31. Does not cover graduates of the Ontario Chiropody Program.
Psychologist - No coverage.
Speech therapy - Coverage for services performed in a hospital when prescribed by a doctor.
Physician servicesCoverage for physicians' fees including office, home and hospital visits.
Prescription drug coverageFor information about the Ontario Drug Benefits (ODB), phone
Ontario Drug Benefit program provides partial coverage for the cost of prescription drugs for seniors (age 65 plus) and social assistance recipients. $2 payment per prescription for low income seniors (income less than $16,018 for a single person and less than $24,175 for a couple), social assistance recipients, long term care residents, and home care recipients (regardless of income). All other seniors pay the first $100 in prescription costs each year and up to $6.11 per prescription after they reach the deductible. The benefit year runs from August 1 to July 31.
For more information about the Trillium Drug Program, phone
Trillium Drug Program (TDP) provides help to Ontario residents who have high drug costs in relation to their income.
- Drug benefits will be provided after an individual or household spends a certain amount on drugs each year. This amount is called the deductible and it is based on the number of people in your household and your household's net income.
- The deductible is approximately 4% of individual or household net income and is paid in four installments over the Trillium program year. Please contact TDP directly for further information on your deductible calculation.
- If, during the deductible phases, the individual or any member of the household has a private drug plan, they must first submit any prescription drug costs to the insurance company for reimbursement. That portion of prescription costs not covered by the insurer may be applied to your Trillium deductible.
- Individuals can apply and become registered with the Trillium Drug Plan at any time, even if they haven't reached their deductible.
- The list of prescription drugs that count toward the deductible includes those listed on the Ontario Drug Benefit formulary and a number requiring preapproval by the Ontario Ministry of Health.
- Applicants must pay a deductible based on their family's net income before becoming eligible. Once eligible, those on the program may pay up to $2 per prescription.
- Trillium benefit year runs from August 1 to July 31 of the following year.
- The deductible can be paid in quarterly installments with any unpaid deductible added to the next quarter's deductible.
- Families or individuals who come into the program later in the year would pay a deductible based only on the number of months left in the program. This pro-rated deductible is offered only for the first year a household is enrolled in the program.
Special Drugs Program
For more information, contact:
| Special Drugs Program | 416-327-8109 |
| The Toronto Hospital HIV Clinic | 416-340-5077 |
| Trillium Drug Program | 1-800-575-5386 |
Though the Special Drugs Program, coverage for the full cost of certain out-patient drugs used in the treatment of specific conditions is provided. The program covers:
- many drugs for the treatment of cystic fibrosis and thalassaemia
- AZT, ddI, ddC and pentamadine for people who are HIV positive
- Erythropoietin (EPO) for people with end stage renal disease
- Cyclosporine for people who have had a solid organ or bone marrow transplant
- human growth hormone for children with growth failure
- Clozapine for treatment of schizophreni;
- Alglucerase for people with Gaucher's Disease
As a way for the ministry to ensure that the appropriate treatments for the diseases and conditions are prescribed, special facilities, usually at hospitals, have been designated to distribute these treatments.
The Trillium Drug Program provides coverage for unmanageable prescription drug costs. For the purposes of this program, "prescription drugs" normally refers to drugs covered by the ODB. In some circumstances, however, consideration by a health review panel may be given to a request for coverage of a prescription drug product not listed in the ODB formulary. This process is known as Section 8. Generally, a Section 8 request can be granted for up to a 12 month period.
Multiple Sclerosis (MS) drug therapies covered:
- Avonex
- Betaseron
- Copaxone
- Rebif
Patient must:
- be assessed by general practitioner or specialist.
- must have prescription approved by ministry of health review panel. Approval is given for six month period.
- must have relapsing-remitting MS, at least 2 attacks in previous 2 years and ambulatory for 100 metres without a mobility aid (EDDSS 5.5).
For more information, please refer to the Multiple Sclerosis Society of Canada Web site: www.mssociety.ca
Services for seniors
For more information, please refer to the Ontario Seniors' Secretariat Web site: www.health.gov.on.ca/english/hlinks/seniors.html
Contact, Seniors InfoLine 1-888-910-1999
The Government of Ontario is committed to planning and co-ordinating efforts to ensure that seniors live in comfort, security and dignity. One commitment to that end is the creation of My Ontario Web for Seniors. This is an Ontario government Web site created to provide direct access to information from various government sources. The site also provides links to other Web sites of interest to seniors.
TravelFor travel information, contact:
416-327-4327 or toll-free 1-800-268-1153 (English and French)
Out-of-province coverage - Under federal-provincial agreement, out-of-province recipients are insured for all hospital care and physicians services offered by the province in which they are treated. All provinces and territories participate except Quebec for physician services. The Quebec government reimburses physicians at Quebec rates.
Out-of-Canada coverage - Coverage for hospitalization up to $400 per day depending on the level of care provided. Coverage for emergency outpatient care is $50 per day. Coverage for renal dialysis is $210 per treatment. Physicians reimbursed at Ontario rates.
Effective March 1, 1999, Ontario residents are allowed to be away from the province of Ontario for 182 days plus an extra thirty days for travel in any 12 month period.
For more information on out-of-province coverage, please refer to the Ontario Ministry of Health and Long-Term Care Web site: www.health.gov.on.ca/english/public/pub/ohip/travel.html
Vision servicesOptometrist - Effective April 1, 1998, OHIP will only allow one routine eye examination for glasses every two years for adults aged 20 to 64, and annually for children under 20 and seniors aged 65 or older. Exceptions will be made when medically warranted. No coverage for fitting of contact lenses.
Vision care - No coverage.