OHIP Eligibility

[canukconnection]

Hello Everyone,
I could really use your assistance in determining whether or not my husband his eligible for OHIP. He arrived in Canada on June 29 2108 and we applied for PR under family sponsorship on July 26 2018. I'm Canadian by birth and he's British.
This is our timeline:
Application + OWP recieved July 26 2018
AOR: Aug 23 2018
OWP Oct 25 2018
Medical Requested Oct 29 2018
Medical done Nov 14 2018 ( uploaded Nov 25 , 2018) - currently being reviewed
RCMP police clearance and biometrics request Nov 24 2018

Recently my husband accepted a permanent full time position and begins his new job Dec 1 2018. My employers require an addition to benefits within 30 days of a major change in status i.e. marriage in our case it would be receipt of OWP as we were married last year and he returned home to fulfill work obligations. They also require him to have OHIP coverage.

Would he be eligible for OHIP now, if not when would he be able to apply? I have a very narrow window to add him to my benefits otherwise he will have limited access to my benefits in the next calendar year .

Please note we were out of country for 2.5 weeks in August 2018.
He was away 10 days in Nov 2018.

Thanks for your assistance in advance .

Harm

 

[1887CAN]

Your husband will have OHIP eligibility three months after his first day of work, so around 1st Feb 2019.

Daft as this sounds, he also needs to provide a letter to Service Ontario from his employer stating that they intend to employ him for 6 months or more. His employment contract for some bizarre reason is not sufficient for this. I’ve just been through this myself, I couldn’t believe they wouldn’t accept my contract. I had to get HR at my employer to write me a letter for this specific purpose. He can get the letter and go to Service Ontario now and get everything set up, they will then mail him his OHIP card in February. Or, he can wait until three months of work have been completed and do it in person and have OHIP coverage start immediately. It’s up to him.

I’m covered by my wife’s benefits without any caveats at all. I have been even before I got my OWP. Seems strange that they require him to be covered by OHIP. Are you absolutely sure this is correct, that there’s been no misunderstanding? I don’t get what difference it makes to them as to whether he has OHIP coverage or not. I’ve used my wife’s benefits for medication, dental, RMT services without any issues. Been paid in full every time.

 

[canukconnection]

1887Can thank you for your response.

I'm not exactly sure why they require OHIP coverage for benefits but that's what they've said. I also work in the public sector and perhaps have different rules than the private. I've contacted the benefits coordinator and hopefully a copy of the open work permit will do.

Thanks for your help

 

[scylla]

1887Can thank you for your response.

I'm not exactly sure why they require OHIP coverage for benefits but that's what they've said. I also work in the public sector and perhaps have different rules than the private. I've contacted the benefits coordinator and hopefully a copy of the open work permit will do.

Thanks for your help

It's normal for benefits providers to require a person to have OHIP coverage as a condition for their coverage - I would say that it's rare for a benefits provider to allow coverage without OHIP being in place first. I would absolutely push to see if you can get coverage without OHIP. But quite possible/likely that your husband may miss out on this year. I know that's happened to many of us on this forum.

 

[YVR123]

It's normal for benefits providers to require a person to have OHIP coverage as a condition for their coverage - I would say that it's rare for a benefits provider to allow coverage without OHIP being in place first. I would absolutely push to see if you can get coverage without OHIP. But quite possible/likely that your husband may miss out on this year. I know that's happened to many of us on this forum.

The same for my provider at work. My hubby needed to wait for MSP (BC) coverage before he can get covered by the extended health and other benefits (as a spouse) .

 

[canuck_in_uk]

I’m covered by my wife’s benefits without any caveats at all. I have been even before I got my OWP. Seems strange that they require him to be covered by OHIP. Are you absolutely sure this is correct, that there’s been no misunderstanding? I don’t get what difference it makes to them as to whether he has OHIP coverage or not. I’ve used my wife’s benefits for medication, dental, RMT services without any issues. Been paid in full every time.

As scylla said, it is normal. The vast majority require provincial coverage first, as provincial coverage does sometimes cover things that extended benefits also cover, even if only partially. Insurance companies don't want to pay out when the government should be covering it.

Many company HR people aren't aware of this and don't bother to confirm with the insurance underwriter. If your wife's company informed the insurance underwriter, you could probably expect a bill for all of the services you have used.

 

[1887CAN]

As scylla said, it is normal. The vast majority require provincial coverage first, as provincial coverage does sometimes cover things that extended benefits also cover, even if only partially. Insurance companies don't want to pay out when the government should be covering it.

Many company HR people aren't aware of this and don't bother to confirm with the insurance underwriter. If your wife's company informed the insurance underwriter, you could probably expect a bill for all of the services you have used.

I can see the logic in them not wanting to pay out for things that would be covered by provincial healthcare, however, none of the most common services they pay out on covered by provincial healthcare. Dental, medicine (for those over 24 years old), RMT services, etc, aren’t paid for by any province as far as I’m aware.

If the benefits company offer services contingent on being covered by provincial healthcare, surely they’d request confirmation of your health card number? In our case, they never wanted a copy of our marriage certificate after we got married and after our son was born they didn’t want to have a copy of his birth certificate. They just added he and I to my wife’s policy after a phone call. Maybe our provider has less strict rules, but they’ve never once requested formal proof of anything.

 

[canuck78]

Also your husband needs to be careful. He needs to stay in Canada for 5 months out of the first 6 months to meet one of the residency requirements for OHIP. Not sure when that would start for him.

 

[canuck_in_uk]

I can see the logic in them not wanting to pay out for things that would be covered by provincial healthcare, however, none of the most common services they pay out on covered by provincial healthcare. Dental, medicine (for those over 24 years old), RMT services, etc, aren’t paid for by any province as far as I’m aware.

If the benefits company offer services contingent on being covered by provincial healthcare, surely they’d request confirmation of your health card number? In our case, they never wanted a copy of our marriage certificate after we got married and after our son was born they didn’t want to have a copy of his birth certificate. They just added he and I to my wife’s policy after a phone call. Maybe our provider has less strict rules, but they’ve never once requested formal proof of anything.

Some of those things are partially covered, depending on circumstances. BC Pharmacare covers a portion of prescription medicine, based on income; even a high income family with multiple regular prescriptions will receive some coverage.

They generally do request the health card number. As I said, the issue tends to be the company HR not knowing the specific requirements of the insurance underwriter. It is possible that yours doesn't require provincial coverage but don't go asking around just in case.