Important OHIP eligibility info for all PR applicants residing in Ontario

[Intel]

Starting April 1st, 2009, Ontario considered a PR applicant residing in Ontario eligible for OHIP according to the following:



"Being a person who has submitted an application for permanent residence in Canada to the proper federal government authority, even if the application has not yet been approved, as long as Citizenship and Immigration Canada has confirmed that the person meets the eligibility requirements to apply for permanent residency in Canada, and the application has not yet been denied"

Source: Health Insurance Act R.R.O. 1990, REGULATION 552, Subsection 1.4 paragraph 5



I have two points to clarify:

• I know that the common understanding for the above statement is that it is only true for inland applicants. However, this understanding is totally WRONG. The term "application for permanent residence in Canada" does not mean that it should be submitted within Canada, but it means that the applicant had submitted an application to reside permanently in Canada. If you check the PR application form, then you will see that it mentions "Application for Permanent Residence in Canada"
• The PR applicant residing in Ontario is eligible from the time when the IO at visa office determines that eligiblity to apply for PR is being met in principle (commonly known as Initial Assesment). In CAIPS notes concering FSW cases, this eligibility is determined by PSDEC 1. Ontarian PR applicants under FSW who got their positive initial assesments, or who has CAIPS notes indicating PSDEC: 1, should be able to apply for OHIP and get the coverage after 3 months from the date of positive initial assesment/PSDEC.

 

[abhi812]

Qorax,

Is above true

 

[Leon]

As far as I know, this has been used for people being sponsored under inland who already have first stage approval. I am not sure if FSW or other applicants can also get it. I would assume that most FSW applicants already in Canada are working and are therefore covered by OHIP because of their work permits.

 

[Intel]

Sorry to bump this old topic. I did not want to open a new topic to follow up on the same matter.

I wanted to clarify that all PR applicants residing in Ontario are eligible regardless of what category they applied for, as long as they receive a written letter from CIC showing their eligibilty as applicants.

I saying this because I was under FSW, yet I got my coverage started retroactively a year before landing. So the assumption that only inland sponsored applicants can apply is wrong.

As far as I know, this has been used for people being sponsored under inland who already have first stage approval. I am not sure if FSW or other applicants can also get it. I would assume that most FSW applicants already in Canada are working and are therefore covered by OHIP because of their work permits.

 

[bartjones]

I've been looking at that provision on OHIP's website for a few weeks now, trying to figure out what it means. I'm a Canadian citizen applying outland for PR for my Korean wife. We'll be arriving in Ontario in May at which point I expect CIC will have approved me as her sponsor and forwarded her PR application to Manilla for processing there.

What confuses me is determining when CIC has "confirmed that you meet the eligibility requirements to apply for permanent residence in Canada".. Will my wife be getting an "Initial Assessment" as the above poster suggested that will allow her to apply for OHIP coverage? I wasn't aware that an "Initial Assessment" was even a step in the process and thought you went from "Sponsorship Approval" to "In Progress" to "PR Approval". Am I missing something?

 

[scylla]

What confuses me is determining when CIC has "confirmed that you meet the eligibility requirements to apply for permanent residence in Canada".. Will my wife be getting an "Initial Assessment" as the above poster suggested that will allow her to apply for OHIP coverage? I wasn't aware that an "Initial Assessment" was even a step in the process and thought you went from "Sponsorship Approval" to "In Progress" to "PR Approval". Am I missing something?

This statement applies to sponsorship applications filed inland only. With inland applications (applications sent to Vegreville), there is a first stage approval (AIP) that is received at approximately the six month mark (assuming there are no issues with the applications). Once AIP has been received, the sponsored individual qualifies for OHIP.

It sounds like you applied outland (application sent to Mississauga). If so, then the above statement unfortunately doesn't apply to your wife. She will have to wait until she lands in Canada and becomes a PR + an additional three months of living in Canada after become a PR before qualifying for OHIP coverage.

