For newcomers settling in Ontario, understanding how the province’s healthcare system works is one of the most important steps toward building a comfortable life in Canada. Ontario offers a publicly funded healthcare system that ensures most essential medical services are free for eligible residents.
This guide will help you understand how to navigate the Ontario healthcare system, whether you qualify for the Ontario Health Insurance Plan (OHIP) or not.
So, without further ado, let us begin!
Who Qualifies For OHIP?
The Ontario Health Insurance Plan (OHIP) provides free health coverage for Ontario residents. To qualify, you must live in Ontario and be physically present for at least 153 days in any 12-month period and within the first 183 days after you move to the province.
Eligible Residents
You qualify for OHIP if you are:
- A Canadian citizen or permanent resident living in Ontario
- A work permit holder working full-time for an Ontario employer for at least six months
- A permanent residence applicant with an Acknowledgement of Receipt (AOR) from IRCC
- A participant in the Live-in Caregiver or Seasonal Agricultural Worker Program
- A Temporary Resident Permit holder (case types 86–95)
- A full-time clergy member serving in Ontario for six months or more
- A convention refugee or protected person
Note that your spouse or dependents may also qualify for OHIP if they live with you.
Accessing Primary Care
Your first step in the healthcare system will likely be through a primary care provider, i.e., a family doctor or a nurse practitioner. These professionals handle general health concerns, perform checkups, prescribe medications, and help manage chronic conditions.
They also act as your gateway to other medical services, referring you to specialists when advanced or specific care is required.
You’ll usually see your primary care provider at a medical office or clinic, either through an in-person or virtual appointment. The waiting time depends on your provider’s availability.
Primary Care Through A Family Doctor
In order to navigate the Ontario healthcare system, the next thing to understand is having primary care through a family doctor.
Well, the most common model for primary care in Ontario is through a family doctor, i.e., a general practitioner who gets to know your health history and provides long-term care.
However, due to an ongoing shortage of family doctors, finding one can take time.
How To Find A Family Doctor?
You can:
- Use Ontario’s Health Care Connect program to be matched with doctors or nurse practitioners accepting new patients.
- Contact local clinics directly and ask if they are taking new patients.
To register with a family doctor, you must have valid OHIP coverage. If you don’t, there are other options available.
If You Don’t Have A Family Doctor
If you can’t find a family physician or need faster care, Ontario offers several alternative healthcare options:
1. Walk-In Clinics
Walk-in clinics are great for non-emergency issues such as infections, rashes, minor injuries, or sprains. You don’t need any prior appointment for it.
What to Expect:
- Wait times can range from 30 minutes to three hours depending on the clinic.
- Clinics usually open early (around 7 a.m.) and close by 6–8 p.m.
- If you have OHIP, most services are free. Without it, you’ll pay around $60–$150 per visit.
- You can also get a specialist referral from walk-in clinics.
2. Virtual Clinics
A virtual clinic is an online healthcare service where you can talk to doctors or nurses through video calls, phone calls, or chat messages. You can either use their websites or mobile apps to book an appointment at a time that suits you, and many clinics even offer same-day visits.
Most virtual clinics provide many types of care, like general check-ups, mental health support, prescription renewals, and referrals to specialists.
If both you and your doctor or nurse are in Ontario and you have a valid Ontario health card, most visits are free (except for some chat-only services). Many clinics also take private insurance, but if you don’t have any, you’ll need to pay yourself.
Examples of virtual clinics in Ontario include Health Connect Ontario (also called Health 811), Rocket Doctor, Maple, and Tia Health — some of which are available 24/7.
3. Community Health Centres (CHCs)
In Ontario, some clinics and Community Health Centres (CHCs) provide free healthcare services, including basic medical care.
These centres are often run by volunteers and have doctors, nurses, and other community workers like social or settlement workers.
Depending on the clinic, you may not need an OHIP card, and many places offer care for free. They provide services like general check-ups, mental health support, and sexual or prenatal care.
Moreover, there are 75 CHCs in Ontario, and you can also go there if you need a referral to a specialist.
Some CHCs accept walk-ins, while others require you to book an appointment first.
Certain clinics have eligibility criteria you must meet to receive care.
4. Specialist Clinics
Specialist clinics focus on specific areas of medicine like cardiology, dermatology, or psychiatry. You usually need a referral from a family doctor or walk-in clinic to see a specialist.
After the referral is sent (usually electronically or by fax), the specialist’s office will contact you to schedule an appointment. Wait times vary depending on the urgency of your case and the specialist’s availability.
If you don’t have OHIP, you’ll need to pay for consultations, which can range from $100 to $300.
The Ontario government’s wait time tool lets you check average waiting periods for surgeries, imaging, and mammograms in your area.
How To Get A Specialist Referral?
In order to navigate the Ontario healthcare system, let us now understand how you can obtain a referral to see a specialist.
Well, Ontario has over 33,000 specialists in 47 medical fields – from endocrinology (hormones) to gynecology and hematology.
