How to navigate the Ontario healthcare system
Newcomers to Ontario have much to learn about how to seek and receive care through Ontario’s publicly-funded healthcare system.
We’ll discuss how to access healthcare in Ontario, both for those who qualify for Ontario’s health insurance, and those who do not.
In Ontario, Canadian citizens, permanent residents, and even certain work permit holders can get free-of-charge health coverage through OHIP, the Ontario Health Insurance Plan.
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In this article, we’ll go over
Who qualifies for OHIP;
How to access primary care providers;
When to visit the emergency room;
How to obtain referrals to specialists; and
Tips for accessing care if you are not covered by OHIP.
Who qualifies for OHIP
The Ontario Health Insurance Plan (OHIP) is a publicly-funded health insurance program that provides coverage for Ontario residents.
To be eligible for OHIP, your primary residence must be in Ontario, and you must be physically present in Ontario for at least 153 days in any 12-month period and within the first 183 days immediately after moving to the province.
If you have permanent status in Canada, for example, as a permanent resident or citizen, you will always qualify for OHIP provided you meet the Ontario residency requirements.
You can also qualify for OHIP with the following types of temporary resident statuses:
Valid work permit holder, working full-time in the province for an Ontario employer (at least six months). *
Permanent resident applicant whose application is being processed and has received an acknowledgement of receipt (AOR).
Work permit holder through the federal Live-in Caregiver or Seasonal Agricultural Worker Program.
Temporary Resident Permit holder (case types 86-95).
Clergy member ministering full-time in the province for at least six months.
Convention refugee or other protected person status.
*Your accompanying spouses and dependents may also qualify for OHIP.
Primary care
As a patient, your first contact with the health care system will generally be through a primary care provider, such as a general practitioner (GP) physician (often called a family doctor), or nurse practitioner.
Your primary care provider will assist you with initial complaints or concerns about your health, and can provide checkups, preventative screenings, diagnoses, prescriptions, and chronic disease management.
Primary care providers can treat a wide variety of medical conditions. They can also coordinate care with other healthcare professionals; if you require specialist or advanced care, your primary care provider can refer you to a specialist and follow up on your progress.
You can generally expect to visit a primary care provider in an independent medical office which has set hours of availability. You generally must book an in-person or virtual appointment, and the wait time will vary based on your provider’s availability.
Primary care through a family doctor
The default model for accessing primary care in Ontario is through a family doctor – a single general practitioner who takes you on as a patient in their practice over the long term.
Finding a family doctor in Ontario may prove challenging, due to an ongoing shortage of family doctors leading to long waitlists.
To find a family doctor in Ontario, you can use Ontario’s Health Care Connect program, which helps connect you with family physicians, nurse practitioners, or primary care teams in your area who are currently accepting patients.
You may be able to find a family doctor more quickly yourself by contacting local clinics and doctors’ offices and asking whether they are accepting patients.
To get a family doctor in Ontario, you need to have OHIP coverage. If you do not have OHIP coverage, you can seek a primary care provider through the alternative options mentioned below.
Alternative options if you have no general practitioner
If you are unable to find a family physician or wait for an appointment, there are other options available to you.
1. Walk-in clinics
At a walk-in clinic, you can get medical advice, assessments, and treatment for minor and non-urgent illnesses and injuries (such as infections, sprains, and burns) from healthcare professionals without a prior appointment.
Most services are covered by OHIP. If you do not have a valid Ontario-issued health card, you can use private or third-party insurance or pay per visit (typically around $60 to $150, not including medication or certain testing costs).
If you need to see a specialist (such as a dermatologist or neurologist), walk-in clinics can provide you with a referral.
Walk-in clinics operate on a first-come-first-served basis. To be seen at a walk-in clinic, simply register with the clinic staff and wait to be seen. Wait times vary from location to location but typically range from 30 minutes to three hours.
Clinics open as early as 7 a.m. and typically close around 6 to 8 p.m.
2. Virtual clinics
A virtual clinic is a healthcare service that allows individuals to consult with medical professionals through video conferencing, telephone, or secure messaging.
They generally function though websites or mobile apps where patients can book an appointment at a time that works for them, and many even have same-day availability.
Most virtual clinics offer a wide range of services including general medical consultations, mental health support, and even prescription renewals and specialist care.
