Health insurance - how does in work in Canada?

[kiwissima]

My employer in Canada provide me with health insurance and issued me a benefit card. I am new to the healthcare system in Canada and have very primitive questions.
If I need to visit a doctor, how does it work? Should I pay on my own and then claim the expenses. Or when going to the doctor I need to present my benefit card and they charge my health insurance company (Encon)? Can I go to any healthcare provider or need to choose a specific hospital? Do I need to visit a GP to give me a prescription to go for example to an ophthalmologist or make a blood test? Or maybe it depends on my benefit plan and insurance company?

Thank you in advance!

 

[canuck78]

You should ask for a benefit pamplet or it is probably online. Not sure your status but it does seem like you qualify for OHIP. Hopefully you have registered for OHIP and started your 3 month waiting period. Your employer benefits are usually contingent on you having OHIP already. You can visit a family doctor by showing your OHIP card. You obviously have to make an appointment. You should call around to find a family doctor who is taking on new patients or there are walk-in clinics if you haven't found one. ERs are only for serious emergencies not colds, etc. You will not be charged for the appointment if you have your valid OHIP card. You will need your benefit card for when you go to for example the pharmacy. Usually you will only have to pay the remaining amount the your insurance doesn't cover. If you need to see a specialist physician your family doctor will refer you. You can't call and make an appointment yourself. Both family doctors or specialists may not be located in a hospital. If you break your arm or something like that you can go to whatever emergergency room but be prepared to wait. The most serious get treated first. Avoid the hospital and ER if at all possible. You don't need to see an opthamologist unless you have an eye disease. Tha majority of people see an optometrist and you should have partial or full coverage for the visit. You may have to pay in advance and send in your receipt to be reimbursed. Same things and contact lenses and glasses, you should have a yearly maximum that you can claim. Your family doctor needs to give you a prescription for things like massage therapy, accupuncture, physiotherapy if you have an injury. Your plan will outline what your benefits are for the year. Any doctor can give you a lab requisition. There are labs in many buildings where there are doctors offices or you can look up the office locations. You need to bring your OHIP card and there won't be a cost. Hope that answers some questions. First thing I would recommend is trying to find a family doctor. You should call around or ask neighbours or colleagues for a convenient office and then find out if they are taking new patients. There used to be a number you could call but not sure if it is still in use. You should carry OHIP and benefit card in your wallet. There are residency requirements to maintain covereage even with a valid card so I would read the OHIP website as well as your benefit plan info.

 

[Copingwithlife]

Further to Canuck78, ALWAYS bring your card with you whenever you are getting service. I had to head to a walkin last week, and I had taken my OHIP card out for some reason and forgot to put it back. No card, no service .Simple as that. Even my own Family Doctor wants to see and swipe that card at every visit . And I’ve seen her for 25 years .I asked her once what they see when they swipe . She said if I’ve been cut off from OHIP it’ll flash a certain code .The receptionist did tell me they accepted AMEX while I was dumping my wallet out looking for it though I think the charge was $75.00 if I didn’t have the card .

 

[kiwissima]