Referral Process:
- Book an appointment with your family doctor or visit a walk-in clinic.
- Discuss your symptoms. If specialized care is needed, your provider will write a referral letter.
- The referral is sent directly to the specialist or given to you to deliver.
- The specialist reviews your case and determines urgency.
- You’ll receive a call, email, or letter with your appointment details.
In some cases. The office may simply mail you a letter with your appointment time and date, which you will be required to reschedule if you cannot make it.
ER vs. Urgent Care
For serious or life-threatening medical issues, go to the Emergency Room (ER) or call 911.
When To Visit The ER:
- Difficulty breathing
- Chest pain or stroke symptoms
- Seizures or loss of consciousness
- Severe injuries or heavy bleeding
- Allergic reactions
- Major burns
When To Visit Urgent Care:
For urgent but non-life-threatening issues like:
- Sprains, cuts, or minor fractures
- Minor burns
- Rashes
- Infections (ear, throat, urinary)
- Mild allergic reactions or rashes
If you are not sure where to go for medical help, you can call Telehealth Ontario at +1 866-553-7205 for advice.
Emergency rooms (ERs) are open all the time, day and night. Urgent care centres are open only during certain hours.
You don’t need an appointment to visit the ER or an urgent care centre.
Wait times depend on how busy it is and how serious your condition is. Doctors see patients based on how urgent their problem is, not by who arrived first.
If you have a serious issue, like a heart attack, you’ll be seen right away. If it’s not serious, you might have to wait for several hours.
Urgent care centres are a middle option between your family doctor and the ER. They usually have shorter wait times.
If you don’t have OHIP or private insurance, going to an urgent care centre usually costs less than visiting the ER.
Services Covered By OHIP
If you’re eligible for OHIP, most medically necessary services are covered. This includes both in-person and virtual care, such as:
- Doctor and hospital visits
- Emergency and ambulance services
- Abortions
- Diagnostic tests (bloodwork, X-rays, ultrasounds)
- Medically necessary surgeries (including certain dental and eye surgeries)
- Laboratory and imaging services
When you travel to another province in Canada, your OHIP card still covers necessary hospital or clinic care.
Services Not Covered By OHIP
As you navigate the Ontario healthcare system, it is important to know which services are not covered by OHIP.
They are:
- Prescription drugs (outside hospitals)
- Dental care and cleanings
- Eye exams, glasses, or contact lenses
- Cosmetic surgeries
- Physiotherapy, chiropractic care, massage therapy, and acupuncture
- Doctor’s notes for employers or schools
How To Apply For OHIP?
In order to get your OHIP health card, you must apply in person at a ServiceOntario centre and bring the following documents:
- A completed Registration for Ontario Health Insurance Coverage form (available online or at ServiceOntario).
- An original document showing your identity and signature (e.g., passport, driver’s license).
- A document proving your Ontario residency (e.g., utility bill, lease agreement).
- A document proving your citizenship or eligible immigration status.
You must provide three separate documents, i.e., one for each category above.
After your application is processed, your OHIP card will arrive by mail in about four to six weeks.
Tips For Accessing Care Without OHIP
Some people in Ontario don’t qualify for OHIP but still need healthcare coverage for the duration of their stay in Canada.
International Students
Most international students are automatically enrolled in the University Health Insurance Plan (UHIP). It works like OHIP and covers medically necessary services, offering up to $1 million in coverage.
Super Visa Holders
Super Visa holders must have health insurance from either:
- A private insurance company in Canada, or
- An approved insurance company from another country.
The insurance must cover at least $100,000 in medical costs.
Temporary And Work Permit Holders
Participants in programs like International Experience Canada (IEC) are required to maintain valid health insurance for the entire length of their stay.
Paying For Services Without OHIP
It is important to note that people without OHIP coverage may have trouble getting services like lab tests or prescription medicines. For example, places like LifeLabs and many pharmacies usually bill through OHIP and may not handle private insurance directly. This means you might need to pay first and then ask your insurance company for a refund.
To avoid problems, always carry proof of your private insurance and ask about billing before getting treatment. When you can, try to go to clinics that often serve international or uninsured patients.
Diagnostic Testing In Ontario
If your doctor orders diagnostic tests, they’ll give you a requisition form to bring to a testing centre such as LifeLabs or Dynacare.
Common diagnostic tests include:
- Blood and urine tests
- X-rays and ultrasounds
- ECGs and Holter Monitoring
- Cancer screenings
- Infectious disease panels
- Immunological disorder testing
- Neurological/ neurodegenerative disorder testing
- Naturopathic tests (hormone levels, food reactions, toxin identification, etc
- Genetic tests
Common tests like X-rays, blood tests, and urine tests usually don’t need an appointment, but booking one can help you save waiting time.
Tests like ultrasounds, cancer screenings, or other special scans usually need an appointment.
If you go to places like LifeLabs or Dynacare, most common tests are covered by OHIP, but it depends on the type of test your doctor asks for.
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