Clinic services are free (except if through secure messaging) if the physician or nurse practitioner and the patient are both located in Ontario and the patient has a valid Ontario health card. Most also accept a variety of third-party private insurances, though patients without coverage must pay out of pocket.
Some examples include Health Connect Ontario (also known as Health 811), Rocket Doctor, Maple, and Tia Health, with some being accessible 24/7.
3. Community Health Centres (CHCs)
Across Ontario, some clinics and Community Health Centres (CHCs) offer free healthcare services, including clinical treatment.
They are often volunteer-run and include a team of healthcare professionals as well as other types of community support workers—such as settlement or social workers.
Depending on whether it’s a CHC or an independent clinic, you may not be required to have OHIP, and in many cases you can be seen free of charge.
Services include but are not limited to general medical care, mental health support, and sexual health or prenatal care.
There are 75 CHCs in Ontario, which you can also visit if you need a referral to a specialist.
Some offer walk-in care; others require an appointment to be booked.
Certain clinics have eligibility criteria you must meet to receive care.
4. Specialist clinics
At a specialty clinic, care is provided by healthcare professionals trained in a particular area of medicine, such as psychiatry, cardiology, or oncology. These clinics can be found in hospitals, medical centres, and private offices.
In most cases, you’ll need a referral from a primary care provider and an appointment to access specialist services. Certain clinics, however, may not require a referral, and some even double as walk-in clinics, either full-time or between certain hours.
Wait times vary widely depending on urgency, specialty, and availability. For a chance at an earlier appointment at short notice, you can call your clinic and request to be placed on a cancellation list.
Specialists can conduct any necessary tests, such as blood work, x-rays, or MRIs, and provide recommendations on any course of action moving forward, such as surgery.
The Government of Ontario has an online tool which allows you to check surgical, diagnostic imaging, and mammogram wait times by city or postal code.
Specialist services are typically covered by OHIP. Without OHIP, you must pay out of pocket, with consultations alone often ranging from $100 to $300.
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How to get a referral to see a specialist
More than 33,000 physicians in Ontario deliver specialized care, spanning across 47 distinct specialties. Commonly accessed specialties include endocrinology (hormonal disorders), gynecology (women’s reproductive health), and hematology (blood disorders).
In Ontario, you almost always need a referral from a physician or nurse practitioner to see a specialist.
The process of getting a referral typically includes the following:
Step 1: Make an appointment with your primary care provider or visit a walk-in clinic.
Step 2: Discuss your symptoms or medical concerns. If the primary care provider believes you need specialized care, they will write you a referral letter.
You may express a preference for a specific specialist, and your provider will accommodate your request if possible.
Step 3: The referral is typically sent directly to the specialist’s office electronically or by fax. In some cases, you may need to bring the referral letter with you.
Step 4: The specialist’s office will review the referral and determine the urgency of your case. The wait time will vary depending on the availability of the specialist.
To schedule an appointment, the specialist’s office may call you or email you, or you may need to follow up with them yourself.
In some cases, the office may simply mail you a letter with your appointment time and date, which you’ll be required to reschedule if you cannot make it.
ER versus urgent care
For urgent medical needs that require immediate medical attention, you’ll want to visit an emergency room (ER) or urgent care centre.
You should call 911 and/or proceed to the nearest emergency room if you are experiencing symptoms or injuries that pose an immediate threat to life, limb(s), or long-term health, such as
Shortness of breath;
Heart attack or stroke symptoms;
Seizures;
Confusion or delirium;
Severe injuries, including trauma, burns, or heavy bleeding; or
Severe allergic reactions.
If your condition requires urgent treatment but is not a medical emergency, an urgent care center is typically more appropriate – this would include conditions such as
Sprains or minor fractures;
Cuts that may require stitches;
Minor burns;
Rashes;
Minor allergic reactions;
Infections, such as ear infections, or urinary tract infections.
If you are not sure whether to seek care or where to seek care, you can call Telehealth Ontario at +1 866-553-7205.
Emergency rooms are open 24/7, while most urgent care centers have limited hours.
You do not need an appointment to be seen at the ER or at an in-person urgent care centre.
The wait time will vary depending on availability of medical personnel and demand for services. ERs and urgent care centers operate on a triage system, in which patients are seen in order of their medical need, not on a first-come, first-served basis.
