To maintain optimal oral health, it is necessary to visit a dentist at least every six months.

However, due to the cost required for every dental visit, many people in Canada skip it.

Therefore, having dental insurance is key to fend for yourself. Fortunately, the government of Canada offers a health insurance plan for the people living in the province of Ontario.

In this blog, we will explore OHIP dental coverage in detail. Read on to learn what services are included and not included in OHIP dental coverage.

The Ontario Health Insurance Plan (OHIP): Brief Introduction

The Canadian government offers basic health care for those meeting eligibility standards.

The Ontario Health Insurance Plan (OHIP) is the state-run health program in Ontario. The tax revenue funds OHIP dental coverage.

OHIP covers a wide range of medical treatments. These services encompass consultations with specialists and your family physician.

OHIP covers the majority of emergency and basic medical treatments.

OHIP Coverage List For Adults & Children: What Does OHIP Cover?

Below is the OHIP coverage list for adults and children:

Visits to physicians
Hospital stays and visits
Laboratory tests in hospitals or community labs
Hospital-eligible dental surgery
Eye health treatments
Podiatry (services related to foot health)
Ambulance services
Travel for medical care

It's critical to realize that OHIP dental coverage has restrictions that we will discuss in detail in the subsequent sections.

OHIP Dental Coverage List for Under 25, Children, and Seniors

The services included in the OHIP dental coverage for under 25, children, and seniors are as follows:

Intricate oral procedures, such as tumor excision and fracture restoration.
Dental procedures are carried out in a hospital because of bone problems.
OHIP dental coverage in Ontario is likely to pay for dental surgery conducted in a hospital if required due to a jawbone issue.

Moreover, OHIP dental coverage excludes common dental procedures, including cleanings, fillings, and extractions.

Getting your OHIP Card

Each family member must have a health card to access OHIP dental coverage and healthcare services.

Children above 15½ years of age must apply for their own health card and register in person.

How To Apply For OHIP Health Card

Apply for a health card as soon as you arrive in Canada.

If you are a newcomer to Ontario and want to apply for an OHIP card, bring your documentation to the local Service Ontario Centre.

You must present three original documents:

Citizenship and immigration status
Documents of Residency in Ontario

You may also be requested for further documentation. For example, if your name has changed, you may be required to present a marriage or change of name certificate.

How To Maintain OHIP Coverage

To keep OHIP dental coverage, you must be physically present in Ontario for 153 days out of every 12 months.

For example, if you were physically present in Ontario for 153 days from September 2021 to September 2022, you would not be required to reapply for OHIP.

Special Cases

Those traveling from Canada to any other place in the world for longer than seven months in any 12-month period can maintain their OHIP dental coverage for up to two years.

To hold your OHIP dental coverage during such a period, you need the following:

Obtain a valid health card in Ontario.

Your principal residence will be in Ontario for at least 153 days each year in the two years leading up to your departure.

Reapplying for OHIP Dental Coverage

If you have been away from Ontario for more than 212 days in a 12-month period, you may need to reapply for OHIP at a specialized ServiceOntario Centre in Ontario.

To reapply for OHIP at the ServiceOntario Centre, bring the following papers with you:

A completed Registration for Ontario Health Insurance Coverage form.

Three distinct papers from the list of eligible identification documents:

One authentic piece of paperwork demonstrating your Canadian citizenship or OHIP-eligible immigrant status
Original, printed, or digital/electronic that establishes your residency in Ontario (how they want the document would be mentioned on the list)
A document proving your identification.

OHIP Dental Coverage Outside Canada

If you obtain emergency health care while traveling outside of Canada, your OHIP coverage will only pay a portion of the cost.

To be eligible for out-of-country care, the treatment or service must fulfill the following criteria:

Provided in a licensed hospital or health facility for an acute and unexpected illness, disease, or accident, not pre-existing (produced outside of Canada) and requiring prompt treatment.
Treatment prescribed by doctors
The Ontario government recommends buying private health insurance before leaving the province to cover any uninsured treatments you may require.

Services Excluded From OHIP Dental Coverage

Significant gaps in dental coverage exist under Ontario's Health Insurance Plan.

The exclusions mostly apply to regular and preventative care, which may result in out-of-pocket costs for many people.

Let's look at those services in the sections below:

1.Routine Dental Checkups

Routine dental checkups are vital for maintaining excellent oral health.

These examinations can discover the early stages of dental problems such as cavities, gum disease, and oral cancer. OHIP dental coverage doesn't cover these visits.

Without OHIP dental coverage, you will need to look into alternative insurance choices or pay out of pocket to guarantee that your dental health is monitored on a regular basis.

2.Dental Cleaning

Dental cleanings and examinations are part of preventative dental care, which aims to keep your teeth and gums healthy. Regular cleanings assist in eliminating plaque and tartar buildup, hence avoiding periodontal disease and tooth decay.

OHIP dental coverage does not cover certain operations.

