Important OHIP eligibility info for all PR applicants residing in Ontario

[Rob_TO]

If we move in Canada (Ontario) in April and I am pregnant and pay for all the check-ups during the first three months and have my baby in July, will I pay for the delivery or will OHIP cover it?

That is cutting it pretty close. What if baby is born a bit premature and within first 90 days of being in Ontario? You will have to pay for entire delivery out-of-pocket.

 

[akvarium]

Well, I guess that's the risk we have to take. Cuz we do not have other choice. If my baby is born in my home country it would be much more complicated to bring him/her in Canada.

 

[steaky]

Well, I guess that's the risk we have to take. Cuz we do not have other choice. If my baby is born in my home country it would be much more complicated to bring him/her in Canada.

Why not move to Alberta (Canada) then? Immediate provincial health coverage - no 90 days wait!

 

[Leon]

Why not move to Alberta then? Immediate provincial health coverage - no 90 days wait!

That's right. You can go to any province that is not Ontario, BC or Quebec (and possibly NB, don't know if they've changed it yet) and you would get first day health care as a new PR.

However, keep in mind that it is not an option to go to such a province to get signed up for health care quickly if you are planning on leaving again to live in Ontario. Health care in almost all provinces is based on your commitment to live there at least 6 months a year (Ontario 5 months) and so if you were to go to a province just to get signed up but with the intention of leaving in less than 6 months, it would be considered fraud and you would have more problems than just having to pay for the delivery of your child.

 

[akvarium]

Well, we've got friends in Toronto and somewhere to go for the first month or two until we find a place to live and job. We do not have anyone in Alberta or any other province, and going there would cause much more stress with one two year old and one baby waiting to be born. If we had been just the two of us, I wouldn't have even thought about it. We would go where ever is convenient, but with small children it is definetely important to have someone to go to if you ever feel the need to. Just the thought of having someone makes you feel safer.

 

[Panamai]

So let me get this straight.. I've been in Ontario as a visitor since December 2013. I just got common-law status with my partner and sent in my PR application January 29th. Does this mean I can get OHIP immediately from the day I get my COPR without a 3 month wait? My proof of address will be my Ontario driver's licence, which I got in September 2014. If nothing else, that will prove I've been here more than 3 months, right? I'm really anxious to get OHIP. I've spent a couple thousand dollars on health care here already.

 

[JayPinNC]

Wow, super fast. Congratulations.

The OERC will determine your eligibility based on the date CIC completed your 'eligibility assessment'. Your 3 month waiting period will begin from that date. When the OERC responds to your appeal, they will tell you exactly which date your coverage begins or began.

What if the sponsored spouse did NOT take up residency in Canada until after that date? For example, if my spouse was deemed eligible to be sponsored on December 15th 2015, but was not IN Canada as a visitor until after that date....would her coverage date be 90 days after the most recent date? I'm trying to figure out what date to use as my wife's first day in Canada.

She visited from Dec 19 - Jan 26 (no stamp in passport or visitor record), left for four days and returned on Jan 30 and received a visitor record from CBSA. So I don't know if Dec 19 or Jan 30 should be her "Date moved to This Address" on her OHIP application.

Let me know if anyone has any experience like this...

 

[bartjones]

So let me get this straight.. I've been in Ontario as a visitor since December 2013. I just got common-law status with my partner and sent in my PR application January 29th. Does this mean I can get OHIP immediately from the day I get my COPR without a 3 month wait? My proof of address will be my Ontario driver's licence, which I got in September 2014. If nothing else, that will prove I've been here more than 3 months, right? I'm really anxious to get OHIP. I've spent a couple thousand dollars on health care here already.

Correct. In fact, if you follow the process outlined in this thread, you will be eligible for OHIP sooner than your COPR date.

 

[bartjones]

What if the sponsored spouse did NOT take up residency in Canada until after that date? For example, if my spouse was deemed eligible to be sponsored on December 15th 2015, but was not IN Canada as a visitor until after that date....would her coverage date be 90 days after the most recent date? I'm trying to figure out what date to use as my wife's first day in Canada.

