2025 Guide for Ontario Residents
If you live in Ontario, you’ve likely heard of OHIP — the Ontario Health Insurance Plan that covers many essential medical services. But what exactly does it include? What’s not covered? And how do you make sure you’re getting the most out of your OHIP benefits?
At Viva Health Centre in Richmond Hill, we often meet new patients who are unsure about what OHIP offers — especially when it comes to family medicine, preventive care, and specialist referrals. That’s why we’ve put together this 2025 OHIP guide to answer your most common questions.
Whether you’re new to Ontario or just want a refresher, this article will help you better understand what OHIP covers, how to use it, and where to go when you need care.
What Is OHIP?
OHIP stands for the Ontario Health Insurance Plan. It’s a public health insurance program funded by the provincial government that pays for a wide range of medically necessary services.
If you’re an Ontario resident with a valid health card, OHIP helps cover:
- Family doctor visits
- Walk-in clinic appointments
- Hospital stays
- Diagnostic tests (e.g., blood work, X-rays)
- Surgeries
- Many specialist visits
Your OHIP card is your gateway to the Ontario healthcare system. Make sure it’s valid and up to date!
What OHIP Covers in 2025
Here’s a breakdown of what’s typically covered:
1. Visits to a Family Doctor
- Routine checkups
- Preventive screenings (e.g., cancer, diabetes)
- Chronic disease management (e.g., asthma, hypertension)
- Immunizations (as per Ontario’s public schedule)
2. Diagnostic Tests
- Blood and urine tests
- Imaging (X-rays, ultrasounds, CT scans, MRIs when medically required)
3. Hospital Services
- Inpatient hospital stays
- Emergency room visits
- Surgeries
- Anesthesia and nursing care
4. Mental Health Services (Limited)
- Psychiatrist visits (when referred by a physician)
- Mental health assessments at hospitals
Note: Psychologists, therapists, and counsellors outside hospitals are usually not covered.
5. Maternity and Newborn Care
- Prenatal checkups
- Labour and delivery
- Postnatal follow-up care
6. Some Eye Exams
- One annual eye exam for:
- Patients aged 19 and under
- Seniors 65+
- Adults with certain medical conditions (e.g., diabetes)
7. Some Hearing Tests
- When ordered by a physician
- Hearing aids are not covered
8. Some Dental Surgery
- Procedures done in a hospital setting (e.g., jaw surgery)
What OHIP Does Not Cover
While OHIP is comprehensive, there are important exclusions. These include:
- Prescription medications (unless through ODSP, Trillium, or OHIP+)
- Dental cleanings, fillings, crowns
- Glasses, contact lenses
- Most physiotherapy and chiropractic care
- Cosmetic procedures
- Most travel vaccines
- Ambulance services (unless criteria met)
Tip: You can combine OHIP with private insurance (like from your employer or school) to cover these out-of-pocket costs.
OHIP at Family Practices: What to Expect
At Viva Health Centre, OHIP covers nearly all standard visits, including:
- First-time patient consultations
- Routine checkups and physicals
- Chronic disease management
- Lab work ordered by our doctors
- Preventive care (e.g., pap smears, mammograms, colon cancer screening)
- Referrals to specialists
- Vaccinations on Ontario’s schedule
You will not be charged out of pocket for these services if you have a valid OHIP card.
Who Is Eligible for OHIP?
You’re eligible for OHIP if you:
- Are a Canadian citizen, permanent resident, or certain visa holder
- Make Ontario your primary residence
- Are physically present in Ontario for at least 153 days per year
Need help applying? Visit ontario.ca for forms and information.
Changes to OHIP in 2025
OHIP evolves regularly. As of this year:
- Virtual care is covered but only through your family doctor or physician group
- Coverage for eye exams and ear-related services has changed (age-based restrictions)
- Some previously covered lab services may now require co-pay if done at private labs
Always check with your doctor’s office or the Ontario Ministry of Health for the most current updates.
OHIP vs. Private Insurance
OHIP is your base layer of protection. For services not covered, many Ontarians turn to:
- Employer-sponsored plans (Sun Life, Manulife, Greenshield, etc.)
- University/college plans
- Individual private plans
These can help with:
- Medications
- Mental health therapy
- Dental and vision care
- Travel insurance
Read more about this in our related post:
Private Insurance vs. OHIP: Which Medications Are Covered for Diabetics?
Common Questions About OHIP
Do I need to renew my OHIP card?
Yes. Check the expiry date on the front of your card and renew through ServiceOntario.
Do all clinics accept OHIP?
Most do — especially family practices and walk-in clinics. But some private clinics or specialist centres may charge for certain services.
Can I get a second opinion under OHIP?
Yes. You can request a second opinion from another doctor or specialist covered under OHIP.
Why Choose Viva Health Centre?
At Viva Health Centre, we offer comprehensive OHIP-covered services, including:
- Family doctor appointments
- Walk-in clinic access
- Preventive screenings
- Chronic condition management
- Flu shots and routine vaccines
- Virtual appointments (OHIP-covered)
📍 Conveniently located in Richmond Hill, we’re committed to making health care easy, accessible, and trustworthy.
Accepting new patients
Bilingual staff
On-site pharmacy and lab access
📞 Call: (905) 237-5567
🌐 vivahealthcentres.com
Understanding what OHIP covers can help you make more informed decisions and avoid unexpected medical costs. Whether you’re managing a chronic condition, planning your next check-up, or just moved to Ontario, knowing your rights as a patient is a powerful first step.
And if you’re looking for a family doctor in Richmond Hill, we’re here for you.