If your condition is severe, such as a heart attack, you may be seen immediately after being triaged. If your condition is less severe, you may wait up to eight hours or longer.
Urgent care centres essentially bridge the gap between your primary care provider and the ER, and have significantly shorter wait times.
In the absence of OHIP or private insurance, visiting an urgent care centre is typically a more cost-efficient option than seeking treatment in an emergency room.
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Services covered by OHIP
For services delivered in Ontario by certified practitioners, OHIP covers both in-person and virtual visits provided they are medically necessary, including part of or all the following services:
Doctor’s visits.
Hospital stays and visits.
Ambulance services.
Laboratory testing and medical imaging.
Abortions.
Eligible dental surgeries in hospital (such as fracture repair, tumor removal, or reconstructions).
Under certain circumstances, OHIP may cover some eye care and foot-heath services.
When visiting another Canadian province or territory, your valid Ontario health card covers medically necessary services including such as a visit to a walk-in clinic and services provided in public hospitals.
Services not covered by OHIP
OHIP generally does not cover the following:
Doctor’s notes.
Prescription medications.
Dental care.
Routine vision care such as testing, corrective lenses, and corrective surgery.
Paramedical services, such as physiotherapy, massage therapy, chiropractic medicine, chiropody, and acupuncture.
Cosmetic surgery.
How to apply for OHIP
To obtain an Ontario health card and obtain health coverage, you must apply in person at a ServiceOntario centre and bring the following documents with you:
A completed Registration for Ontario Health insurance Coverage form (obtained online or from your local ServiceOntario location);
An original document proving your identity, which includes your name and signature;
An original, printed, or electronic document showing you live in Ontario; and
An original document proving you are a Canadian citizen or have OHIP-eligible status.
Three separate documents must be used to prove each requirement. To see a comprehensive list of which documents can be used to meet identity, residency, and eligibility requirements, visit the Government of Ontario’s official webpage.
Once your application is processed, your health card will be mailed to the Canadian address provided within four to six weeks.
Tips for accessing care without OHIP
Certain individuals will not have access to OHIP but are required to have health insurance for the duration of their stay in Canada.
International students in Ontario typically have coverage through the University Health Insurance Plan (UHIP), which provides access to most medically necessary services—much like OHIP. A UHIP policy provides up to $1 million in coverage for primary health care services.
Super Visa holders are required to have a health insurance policy from either
A private Canadian health insurance company; or
A qualifying health insurance company from outside Canada.
Minimum coverage must be $100,000.
Certain work permit holders, such as participants in the International Experience Canada Program, must have health insurance that covers the entire validity of their permit, either through one comprehensive policy or two back-to-back policies if needed.
While insured, individuals without OHIP coverage may face challenges when accessing services such as laboratory testing or prescription medications. For example, LifeLabs and many pharmacies are accustomed to billing directly through OHIP, and may not be set up to process private insurance claims. In such cases, patients are often required to pay upfront and submit claims to their insurance provider for reimbursement.
To minimize complications, it’s recommended that non-OHIP patients carry proof of private coverage at all times and clarify billing procedures with healthcare providers in advance. When possible, choose clinics familiar with international or uninsured patients.
Diagnostic testing
If you need a diagnostic test done, you can often do so outside a medical clinic or ER/urgent care environments at a diagnostic service provider such as LifeLabs or Dynacare.
Your physician will order the necessary test(s), provide you with a requisition/referral form, and then you will need to look up your local diagnostic service provider.
These diagnostic testing providers typically provide tests and services including, but not limited to:
X-ray scans;
Ultrasounds;
Blood and urine tests;
Electrocardiograms (ECGs) and Holter Monitoring;
Cancer screenings;
Infectious disease panels;
Immunological disorder testing;
Neurological / neurodegenerative disorder testing;
Naturopathic tests (hormone levels, food reactions, toxin identification, etc.); and
Genetic tests.
Common tests and services, such as X-rays and blood and urine tests, do not typically require an appointment—but in many cases, you can significantly reduce wait time by booking one.
Imaging services—such as ultrasounds or cancer screenings—and other less common tests typically require you to book an appointment.
Common tests through diagnostic service providers such as LifeLabs or Dynacare are typically covered by OHIP, but it will ultimately depend on the specific type of test order by your physician.
