Ontario (ON)
Ontario Health Coverage
Professional Services
Physicians
The provincial plan pays up to 100% of a fixed schedule established by the province for the following covered services:
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Physician's services in the home, the physician's office, the hospital or institution:
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one annual health examination
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services of specialists certified by the Royal College of Physicians and Surgeons of Canada
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diagnosis and treatment of illness and injury
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treatment of fractures and dislocations
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surgery
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administration of anaesthetics
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x-rays for diagnostic and treatment purposes
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obstetrical care, including prenatal and postnatal care
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patients are free to choose the physician of their choice and physicians are free to choose their patients (they are not obligated to treat any insured person).
Optometrists
The following optometrist's services are covered:
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$39.15 Oculo-Visual assessment limited to one per 12 months (24 months if age 20-64)
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$19.25 follow-up Oculo-Visual Assessment limited to one per 12 months (24 months if age 20-64)
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all subsequent visits and connected necessary procedures on the same day are included in the one visit claimed for that day
Chiropractors
Services rendered in a home, office or institution are payable as follows:
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$11.75 initial service
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$ 9.65 subsequent service
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$12.00 home service
X-rays requested are payable as follows:
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$ 8.00 to $35.00 for different x-rays specified in the plan
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$ 40.00 maximum for x-rays annually (Apr.1 - Mar.31)
Combined maximum:
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$150.00 maximum for services and x-rays combined annually (Apr.1 - Mar.31)
Osteopaths
Services rendered in an office, institution or home are
payable as follows:
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$12.00 initial (office or institution)
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$ 9.50 subsequent
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$15.00 home
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$10.00 x-ray examination
X-rays requested are payable as follows:
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$ 25.00 maximum for x-rays annually (Apr.1 - Mar.31)
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$155.00 maximum for services and x-rays combined annually (Apr.1 - Mar.31)
Chiropodists or Podiatrists
Services rendered in an office, Podiatrists institution or home are payable as follows:
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$16.40 initial office visit
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$11.45 subsequent office visit
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$14.00 home visit
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$ 7.00 institution visit
X-rays requested are payable as follows:
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$ 5.50 to $11.00 for different x-rays specified in the plan
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$ 30.00 maximum for x-rays annually (Jul.1 - Jun.30)
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$135.00 maximum for services annually (Jul.1 - Jun.30)
Physiotherapists
Only services provided by physiotherapists who work in physiotherapy facilities approved and listed in Part 1 of Schedule 5 of Ontario Health Insurance Regulation 552 (1990).
When prescribed as medically necessary, amount payable per service is:
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$ 12.20 office visit
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$ 24.40 home visit
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150 visit maximum annually (Jul.1 - Jun.30)
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