 

[bartjones]

This statement applies to sponsorship applications filed inland only. With inland applications (applications sent to Vegreville), there is a first stage approval (AIP) that is received at approximately the six month mark (assuming there are no issues with the applications). Once AIP has been received, the sponsored individual qualifies for OHIP.

It sounds like you applied outland (application sent to Mississauga). If so, then the above statement unfortunately doesn't apply to your wife. She will have to wait until she lands in Canada and becomes a PR + an additional three months of living in Canada after become a PR before qualifying for OHIP coverage.

Thanks and yes you're right, we are applying outland but will be arriving before the PR application is complete. I understand what you're saying but it seems to conflict with Intel's opinion and the plain wording of Regulation 552. I think I'll call OHIP next week and see what they say.

 

[bartjones]

Just thought I'd update this thread. We arrived in Canada in May, waited the 3 months and both my wife and I applied today for OHIP coverage. I got mine. She was denied on the grounds that Reg. 552 only applied to inland applications.

I'll file an appeal to the OHIP Eligibility Review Board tomorrow and see what happens.

 

[UsCa]

When I applied for my OHIP . they gave me a paper which stated a number and said it will be activated after 90 days

now in couple of weeks I am completing my 90 days. and still waiting for my heathcard.

(If my healthcard doesnt arrives on time) does that mean I can still go to a doctor (after completing my 90 days.. like on 91st day) and give them my number and I will be covered ? or I have to still wait for my heathcard ?

 

[bartjones]

When I applied for my OHIP . they gave me a paper which stated a number and said it will be activated after 90 days

now in couple of weeks I am completing my 90 days. and still waiting for my heathcard.

(If my healthcard doesnt arrives on time) does that mean I can still go to a doctor (after completing my 90 days.. like on 91st day) and give them my number and I will be covered ? or I have to still wait for my heathcard ?

I would call them at 1-866-532-3161 and ask. Have that paper handy when you call.

 

[bartjones]

I thought I would post this little update regarding OHIP coverage for your spouse if he or she lands in Ontario and starts living here before her PR application is approved. Here is what I found out.

A lot of people on this board and elsewhere have said that Reg. 552 only applies to inland applicants. That's not correct. Here is what I've learned.

After my wife was denied coverage at the Service Ontario Center I wrote to the OHIP Eligibility Review Committee (OERC) requesting a review of the Service Ontario representative's decision. The letter explained my wife's PR situation and enclosed the denial document as well as the letter I got from CIC approving me as sponsor.

So, yesterday I got a letter from the OERC enclosing a consent form for my wife to sign which will allow OERC to contact CIC and make inquiries about the status of her PR application. I spoke with the people at OERC by phone today and they told me this.

I had always thought that the outland PR process was a two step procedure; sponsorship approval/denial and then PR approval/denial. Unbeknownst to me, according to the OERC representative, in outland applications there is an intermediary step that the visa office goes through behind the scenes where they take a preliminary look at each application to determine if the applicant appears to be eligible for PR. Unlike inland applications where this step is called Stage One Approval, they don't tell the outland applicant anything about this step. If you appear to meet all the PR requirements your application then moves forward and someone looks at it later in more detail. If you get this interim approval they call you an "AFP", (Applicant For Permanent Residence).

So, as far as OHIP goes, once you sign the consent form allowing the OERC to communicate with CIC, the OERC will send a letter to the visa office where your application is being processed and inquire as to whether you are an "AFP". If CIC confirms that you are an AFP you can get OHIP three months after the date that CIC determined you were AFP. You don't need to wait for the final determination of your PR status.

Hopefully that clarifies matters for anyone who, like me, came to Canada with his wife before she had PR approval.

 

[frege]

I thought I would post this little update regarding OHIP coverage for your spouse if he or she lands in Ontario and starts living here before her PR application is approved. Here is what I found out.

A lot of people on this board and elsewhere have said that Reg. 552 only applies to inland applicants. That's not correct. Here is what I've learned.

After my wife was denied coverage at the Service Ontario Center I wrote to the OHIP Eligibility Review Committee (OERC) requesting a review of the Service Ontario representative's decision. The letter explained my wife's PR situation and enclosed the denial document as well as the letter I got from CIC approving me as sponsor.

