Coverage
What OHIP Does Not Cover
Most coverage arguments end the moment the two lists are written side by side. This is the Ontario scope ledger as an employer needs to read it — what the province pays for in full, what falls to an employer plan or to the employee, and the narrow age-based exceptions that do not apply to a working-age crew.
Direct answer
AEC Benefits is an Ontario group benefits brokerage, and this is the coverage line we walk employers through most often. OHIP does not cover prescription drugs filled at a pharmacy for most working adults, any routine dental including exams, cleanings, fillings, root canals and crowns, eyeglasses or contact lenses, physiotherapy, chiropractic, massage or orthotics for working-age adults, psychologists or counselling outside a hospital, the ambulance co-payment, semi-private or private hospital rooms, hearing aids and most mobility equipment beyond a partial subsidy, or any medical care outside Canada — Ontario ended out-of-country coverage in 2020. It also does not replace income when someone is too sick or injured to work. OHIP does cover family doctor and specialist visits, emergency room care, hospital admission, medically necessary surgery, a standard ward room, and lab work and diagnostic imaging ordered by a physician.
9
categories inside the public scope
Physician and specialist visits, emergency care, hospital admission, medically necessary surgery, standard ward rooms, physician-ordered diagnostics, in-hospital drugs, in-hospital dental surgery, and age-based eye and drug exceptions.
10
categories outside it
Pharmacy drugs, routine dental, vision, paramedical, psychology, the ambulance co-payment, upgraded rooms, hearing and mobility equipment, out-of-country care, and income replacement.
2020
out-of-country coverage ended
Ontario ended its out-of-country travellers programme in 2020. Medical care outside Canada is now entirely a private matter.
25
the age OHIP+ stops
OHIP+ covers formulary prescription drugs for Ontario residents aged 24 and under with no private plan. It ends at 25, and where a private plan exists that plan pays first.
What you will get from this resource
- •The nine coverage categories OHIP pays for in full, with no cost to employer or employee
- •The ten categories that fall to an employer plan or to the employee
- •The age-based exceptions: eye exams under 20 and 65+, drugs to age 24
- •Why the ambulance co-payment applies on every trip
- •The out-of-country change Ontario made in 2020 and what it means for travel
In the public scope — paid by OHIP, no cost to employer or employee
This is the half people are thinking of when they say health care in Canada is free. It is genuinely comprehensive, and it is the reason a Canadian benefits plan costs a fraction of an American one. Nobody is billed for the operating room.
- Family doctor and specialist visits
- Emergency room and hospital admission
- Medically necessary surgery
- Standard ward hospital room
- Lab work, X-rays, MRI and CT when ordered by a physician
- Drugs administered while admitted to hospital
- Dental surgery, but only when it must be performed in a hospital
- Eye exams for residents under 20 and 65 and over
- Prescription drugs for residents 24 and under with no private plan
By others — an employer plan, or the employee’s own money
Every line here is a real cost that lands somewhere. On a crew with no plan, it lands on the employee, and the usual outcome is not that they pay it. It is that they wait, and a small problem becomes a scheduled absence.
- Prescription drugs filled at a pharmacy, for most working adults
- All routine dental: exams, cleanings, fillings, root canals, crowns
- Eyeglasses and contact lenses
- Physiotherapy, chiropractic, massage and orthotics for working-age adults
- Psychologists and counselling outside a hospital
- The ambulance co-payment, on every trip
- Semi-private or private hospital rooms
- Hearing aids, braces and most mobility equipment, beyond a partial subsidy
- Any medical care outside Canada — Ontario ended out-of-country coverage in 2020
- Income, once someone is too sick or injured to work
Related: What those lines cost in 2026 — The uncovered side priced out, from a recall exam to a root canal.
The age-based exceptions are narrower than they sound
Two exceptions get quoted back at us regularly, and neither one helps a working-age crew. Eye exams are covered for residents under 20 and 65 and over, which excludes the entire working population in between. And OHIP+ covers formulary prescription drugs for residents aged 24 and under who have no private plan — it stops at 25, and where a private plan exists, that plan pays first. Both are floors for the uninsured. Neither is coverage for a workforce.