She visited from Dec 19 - Jan 26 (no stamp in passport or visitor record), left for four days and returned on Jan 30 and received a visitor record from CBSA. So I don't know if Dec 19 or Jan 30 should be her "Date moved to This Address" on her OHIP application.

Let me know if anyone has any experience like this...

Her coverage will begin 90 days from the date she takes up residency in Ontario, which appears to be the Jan 30 date (assuming she also passed her eligibility assessment by that date).

 

[Panamai]

Yay! Thanks, bartjones! I've spent way too much money on the walk-in clinic and urgent care since I've been here!

 

[JayPinNC]

Her coverage will begin 90 days from the date she takes up residency in Ontario, which appears to be the Jan 30 date (assuming she also passed her eligibility assessment by that date).

Thanks for your reply. She was in Canada Dec 18 - Jan 26 and left for 4 days to be in the U.S. to help me pack. We crossed back into Canada on Jan 30 - when we got the Visitor Record for her. I'm going to try and use Dec 18 as her first day in Ontario with the understanding that CIC may determine her eligibility date to be after that (and it's very likely they will). She has nothing in her passport to show she was in Canada on the 18th but we do have bank statements that would appear to satisfy OHIP's proof of residency requirement.

Side note - I spoke to a very knowledgeable person at OHIP today and he seemed quite familiar with what I was trying to accomplish. He suggested that I reach out to CIC in advance and ask for some sort of verification of my wife's eligibility in an effort to save some time dealing with the OERC. I had to call CIC anyway to verify an address change and the CIC agent I spoke with didn't seem very interested in entertaining the notion that what I described was even remotely possible.

I'll stick with the path laid out here on the thread - apply, denial letter, OERC appeal, OHIP + CIC connection, etc.

 

[Mariac819]

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.

Thank you for posting this. Would you be willing to share a template of the appeal letter you wrote? Thank you

Also, when she went to Service ON what did she say before she got denied coverage? I am going to try this and would just like to be prepared.

 

[karafili]

Well, we've got friends in Toronto and somewhere to go for the first month or two until we find a place to live and job. We do not have anyone in Alberta or any other province, and going there would cause much more stress with one two year old and one baby waiting to be born. If we had been just the two of us, I wouldn't have even thought about it. We would go where ever is convenient, but with small children it is definetely important to have someone to go to if you ever feel the need to. Just the thought of having someone makes you feel safer.

Hi,
I am in the same situation...how did you resolve this? My wife will be 6 months pregnant when we land in Ontario and I am a little stressed about this.
Would some Insurance from my home country be eligible in ON if I am not able to get OHIP for her?

Thank you all for the valuable information you share here!

 

[Rob_TO]

Hi,
I am in the same situation...how did you resolve this? My wife will be 6 months pregnant when we land in Ontario and I am a little stressed about this.
Would some Insurance from my home country be eligible in ON if I am not able to get OHIP for her?

Thank you all for the valuable information you share here!

In general no, you will not find private health insurance that will pay for your delivery costs if you are already pregnant. Your wife will need to wait 3 months after landing before she will be covered by OHIP. Sounds like that will be cutting it very close and she may or may not be covered when she actually does the delivery.

What you should do the second you land in Ontario, is research the closest midwives to your location and see if any of them have openings. In Ontario midwifes are FREE to anyone even if they don't have OHIP coverage. You can eliminate practically all costs of the pregnancy if you do a home birth with them, or pay just a fraction of the cost if you give birth in hospital with your midwife. However since midwives are in very high demand and she will already be so late into her pregnancy, depending on where you're located you may find none are able to take you as a patient.

If you deliver in a hospital with an OB, you should budget $5K for the delivery. If any complications or c-section is necessary requiring extended hospital stay, then that price can jump up to $10K or so.

 

[karafili]

Thank you Rob the info/reply.
Yeah we would be pretty close to delivery if we wait for OHIP and was just worried for unexpected medical conditions. Have you heard for any exceptions in the 90 days waiting period?

Wish you all the best!