So, yesterday I got a letter from the OERC enclosing a consent form for my wife to sign which will allow OERC to contact CIC and make inquiries about the status of her PR application. I spoke with the people at OERC by phone today and they told me this.

I had always thought that the outland PR process was a two step procedure; sponsorship approval/denial and then PR approval/denial. Unbeknownst to me, according to the OERC representative, in outland applications there is an intermediary step that the visa office goes through behind the scenes where they take a preliminary look at each application to determine if the applicant appears to be eligible for PR. Unlike inland applications where this step is called Stage One Approval, they don't tell the outland applicant anything about this step. If you appear to meet all the PR requirements your application then moves forward and someone looks at it later in more detail. If you get this interim approval they call you an "AFP", (Applicant For Permanent Residence).

So, as far as OHIP goes, once you sign the consent form allowing the OERC to communicate with CIC, the OERC will send a letter to the visa office where your application is being processed and inquire as to whether you are an "AFP". If CIC confirms that you are an AFP you can get OHIP three months after the date that CIC determined you were AFP. You don't need to wait for the final determination of your PR status.

Hopefully that clarifies matters for anyone who, like me, came to Canada with his wife before she had PR approval.

This is really interesting. Thanks for having the guts to challenge the system.

You must have had a bunch of people at OHIP stare at you in disbelief as you put your arguments to them, thinking "What am I going to do with this lunatic?"

Quebec has vaguely similar wording to Ontario's, so I wonder if the same thing would happen here:

2. The following are the classes of persons referred to in subparagraph 5 of the first paragraph of section 5 of the Act:

(1) persons who hold a permit issued by the Minister of Immigration of Canada under the Immigration and Refugee Protection Act (S.C. 2001, c. 27) with a view to granting landing and identified by code number 86, 87, 88, 89, 90, 91 or 92, as well as a Québec selection certificate, or persons who hold a permit issued by the Minister of Immigration of Canada under the Immigration and Refugee Protection Act with a view to granting landing and identified by code number 93, 94 or 95;

(2) persons who have been authorized under the Immigration and Refugee Protection Act to apply for landing while in Canada and who have been granted entry by Canadian immigration authorities and hold a Québec selection certificate;

(3) minor children who are in Québec while being considered for adoption by a resident of Québec who meets the requirements of the Civil Code for adopting them; and

(4) children born outside Québec if the parent with whom the child resides on a permanent basis is a resident of Québec.

The "while in Canada" part in (2) would suggest not, however.

Case (4) at least takes care of what we've sometimes seen where a PR no longer meets the residency obligation, but manages to enter Canada with a child born outside the country.

I'm also wondering, in places like Alberta where you can get health care almost immediately as the spouse of an outland applicant, would there be any grounds, theoretically, to deny a visitor entry to Canada because they'd be likely to use the public health system? I haven't been able to find any wording like that, but a case came up on the forum recently of someone whose wife was pregnant.

 

[bartjones]

This is really interesting. Thanks for having the guts to challenge the system.

You must have had a bunch of people at OHIP stare at you in disbelief as you put your arguments to them, thinking "What am I going to do with this lunatic?"

Actually, I'm pretty sure they'd heard my argument before. They were just hoping I'd go away once they decided my wife was ineligible. They were only surprised when I told them that I wanted the decision in writing so that I could appeal. I don't think they were expecting that, but I'd done my homework and knew others had succeeded on appeal.

Part of what angers me about the situation is the fact that I think the Service Ontario people know that if you appeal, the OERC will make inquiries of CIC on your behalf and pursue your coverage application further, but they don't tell you that. They really ought to advise people of this. When I asked the folks at the OERC why the Service Ontario rep didn't tell me I could pursue it further with the OERC they really didn't have much of an answer. I suspect they just hope you'll go away and wait for final PR approval before applying again. That seems kind of underhanded to me, particularly when many of the people applying for OHIP coverage in these circumstances are recent immigrants who may not be fluent in English or familiar with the OHIP system.

