How to Navigate the Ontario Healthcare System

Moving to Ontario means learning how its publicly funded healthcare system works—both for those with coverage and those without. Below is a clear guide to help you understand how to access care in the province.

Who Qualifies for the Ontario Health Insurance Plan (OHIP)

The Ontario Health Insurance Plan (OHIP) is the public health-insurance program for Ontario residents. To qualify:

• You must live in Ontario as your main home.
• You must be physically present in Ontario for at least 153 days in any 12-month period, and within the first 183 days after moving to the province.
• If you have Canadian citizenship or permanent resident status, you qualify provided you meet the residency rule.
• Some temporary residents also qualify, including:
• Work-permit holders employed full-time in Ontario for an Ontario employer (six months minimum).
• Applicants for permanent residence who have received an Acknowledgement of Receipt (AOR).
• Work-permit holders under certain federal programs (e.g., Live-in Caregiver, Seasonal Agricultural Worker).
• Temporary Resident Permit holders (case types 86-95).
• Clergy members serving full-time in Ontario at least six months.
• Convention refugees or protected persons.
• Spouses and dependents of eligible work-permit holders may also qualify.
  
  

Accessing Primary Care

Your first contact with the healthcare system is usually through a primary?care provider—typically a general practitioner (GP) or a nurse practitioner. They can:

• Address initial health complaints or concerns.
• Offer check-ups and preventive screenings.
• Diagnose conditions, prescribe medications, manage chronic diseases.
• Refer you to specialists when needed and follow up on your progress.
  
  

In Ontario, primary care is often delivered via a family doctor’s office — you book an appointment (in person or virtual) and attend during the clinic's hours. Because of a shortage of family doctors, you may face waitlists.

Finding a Family Doctor

You can use the provincial program Health Care Connect to be connected with a clinic or provider accepting new patients. You can also call local clinics directly to ask if they are taking on new patients. To register with a family doctor, you generally need OHIP coverage.

Alternatives If You Don’t Have a Family Doctor

If you cannot immediately get a family doctor or you don’t have OHIP coverage, you still have options:

1. Walk-in Clinics
• Provide medical advice, assessments, and treatment for minor injuries and illnesses (e.g., infections, sprains).
• Operate on a first-come, first-served basis; you register on arrival and wait your turn.
• Most services are covered by OHIP if you have a valid health card; if not, you may pay out of pocket or via private insurance.
• Some walk-in clinics can provide referrals to specialists.
  
  
2. Virtual Clinics
• Offer consultations via video, telephone or secure messaging.
• Book appointments online or via an app; some offer same-day availability.
• Free if both provider and patient are in Ontario and patient holds a valid health card; otherwise private payment or insurance.
• Include services like general medical consultations, mental-health support, prescription renewals.
  
  
3. Community Health Centres (CHCs)
• Offer free or low-cost healthcare services, often in community settings, sometimes without OHIP requirement.
• Provide general medical care, mental-health support, and other social support services.
• Some require appointments; others offer walk-in care.
  
  
4. Specialist Clinics
• Provide care in specific fields of medicine (cardiology, oncology, psychiatry etc.).
• Generally require a referral from your primary-care provider.
• Wait times vary widely depending on urgency and available specialists.
• If you don’t have OHIP, you typically pay out of pocket for specialist care.
  
  

How to Get a Referral to a Specialist

If your primary-care provider decides you need specialist care, the process generally works like this:

1. You schedule and attend an appointment with your family doctor or a walk-in clinic.
2. You discuss your symptoms and concerns. If appropriate, the provider writes a referral letter and sends it to the specialist.
3. You may express a preference for a particular specialist and your provider will try to accommodate.
4. The specialist’s office reviews the referral and schedules you for an appointment based on urgency and availability.
5. You attend the specialist’s appointment. Sometimes you’ll need to bring the referral letter with you.
   
   

Emergency Rooms vs Urgent Care

When to Go to the Emergency Room (ER)

You should proceed to the nearest hospital’s ER or call 911 if you have symptoms or injuries that pose an immediate threat to life, limb or long-term health. Examples include:

• Shortness of breath
• Possible heart attack or stroke
• Seizures or sudden confusion
• Severe injuries (heavy bleeding, burns, trauma)
• Severe allergic reactions
  
  

When to Visit Urgent Care Instead

If your condition is urgent but not life-threatening, an urgent care or walk-in clinic may be more appropriate. Examples:

• Sprains or minor fractures
• Cuts needing stitches
• Minor burns or rashes
• Minor allergic reactions or infections
  
  

You can also call Telehealth Ontario at +1 866-553-7205 if you’re unsure where to go. ERs are open 24/7; urgent-care centres usually have limited hours. Both operate on a triage system—patients are seen in order of medical need, not arrival time. Wait times vary.

If you lack OHIP or private insurance, urgent-care centres are often less costly than ERs.

What Services Are Covered by OHIP

OHIP covers medically necessary services in Ontario when delivered by certified practitioners and hospitals. These include:

• Doctor visits (in person or virtual)
• Hospital stays and visits
• Ambulance services
• Lab tests and medical imaging
• Abortions
• Certain dental surgeries in hospital (fracture repair, tumour removal, reconstruction)
• Under certain conditions, some eye-care and foot-health services
• If you travel to another Canadian province or territory, your Ontario health card covers medically necessary hospital and walk-in clinic services.
  
  

What Services Are Not Covered by OHIP

OHIP does not cover:

• Doctor’s notes for work or school
• Most prescription medications
• Routine dental care or vision care (including exams, lenses, corrective surgery)
• Many paramedical services (physiotherapy, massage therapy, chiropractic care, acupuncture)
• Cosmetic surgery
  
  

How to Apply for OHIP

To apply you need to visit a local ServiceOntario centre in person and provide:

• The completed "Registration for Ontario Health Insurance Coverage" form.
• An original identity document with your name and signature.
• An original document showing your Ontario residency (printed or electronic).
• An original document proving Canadian citizenship or eligible status for OHIP.
  You must present three separate documents to meet the identity, residency and eligibility requirements. Once approved, your health card is mailed to your Ontario address—usually within four to six weeks.
  
  

Tips for Accessing Care Without OHIP

If you’re staying in Ontario but do not have OHIP, here are some strategies:

• Many international students have coverage under the University Health Insurance Plan (UHIP) which mimics OHIP for most medically necessary services.
• Visitors under a Super Visa must have private health insurance with at least CAD $100,000 coverage.
• Some work-permit holders must hold private health insurance for the entire length of their permit.
• Non-OHIP patients may face higher costs or upfront payment for services like diagnostics or prescriptions because many providers are set up to bill OHIP. You might need to claim reimbursement later from your private insurance.
• Always carry proof of your private coverage and check billing procedures in advance. Choose clinics used to dealing with uninsured or international patients to avoid surprise costs.
  
  

Diagnostic Testing Details

If you require lab tests or imaging, certain diagnostic service providers (e.g., blood work, x-rays, ultrasounds, ECGs) will process your requisition from your doctor. Common tests often do not require an appointment, but many imaging services do. OHIP typically covers such tests if ordered by a physician, but if you don’t have OHIP, you may have to pay upfront.