Eligibility for Private Scan
1
A “third party service” is a service that is provided to a person by a physician, hospital, or another service provider in connection with a requester requirement, made by a third party that the service is provided to the person, or that information relating to the person be provided to the third party. The third party that makes the request or requirement is liable for payment to the service provider for the service provided to the person. Specified third-party services that are not insured by OHIP are those which are received wholly or partly for the production of a document, or the transmission of information to the third party if the document or the information relates to:
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Admission to/continued attendance in a school/educational program
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Admission to/continued attendance in a recreational/athletic club/program
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An application for/continuation of insurance
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An application for/continuation of a license
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Entering/maintaining a contract
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An entitlement to benefits, including insurance or pension benefits.
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Obtaining/continuing employment
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An absence from/return to work
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Legal requirements/proceedings
2
Automobile Insurance
Auto insurance policies are specifically excluded from the general prohibition against contracts of insurance for the payment of the costs of services insured by OHIP. All auto insurance policies provide for certain “medical benefits” including all reasonable and necessary expenses for medical and hospital services, and any related assessments or examinations, incurred by an insured person because of an automobile accident.
3
WSIB
Services that a person is entitled to receive under the insurance plan established pursuant to the Workplace Safety and Insurance Act are not services insured by OHIP. A worker who sustains a personal injury by accident arising out of and in the course of his employment is entitled to such health care (including services provided by a physician/hospital) as may be necessary, appropriate, and sufficient as a result of the injury, with the costs of such health care to be paid by the Workplace Safety and Insurance Board.
4
Private Screening
"Screening in the medical context is defined as the examination of a person with no symptoms to detect unsuspected disease". Detection of coronary disease or different types of cancer is considered as screening. These screenings are not considered medically necessary and hence are not insured under HIA.
5
Other Non-OHIP
Some health care services are otherwise excluded from services insured by OHIP under provincial regulations (e.g. exam not meeting specific OHIP criteria for a particular body part, exam in support of treatment considered experimental, the exam for purpose of clinical research, etc.)
6
Non Resident
Only persons who are ordinarily resident in Ontario, as well as certain other persons deemed to be residents under provincial regulations, are entitled to receive OHIP-insured services without charge. Therefore, services provided to non-residents of Ontario are not insured by OHIP.
Third Party Service