I'm also wondering, in places like Alberta where you can get health care almost immediately as the spouse of an outland applicant, would there be any grounds, theoretically, to deny a visitor entry to Canada because they'd be likely to use the public health system? I haven't been able to find any wording like that, but a case came up on the forum recently of someone whose wife was pregnant

Jeez, I sure hope not. If you're legally entitled to coverage in the province you are moving to, who is CBSA to tell you can can't enter the country because you might avail your self of that legal right. And if provinces don't want you to have that legal right they can easily take it away by amending their legislation.

 

[frege]

Part of what angers me about the situation is the fact that I think the Service Ontario people know that if you appeal, the OERC will make inquiries of CIC on your behalf and pursue your coverage application further, but they don't tell you that. They really ought to advise people of this. When I asked the folks at the OERC why the Service Ontario rep didn't tell me I could pursue it further with the OERC they really didn't have much of an answer. I suspect they just hope you'll go away and wait for final PR approval before applying again. That seems kind of underhanded to me, particularly when many of the people applying for OHIP coverage in these circumstances are recent immigrants who may not be fluent in English or familiar with the OHIP system.

These are some really good points. I have a feeling some things in Quebec are really similar.

For example, when we wanted to get a driver's licence for my wife after we applied outland, we were told she didn't have the right immigration status. But the law on the SAAQ doesn't define what a Quebec resident is, so by default it's the definition in the Civil Code, which talks about "the place where [one] ordinarily resides." However, we were told that if we pressed things and applied for a driver's licence, it would start the clock on the six months she was allowed to drive on her British licence, so in practice we'd be better off being quiet.

I have to tell you that in my wife's case, the decision that she passed "eligibility," which mainly means the relationship was considered genuine, was made on November 27, and we received the COPR in the mail on Dec. 14. We know this from our GCMS notes. The other parts are "medical," "criminal," and "security."

I don't know anything about "AFP", but in inland cases they look at "eligibility" first, before AIP. So if "AFP" is something that comes after they look at genuineness, you might only be getting an extra couple of weeks of coverage.

Jeez, I sure hope not. If you're legally entitled to coverage in the province you are moving to, who is CBSA to tell you can can't enter the country because you might avail your self of that legal right. And if provinces don't want you to have that legal right they can easily take it away by amending their legislation.

In immigration cases, if someone is likely to incur a lot of medical expenses, they do look at how likely they are to use public money, based on the intended province of residence. For visitors, what I'm wondering is if this would apply also to normal cases like pregnancy. Most of CIC's guidelines in medical cases are premised on the fact that no province gives coverage to mere tourists, so they're not too worried about pregnancy.

 

[bartjones]

I have to tell you that in my wife's case, the decision that she passed "eligibility," which mainly means the relationship was considered genuine, was made on November 27, and we received the COPR in the mail on Dec. 14. We know this from our GCMS notes. The other parts are "medical," "criminal," and "security."

I don't know anything about "AFP", but in inland cases they look at "eligibility" first, before AIP. So if "AFP" is something that comes after they look at genuineness, you might only be getting an extra couple of weeks of coverage.

Yes, I think you're correct here. Looking at some of the Health Services Appeal and Review Board decisions it appears the AFP date usually only proceeds the date PR is granted by a month or two. Nonetheless, the earlier you can get your coverage, the better, I think.

In immigration cases, if someone is likely to incur a lot of medical expenses, they do look at how likely they are to use public money, based on the intended province of residence. For visitors, what I'm wondering is if this would apply also to normal cases like pregnancy. Most of CIC's guidelines in medical cases are premised on the fact that no province gives coverage to mere tourists, so they're not too worried about pregnancy.

Luckily in my case the applicant is my spouse so the "excessive demand" requirement doesn't apply. Presumably a pregnant spousal applicant would be fine. A non-spousal pregnant PR applicant might have an issue, but then again, are there any outland visa offices left who are processing PR applications in under 9 months? If not, then it's a moot point. By the time the baby arrives, the PR application will still be pending.