What is covered?
Overview of Products and Services
UHIP provides coverage for basic health care services such as hospital, physician, laboratory, ambulance and some other services generally covered by Ontario resident health insurance. UHIP pays up to $1,000,000 (Canadian) a year for each covered person incurring eligible health services and medical treatments. Eligible expenses include:
back to top >
Hospital services in Ontario
- emergency room services and out-patient charges
- emergency hospitalization in standard ward accommodation (including meals), at 100% for the first four days and to a maximum of 2.5 times the hospital’s interprovincial rate for each day thereafter
- non-emergency hospitalization in standard ward accommodation (including meals) to a daily maximum of 2.5 times the hospital’s interprovincial rate
- semi-private or private accommodation, when medically necessary and certified in writing by the attending physician
- use of the operating and delivery rooms (including anaesthetic and surgical supplies), diagnostic facilities and respiratory equipment,
- services rendered by any person paid by the hospital
- In-patient and out-patient elective surgery or treatment require pre-approval by Sun Life the Insurer (physician or surgeon must submit a treatment plan with full details in advance, and the UHIP insurer will decide what expenses will be paid, based on current OHIP coverage)
- physicians services, at 125% of OHIP
back to top >
Physicians' services in Ontario
Other services that are medically necessary:
- physicians’ and specialists’ services at home, in a hospital or institution, or in the physicians’ office
- one annual health examination
- diagnosis and treatment of illness and injury, surgery, including the administration of anaesthetics
- care related to pregnancy (prenatal and postnatal), even if pregnancy began before arrival in Ontario
Physicians' services will be paid up to 125% of OHIP.
back to top >
Other Services in Ontario
For all other services listed below, benefits are paid according to the OHIP schedule of fees.
back to top >
Diagnostic laboratory and X-ray services
- X-rays for diagnostic and treatment purposes, laboratory services, and clinical pathology, ordered by a physician and performed in an approved laboratory
back to top >
Ambulance
- a portion (equivalent to the amount paid by OHIP) of the cost of land and—with prior approval—in-province air ambulance to the nearest available hospital, when confirmed as having been essential by a physician or a designated hospital official
back to top >
Vision care
- one eye examination by a physician, ophthalmologist, or optometrist once in every 12 consecutive months for each covered person under age 20 and over age 64. For more frequent exams, preauthorization from the UHIP insurer is recommended
back to top >
Services of other practitioners
- charges for treatment by a osteopath or podiatrist, to the same levels and under the same conditions as OHIP
back to top >
Emergency services outside Ontario or Canada
- emergency hospitalization and medical care outside Ontario or Canada, to the same levels and under the same conditions as OHIP coverage (Please refer to Out of Country and Out of Province Coverage for more details)
back to top >
Nursing homes
- a portion (equivalent to the amount paid by OHIP) of the cost of standard ward accommodation, when a covered person needs regular medical supervision as well as nursing and personal care on a 24-hour-a-day basis
back to top >
Chronic hospital care
- a portion (equivalent to the amount paid by OHIP) of the cost of in-patient hospital services in the chronic care unit of a hospital or an approved nursing home, when authorized by a physician
back to top >
Home care
- when a professional health service is needed and needs cannot be met on an out-patient basis, with a physician’s authorization and pre-approval of the UHIP insurer
back to top >
Drugs dispensed in hospital
- prescription drugs dispensed during a hospital confinement for use in the home and to the same levels and under the same conditions as OHIP coverage
back to top >
Medically necessary dental care in hospital
- dentist fees for specified dental surgery, when hospitalization is judged medically necessary, performed by a dental surgeon who is a member of the hospital’s staff, with prior approval of the UHIP insurer (except in emergencies), to the same level and under the same conditions as OHIP coverage
back to top >
Special assistance
- the cost of certain specialized medical aids and supplies, to the same levels and under the same conditions as OHIP coverage, including the Assistive Devices Program
back to top >
Repatriation
Click here for more information on Repatriation >
back to top >