Understanding OHIP requirements

[Asker302]

According to OHIP site:

To meet the minimum qualifications you must:

• be physically in Ontario for 153 days in any 12‑month period
• be physically in Ontario for at least 153 days of the first 183 days immediately after you began living in the province
• make Ontario your primary home

How to understand "Began living in the province"? Is this the landing date?


My mother-in-law landed July 2017 and now arrived again and is going to stay more than 6 months this year.
She is going to open a bank account and fill taxes in the end of the year.

However her husband is still living abroad until end of the year and her stay will not be contiguous (for instance she will travel June 2019)

When she is she going to be eligible for OHIP and when to apply?

 

[jddd]

If she arrived February 2019, she will be eligible 3 months later.

She MUST stay in Ontario for at least 6 months to continue being eligible, if she is planning to leave and uses health services, she will be required to pay for all costs associated with the use of OHIP.

 

[Asker302]

If she arrived February 2019, she will be eligible 3 months later.

She MUST stay in Ontario for at least 6 months to continue being eligible, if she is planning to leave and uses health services, she will be required to pay for all costs associated with the use of OHIP.

You must mean 153 days, which technically means 5 months?

question was does she need to complete the 153 days out of 183 days, following February (which is establishing residence date) or following landing date?

this "began living in the province" is not exactly clear and probably going to be interpreted differently by different people




P.S.
Not sure how one leaves and continue to use health services.
As an example if you visit a doctor abroad (while traveling and being OHIP eligible)
you can make a claim to OHIP and get ~21 CAD reimbursement, and you have to wait 8 weeks for that and send it using a physical mail (which costs you out of pocket postage rates)

 

[jddd]

You must mean 153 days, which technically means 5 months?

question was does she need to complete the 153 days out of 183 days, following February (which is establishing residence date) or following landing date?

this "began living in the province" is not exactly clear and probably going to be interpreted differently by different people




P.S.
Not sure how one leaves and continue to use health services.
As an example if you visit a doctor abroad (while traveling and being OHIP eligible)
you can make a claim to OHIP and get ~21 CAD reimbursement, and you have to wait 8 weeks for that and send it using a physical mail (which costs you out of pocket postage rates)

We always advice some allowance time but since it seems you already know what you are talking about, leaving this thread and wishing you and your mother in law well.

 

[Asker302]

Thanks for your answers

Eventually my questions are purely technical in nature

Arrive: Feb 2019
plans to stay for 99 days
then has to leave for ~ 2 weeks (but anyway not more than 30 days)
then arrives back for more than 2 months (no travel plans until november)

We currently we have a private travel insurance to cover the first 3 months from February 2019.

Now:
1) Do we need to buy private insurance for the additional 9 days, or we are OK with OHIP after 3 months?
2) Do we need to buy private insurance for the time she comes back and how much time (Additional 3 months / the entire time)

3) Not a question, but for travel outside Canada I advise everybody to buy their own private insurance even if OHIP technically has you covered. This is because OHIP will only reimburse you till "rates listed in and paid to Ontario physicians in the Ontario Schedule of Benefits for Physicians Services" which have nothing to do with what you might actually need to pay in the foreign country

 

[canuck78]

You must mean 153 days, which technically means 5 months?

question was does she need to complete the 153 days out of 183 days, following February (which is establishing residence date) or following landing date?

this "began living in the province" is not exactly clear and probably going to be interpreted differently by different people




P.S.
Not sure how one leaves and continue to use health services.
As an example if you visit a doctor abroad (while traveling and being OHIP eligible)
you can make a claim to OHIP and get ~21 CAD reimbursement, and you have to wait 8 weeks for that and send it using a physical mail (which costs you out of pocket postage rates)

People rarely try to claim 21$. Assume the hassle will be high and refusal rate high as well. Depending on your MIL she must be in Ontario for 5 months out of the first 6 months or she technically will no have coverage. You must be very careful with dates because she is right on the edge.

 

[Asker302]

People rarely try to claim 21$. Assume the hassle will be high and refusal rate high as well. .

I had to claim that 21$ because my travel insurance (Manulife) maintained that I have to claim OHIP first before I can go ahead and claim the rest from them. Interestingly claiming the rest from them required another physical mail

But this is just to show a point that a basic medical visit that cost ~170 CAD out of pocket in foreign country was reimbursed for only 21$ based on OHIP rates

Depending on your MIL she must be in Ontario for 5 months out of the first 6 months or she technically will no have coverage. You must be very careful with dates because she is right on the edge.

She will be, and we are very carefull with recording all the dates correctly (especially since we would need it later to extend PR and/or apply for citizenship).
Just don't want to overpay to private insurance companies. Having double coverage for several days is probably fine but I don't want to pay for extra months if it is not necessary

 

[canuck78]

I had to claim that 21$ because my travel insurance (Manulife) maintained that I have to claim OHIP first before I can go ahead and claim the rest from them. Interestingly claiming the rest from them required another physical mail

But this is just to show a point that a basic medical visit that cost ~170 CAD out of pocket in foreign country was reimbursed for only 21$ based on OHIP rates




She will be, and we are very carefull with recording all the dates correctly (especially since we would need it later to extend PR and/or apply for citizenship).
Just don't want to overpay to private insurance companies. Having double coverage for several days is probably fine but I don't want to pay for extra months if it is not necessary

Your MIL won’t qualify for OHIP until probably May so I’m confused as to how you have OHIP and travel insurance at the same time.

 

[Asker302]

Your MIL won’t qualify for OHIP until probably May so I’m confused as to how you have OHIP and travel insurance at the same time.

She doesn't have OHIP yet, but does have a private insurance for 90 days.

We can get the extra days to be covered until OHIP is starting and at that point I'm OK to having double coverage for a few days to be on the safe side (I assume 3 months doesn't necessarily equal to 90 days, so we probably need few more days)

Anyway I hope ServiceOntario will give us a definite answer on when exactly the OHIP start date would be

 

[canuck78]

She doesn't have OHIP yet, but does have a private insurance for 90 days.

We can get the extra days to be covered until OHIP is starting and at that point I'm OK to having double coverage for a few days to be on the safe side (I assume 3 months doesn't necessarily equal to 90 days, so we probably need few more days)

Anyway I hope ServiceOntario will give us a definite answer on when exactly the OHIP start date would be

If that is the case you use OHIP when she qualifies and travel insurance when she doesn’t. Only emergencies are covered so you have to pay cash for regular appointments. Yes you will be given the 1st day of coverage. Haven’t you signed up for Ohip for your family?

 

[Asker302]

If that is the case you use OHIP when she qualifies and travel insurance when she doesn’t. Only emergencies are covered so you have to pay cash for regular appointments. Yes you will be given the 1st day of coverage. Haven’t you signed up for Ohip for your family?

Long time ago so don't remember, and it might have been changed by now

 

[evdm]

If your mother has proof of status, identity, and address you can go to Service Ontario with the filled in form and they will register her for OHIP. Coverage won't start until the eligible day but you'll get the card mailed to you and your health number will be active starting on the earliest day that coverage can begin.

I landed in August so my coverage didn't start until November; but I went to Service Ontario in September to get all the paperwork sorted. My coverage started on a Monday, and I had my OHIP card sent to me by the Friday before the start-date. As long as you have all the right paperwork, Service Ontario will give you the best answers to your situation.

I, too, had private insurance that overlapped by a few days after OHIP coverage started. I even traveled for 9 days so, would have, if necessary, been able to travel for up to 21 more days before the 6th month anniversary of my landing date.

Your mother's situation is a little different in that she landed in 2017, but Service Ontario will look at the date you fill in on the form as the date of taking up residence.