- Eye exams: under 20 and 65+, which is nobody on a working payroll
- OHIP+ drugs: age 24 and under, and only where no private plan exists
- A private plan always pays first where one is in place
- Neither exception reaches a 30-year-old apprentice or a 45-year-old foreperson
The line employers underestimate most
Income. Everything else on the uncovered list is a bill — unwelcome, but survivable. Income replacement is a mortgage. If someone cannot work, OHIP has nothing to say about it. EI sickness benefits replace 55% of insurable earnings to a maximum of $729 a week in 2026 and stop after 26 weeks. WSIB pays only where the work itself caused the injury or illness, which rules out the heart attack, the cancer diagnosis, and the accident that happened on a Saturday.
Related: Where each government program stops — Six programs, and the eligibility rule that ends each one.
Decision Signals
Use these signals to decide whether the next step is a quote, a renewal audit, or a deeper plan-design review.
| Situation | Signal | Next Move |
|---|---|---|
| An employee asks whether their dental cleaning is covered by OHIP | The work is happening in a dental office, not a hospital | It is not covered. OHIP covers dental surgery only where it must be done in a hospital. |
| A crew member needs physiotherapy after an off-site injury | They are between 20 and 64 and the injury was not work-related | Neither OHIP nor WSIB pays. This is an employer plan line or an out-of-pocket cost. |
| Someone is travelling outside Canada for work or holiday | They assume OHIP follows them | It has not since 2020. Out-of-country medical care is entirely private now. |
| A 24-year-old apprentice is on OHIP+ today | Their next birthday is their 25th | Coverage ends at 25. Plan for the transition before it becomes a surprise. |
Content pillar
Read this alongside
This page is one piece of a larger cluster. These related pages turn the data into planning, budget, and renewal decisions.
Why Canadian employees need employer benefits
The full four-page briefing, free and without a signup.
What uncovered health care costs in Ontario
Every uncovered line priced in 2026 dollars.
Government health programs and where each one stops
The programs that look like they close the gap, and why they do not.
Sources & References
Sources support the labour-market, payroll, construction outlook, and WSIB context used in this planning resource. Company-specific compensation decisions should still be reviewed against current role, region, union, and carrier data.
AI Citation Note: This article is designed to be citeable and passage-extractable for AI search engines, language models, and research tools. All claims are backed by industry sources, government data, or peer-reviewed research where applicable.
Related Pages
Frequently Asked Questions
Does OHIP cover dental?
No. OHIP does not cover any routine dental care — exams, cleanings, fillings, root canals, crowns, or dentures. The only dental work OHIP pays for is dental surgery that must be performed in a hospital. All ordinary dentistry in Ontario is paid by an employer plan, by a government programme with narrow eligibility, or by the patient.
Does OHIP cover prescription drugs?
Only in specific cases. Drugs administered while a patient is admitted to hospital are covered. Outside hospital, OHIP+ covers formulary prescription drugs for Ontario residents aged 24 and under who have no private plan, and the Ontario Drug Benefit covers residents 65 and over. For most working adults, prescriptions filled at a pharmacy are paid by an employer plan or out of pocket.
Does OHIP cover physiotherapy, chiropractic or massage?
Not for working-age adults in private practice. Publicly funded physiotherapy exists in limited circumstances, largely tied to hospital care, age, or specific programmes. Physiotherapy, chiropractic, massage and orthotics for a working-age employee are paramedical lines on an employer plan, or an out-of-pocket cost.
Does OHIP cover mental health care?
Psychiatry delivered by a physician is covered, and mental health care received inside a hospital is covered. Psychologists and counselling outside a hospital are not. That is the category most employees actually need access to, and it is why psychology limits and employee assistance programmes appear on nearly every employer plan.
Does OHIP cover ambulance rides?
Partly. Ontario charges a co-payment on ambulance trips, and the full fee applies where the trip is ruled not medically necessary. The co-payment is a real out-of-pocket cost on every trip, and it is one of the lines an employer plan can pick up.
Does OHIP cover me outside Canada?
No. Ontario ended its out-of-country travellers programme in 2020. Medical care received outside Canada is entirely a private matter, covered by travel insurance or by an employer plan that includes out-of-country benefits, or paid by the traveller.
Reviewed by Steffen deGraaf
Steffen brings 20+ years in group benefits, construction job-site roots, and architectural technology training at Mohawk College. FSRA regulated insurance broker specializing in Ontario group benefits.
Ontario Insurance
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