3.Fillings and Extractions

OHIP dental coverage does not cover dental repair treatments such as fillings and extractions.

Even though these operations are routine and require repairing decaying or broken teeth, they are not covered.

4.Correction Treatments

Orthodontic treatments, such as braces and other devices for correcting dental and jaw misalignments, are not covered in OHIP dental coverage.

Because orthodontics are typically employed to improve look and function, they do not fall under the scope of OHIP's medically essential services, resulting in high costs for those seeking these treatments.

5.Cosmetic Dental Procedures

You can't get cosmetic dentistry operations like teeth whitening, veneers, and smile makeovers with OHIP dental coverage since they are considered non-essential.

Other Government-Funded Dental Coverage Programs

OHIP dental coverage for seniors and kids may not be enough for some families. To help them get dental care when necessary, here are the two popular programs by the government.

1.Ontario Senior Dental Care Program

Many people confuse OSDCP with OHIP dental coverage for seniors in Canada. But these are two entirely different programs.

On November 20, 2019, the Ontario government formally started the Ontario Seniors Dental Care Program (OSDCP), which seeks to provide regular dental treatment to low-income seniors.

The government thinks that this program would reduce emergency hospital wait times and enhance seniors' general well-being by offering regular dental treatment like as exams, cleanings, fillings, x-rays, root canals, and tooth extraction.

OSDCP is not available at your normal dentist. Dental services will be available through Public Health Units, Community Health Centres, and Aboriginal Health Access Centres.

To qualify for the OSDCP, you must:

Be at least 65 years old.
To qualify, applicants must be an Ontario resident with an annual income of $22,200 or less (single) or $37,100 or less (couple).
Must not have any other dental benefits.

Seniors in Ontario have the same OHIP dental coverage as the rest of the population.

2.Healthy Smiles Ontario

Healthy Smiles Ontario is a government-funded dental program that offers free preventative, regular, and emergency dental care to children and teens aged 17 and younger who qualify.

Only the children and teens aged 17 and younger who live in Ontario qualify for the HSO program and belong to a household meeting income-qualifying conditions.

This can be an alternative to OHIP dental coverage under 25.

Children aged 17 and under are automatically eligible and enrolled in the HSO program if they or their families receive Ontario Works (OW), Temporary Care Assistance, Assistance for Children with Severe Disabilities, or the Ontario Disabilities Support Programme (ODSP).

It doesn't exclude children who already have dental insurance.

The program comprises frequent visits to a licensed oral health professional and covers treatment costs, including:

Checkups
X-rays
Scaling
Sealants
Cavity fillings
Tooth removal
Emergency dental care for children
Topical fluoride therapy

The program does not cover cosmetic dentistry, such as tooth whitening or braces.

To get more information on Healthy Smiles Ontario, click on our blog.

Dental Insurance Policies in Canada

Many dental insurance policies pay at least some of the cost of a basic dental examination.

However, the amount of dental coverage you receive in Ontario will depend on your individual plan and the services you require.

According to the Ontario Dental Association (ODA), most dental insurance policies include yearly maximums that limit the coverage available yearly.

For example, your plan may have a maximum benefit of $1,000 per year, which means you would only be covered up to that limit.

In addition to yearly maximums, most dental insurance plans require paying deductibles before your coverage begins.

For example, if you have a $50 annual deductible, you will be responsible for the first $50 of dental procedures before your insurance begins to cover the cost.

It's worth noting that certain dental insurance policies may exclude or limit specific types of services.

For example, some plans may exclude cosmetic procedures like teeth whitening or veneers.

Furthermore, some dental clinics offer special insurance packages. For example, KWC Dental offers special student insurance.

FAQs

What is the waiting period for OHIP dental coverage?

New immigrants to Ontario, temporary foreign workers, and Canadian residents who have been out of the country for more than 212 days in the preceding year must wait three months before receiving OHIP benefits.

What does the term OHIP for All mean?

OHIP for All expresses that healthcare is a fundamental human right and that all Ontarians, regardless of immigration status, should be able to obtain OHIP and access healthcare in Ontario.

What category of Ontario citizens are not eligible for OHIP dental coverage?

Individuals who are qualified for OHIP but have lost their identity documents (e.g., passport, birth certificate) cannot apply for an OHIP card and receive OHIP-funded healthcare. Children born to illegal immigrants are Canadian citizens and entitled to OHIP, but they frequently face difficulties in confirming their status and receiving care.

Contact KWC Dental’s Dentists in Kitchener for OHIP Dental Coverage

Countless people can't get life-saving treatment as they have to pay thousands of dollars in payment in exchange for care and receive debilitating debts. As a result, they have no option but to compromise on their health.

Dental care is one treatment that is often ignored because of financial constraints. However, some services are covered under OHIP dental coverage.

After reading this blog, you may have gotten an idea of how dental care can be accessible to you and your loved ones. Also, you now know the alternatives to OHIP dental coverage for seniors and children.

If you have more questions on different financing options, feel free to contact us.

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