Patient guide

OHIP and uninsured services

Understand why some physician services are covered by OHIP and why other clinic requests may be uninsured or subject to special rules.

The basic difference

An insured service is a service covered by OHIP. An uninsured service is a service that is not covered by OHIP. A request can arise in a medical clinic without being an insured service.

Whether a fee may apply depends on the exact service, why it is needed, who requested it, and the Ontario rules that apply. Requests that appear similar can sometimes be handled differently.

Three important categories

Insured physician services

Many medically necessary physician assessments and treatments are covered by OHIP when applicable eligibility and billing requirements are met.

Uninsured services

Some services are not insured by OHIP and may be billed to the patient or a third party, subject to applicable rules.

Services with special rules

Some forms or requests may be billable to OHIP, billable to a patient or third party, or not separately billable. The details matter.

What can affect whether a fee applies?

The answer depends on the specific circumstances. Factors may include:

  • Whether the service is medically necessary assessment or treatment.
  • Whether the main purpose is a form, note, certificate, report, record request, or other document.
  • Whether an employer, insurer, school, lawyer, government program, or another third party requested the service.
  • Whether an OHIP billing rule or another Ontario rule applies to the request.
  • Whether a separate charge is permitted and how the clinic has communicated its policy and fee.

Questions to ask your clinic

Your clinic is the best source of information about how a particular request is classified and whether a fee applies.

  • Is this service covered by OHIP?
  • What specific service or work does the fee cover?
  • Is the patient or a third party responsible for payment?
  • What amount will be charged, and when is payment due?
  • Will an invoice and receipt be provided?

Important note

ClinicFees.ca provides general education only. It does not determine whether a specific service is insured, uninsured, billable, taxable, permitted, waived, or collectible. Your clinic's own policy and applicable Ontario rules apply.