You should ask for a benefit pamplet or it is probably online. Not sure your status but it does seem like you qualify for OHIP. Hopefully you have registered for OHIP and started your 3 month waiting period. Your employer benefits are usually contingent on you having OHIP already. You can visit a family doctor by showing your OHIP card. You obviously have to make an appointment. You should call around to find a family doctor who is taking on new patients or there are walk-in clinics if you haven't found one. ERs are only for serious emergencies not colds, etc. You will not be charged for the appointment if you have your valid OHIP card. You will need your benefit card for when you go to for example the pharmacy. Usually you will only have to pay the remaining amount the your insurance doesn't cover. If you need to see a specialist physician your family doctor will refer you. You can't call and make an appointment yourself. Both family doctors or specialists may not be located in a hospital. If you break your arm or something like that you can go to whatever emergergency room but be prepared to wait. The most serious get treated first. Avoid the hospital and ER if at all possible. You don't need to see an opthamologist unless you have an eye disease. Tha majority of people see an optometrist and you should have partial or full coverage for the visit. You may have to pay in advance and send in your receipt to be reimbursed. Same things and contact lenses and glasses, you should have a yearly maximum that you can claim. Your family doctor needs to give you a prescription for things like massage therapy, accupuncture, physiotherapy if you have an injury. Your plan will outline what your benefits are for the year. Any doctor can give you a lab requisition. There are labs in many buildings where there are doctors offices or you can look up the office locations. You need to bring your OHIP card and there won't be a cost. Hope that answers some questions. First thing I would recommend is trying to find a family doctor. You should call around or ask neighbours or colleagues for a convenient office and then find out if they are taking new patients. There used to be a number you could call but not sure if it is still in use. You should carry OHIP and benefit card in your wallet. There are residency requirements to maintain covereage even with a valid card so I would read the OHIP website as well as your benefit plan info.

Thank you so much for this detailed explanation of how the healthcare system works in Canada, it answered so many of my questions! I am currently on a work permit in Canada. Checking OHIP website I understood that to qualify for OHIP I need to work full time in Canada for at least 6 months. I will be employed 6 months in a few weeks and I plan to apply immediately (already started preparing all the docs).

You said that your employer benefits are usually contingent on you having OHIP already. Does it mean that I cannot benefit from my employer's benefits (private insurance) without OHIP card or it really depends on my particular insurance plan?
Also, do I understand correctly that to visit any specialist (for example, dermatologist) and to do any lab test I always need to get a reference from the family doctor first, even in a walk-in clinic?

 

[kiwissima]

Further to Canuck78, ALWAYS bring your card with you whenever you are getting service. I had to head to a walkin last week, and I had taken my OHIP card out for some reason and forgot to put it back. No card, no service .Simple as that. Even my own Family Doctor wants to see and swipe that card at every visit . And I’ve seen her for 25 years .I asked her once what they see when they swipe . She said if I’ve been cut off from OHIP it’ll flash a certain code .The receptionist did tell me they accepted AMEX while I was dumping my wallet out looking for it though I think the charge was $75.00 if I didn’t have the card .

Oh, thanks! At the moment I don't have OHIP card. I am currently on a work permit in Canada. Checking OHIP website I understood that to qualify for OHIP I need to work full time in Canada for at least 6 months. I will be employed 6 months in a few weeks and plan to apply immediately considering 3 months waiting period... Once I get it, I will always keep it in my wallet!

 

[canuck78]

Thank you so much for this detailed explanation of how the healthcare system works in Canada, it answered so many of my questions! I am currently on a work permit in Canada. Checking OHIP website I understood that to qualify for OHIP I need to work full time in Canada for at least 6 months. I will be employed 6 months in a few weeks and I plan to apply immediately (already started preparing all the docs).

You said that your employer benefits are usually contingent on you having OHIP already. Does it mean that I cannot benefit from my employer's benefits (private insurance) without OHIP card or it really depends on my particular insurance plan?
Also, do I understand correctly that to visit any specialist (for example, dermatologist) and to do any lab test I always need to get a reference from the family doctor first, even in a walk-in clinic?

You don't need to work for 6 months to qualify for ohip you need proof that you will be employed for 6 months so you could have applied 6 months ago. The specific requirements for the letter from your employer is somewhere on the forum. Once you get the letter and go to service Ontario office your 3 month wait period starts. Yes the private benefit plan is usually contingent on having ohip. You can double check your plan. Yes you need a referral to a specialist from another doctor. It is usually a family doctor but a specialist can refer to another specialist. Many things are taken care of at the family doctor level. You also need a requisition form from a doctor for any lab work. Walk-in clinic is usually a family doctor so no need for a referral. Iff you have a family doctor you usually have to go to their offices and not a walk-in clinic or else they get penalized.