⌵📋 What Is OHIP?

The Ontario Health Insurance Plan (OHIP) is the provincial health insurance program that covers medically necessary healthcare services for residents of Ontario. It is funded through taxes and premiums paid by residents and employers. OHIP covers a wide range of services, including hospital and physician services, but does not generally cover prescription medications outside of hospitals or dental care.

⌵✅ Who Is Eligible for OHIP?

To be eligible for OHIP, you must:

 Be a Canadian citizen, permanent resident, or hold a valid work permit.

 Have a permanent and principal home in Ontario.

 Be physically present in Ontario for at least 153 days in any 12-month period.

 Make Ontario your primary place of residence.

⌵📝 How to Apply for OHIP

To apply for OHIP and obtain a health card:

1. Gather Required Documents:

• Proof of Canadian citizenship, permanent residency, or valid work permit.
• Proof of Ontario residency (e.g., utility bill, lease agreement).
• Proof of identity (e.g., passport, driver’s license).

1. Visit a Service Ontario Centre:

• Submit your application in person at a Service Ontario centre.
• You can find the nearest centre and more information on the ServiceOntario website.

⌵🏥 Understanding OHIP Coverage for Gender-Affirming Surgery in Ontario

1. Mission of OHIP

The Ontario Health Insurance Plan (OHIP) is Ontario’s publicly funded health insurance program. Its mission is to provide residents with free medically necessary healthcare services funded through provincial taxes, ensuring equal access to essential medical treatments and surgeries.

2. Who Is Eligible (Target Applicants)

To qualify for OHIP coverage, you must meet all of the following requirements:

• Be a Canadian citizen, permanent resident, or have an eligible immigration status (e.g., a valid work permit).
• Live in Ontario as your primary residence.
• Be physically present in Ontario for at least 153 days per year.

3. OHIP Coverage for Gender-Affirming Surgery

OHIP covers medically necessary gender-affirming surgeries, including vaginoplasty, phalloplasty, chest surgery, and secondary (revision) surgeries under certain conditions.

a) Criteria for Coverage

Must have a diagnosis of persistent gender dysphoria.

Assessment letters from qualified healthcare providers are required.

b) Number of Assessments Needed

Surgery Type Required Assessments

Chest Surgery 1 letter from a physician or nurse practitioner

Genital Surgery (e.g., vaginoplasty, phalloplasty) 2 letters: at least one from a physician or NP, and the second from a qualified professional (physician, psychologist, or MSW social worker)

c) Additional WPATH-Based Requirements

Hormone Therapy: Must be on continuous hormone therapy for at least 12 months unless medically contraindicated.

Social Transition: Must have lived in your affirmed gender for at least 12 months before surgery (recommended, not always mandatory).

d) Prior Approval Process

Before surgery, your physician submits a Prior Approval Form to the Ontario Ministry of Health.

If approved, you receive a Funding Confirmation Letter to proceed with surgery at an approved facility.

e) Out-of-Province or Out-of-Country Surgeries

If the surgery is available in Ontario, OHIP will not cover procedures performed outside the province.

Exceptions exist for cases where the service is not available in Ontario or would result in serious medical risk due to long waiting times.

To access OHIP funding for these surgeries:

1. Obtain a Referral: Consult with your primary care provider or a specialist who can assess your eligibility and provide a referral.
2. Complete the Application: Your healthcare provider will complete the Request for Prior Approval for Funding of Sex-Reassignment Surgery form.mgcs.gov.on.ca+2Women’s College Hospital+2
3. Submit the Application: The completed form will be submitted to the Ministry of Health for review and approval.
4. Wait for Approval: Once approved, you will be referred to a surgeon who performs the procedure.

It’s important to note that some procedures, such as peritoneal pull-through (PPV), may not be covered by OHIP and could require self-pay.

⌵💡 Additional Information

Private Health Insurance: While OHIP covers many services, it does not cover prescription medications outside of hospitals or dental care. You may need private health insurance to cover these additional costs.

Traveling Outside Ontario: OHIP pays for most of your healthcare costs when you are outside Ontario but still in Canada. However, OHIP only pays for some services when you travel outside of Canada.

⌵📌 Final Thoughts

Navigating the process of accessing gender-affirming surgery through OHIP can be complex, but understanding the steps involved and the resources available can help make the process smoother. Always consult with your healthcare provider for personalized guidance and support.

Learn more about OHIP Coverage for gender affirming surgery here: ontario.ca