Is Telemedicine Covered by OHIP? A Complete Guide to Virtual Care Coverage in Ontario

Understanding whether telemedicine is covered by OHIP is crucial for Ontario residents seeking convenient healthcare access. The good news is that yes, OHIP does cover many virtual healthcare services, but with specific requirements and limitations that have evolved significantly since the pandemic.

What is OHIP Virtual Care Coverage?

The Ontario Health Insurance Plan (OHIP) provides coverage for medically necessary virtual visits delivered by video or telephone with licensed Ontario physicians. This coverage ensures that eligible residents can access healthcare from the comfort of their homes without additional out-of-pocket costs, as confirmed by patient testimonials from services like Ogaei Virtual Healthcare.

Since December 1, 2022, Ontario implemented a new virtual care funding framework that replaced temporary COVID-19 billing codes with permanent coverage structures. This framework distinguishes between two main categories of virtual care services.

Types of OHIP-Covered Virtual Care Services

1. Comprehensive Virtual Care Services

Comprehensive Virtual Care Services are fully covered by OHIP when you have an existing/ongoing patient-physician relationship. This relationship is established when:

• You’ve had at least one in-person visit with the physician in the preceding 24 months

• You’re enrolled with the physician or another doctor in their primary care group

• A specialist has provided a consultation (video or phone) within the past 24 months

• You’ve received specific services like palliative care consultations or substance abuse assessments

Payment Structure:

• Video visits: 100% of the in-person fee rate

• Telephone visits: 85% of the in-person fee rate (95% for mental health and psychotherapy services)

2. Limited Virtual Care Services

For patients without an existing relationship with the physician, OHIP covers “Limited Virtual Care Services” at reduced rates:

• Video visits (A101): $20 per visit

• Telephone visits (A102): $15 per visit

These lower rates were implemented to encourage continuity of care and discourage one-off virtual consultations that may compromise comprehensive healthcare.

OHIP Virtual Care Requirements and Eligibility

To qualify for OHIP-covered telemedicine services, several conditions must be met:

Geographic Requirements

• Both patient and physician must be physically located in Ontario during the virtual visit

• Services provided across provincial borders are not eligible for OHIP coverage

Technology Requirements

• Video visits must use verified virtual visit solutions approved by Ontario Health

• Physicians must ensure secure, privacy-compliant platforms for patient data protection

• Telephone consultations can use standard phone systems

Medical Appropriateness

Virtual care services are only covered when it’s medically appropriate to provide care without direct physical examination. Certain conditions may require in-person assessment for proper diagnosis and treatment.

What Virtual Healthcare Services Are OHIP-Covered?

OHIP covers a wide range of virtual healthcare services when delivered by qualified Ontario physicians:

Primary Care Services

• General consultations for illness and health concerns

• Prescription renewals and medication management

• Chronic disease monitoring and follow-up

• Mental health consultations and psychotherapy

• Preventive care discussions

Specialist Services

• Specialist consultations via referral

• Follow-up appointments after in-person specialist visits

• Second opinions for existing conditions

• Genetic counseling assessments

• Palliative care consultations

Additional Covered Services

• Lab requisitions and imaging orders

• Medical certificates and sick notes (when medically necessary)

• Referrals to other healthcare providers

• Prescription delivery coordination

Cost Comparison: OHIP vs. Private Virtual Care

The cost difference between OHIP-covered and private virtual care services is significant:

Note: Private costs vary by platform and provider

How to Access OHIP-Covered Virtual Care

Step 1: Choose an Approved Platform

Select a virtual care platform that accepts OHIP billing, such as:

• Ogaei Virtual Healthcare

• TELUS Health MyCare

• Tia Health

• Virtual Care Ontario clinics

Step 2: Verify Your Eligibility

Ensure you have:

• Valid OHIP card

• Ontario residence

• Appropriate existing physician relationship (for comprehensive services)

Step 3: Book Your Appointment

• Register with your chosen platform using OHIP card information

• Select appointment time and type (video or phone)

• Complete pre-visit questionnaire if required

Step 4: Attend Your Virtual Visit

• Join the secure video call or phone consultation

• Discuss your health concerns with the licensed physician

• Receive prescriptions, referrals, or follow-up instructions as needed

Recent Changes to OHIP Virtual Care Coverage

October 2022 Updates

Starting October 1, 2022, OHIP reduced payments for one-off virtual visits to discourage episodic care and promote continuity with family physicians. This change aimed to:

• Encourage long-term patient-physician relationships

• Reduce reliance on virtual-only walk-in services

• Improve overall quality of care through comprehensive health management

Secure Messaging Pilot Program

In 2024, Ontario launched a pilot program allowing physicians to bill OHIP for secure messaging services through the K303A billing code. This enables:

• Up to $450 per month for patient messaging engagements

• Enhanced communication between visits

• Improved chronic disease management

Limitations and Exclusions

While OHIP covers many virtual care services, certain limitations apply:

Services Not Covered Virtually

• Emergency medical situations requiring immediate in-person care

• Complex procedures requiring physical examination

• Initial assessments for certain conditions

• Services where virtual delivery is medically inappropriate

Provider Restrictions

• Optometrists, podiatrists, and dental surgeons cannot bill OHIP for virtual care services

• Physicians must be licensed in Ontario to provide OHIP-covered virtual care

Benefits of OHIP-Covered Virtual Care

For Patients

• No cost for eligible services with valid OHIP card

• Convenient access from home, reducing travel time and costs

• Flexible scheduling including evenings and weekends

• Reduced wait times compared to traditional clinic visits

• Continuity of care with existing physicians

For the Healthcare System

• Reduced burden on emergency departments and walk-in clinics

• Improved access for patients in rural or remote areas

• Enhanced efficiency in healthcare delivery

• Better resource allocation across the province

➲ Explore Online Walk-in clinic in Ontario

Frequently Asked Questions

Do I need to pay anything for OHIP-covered virtual care visits?

No, if you have a valid OHIP card and meet the eligibility requirements, virtual care visits are completely free of charge. There are no co-payments, deductibles, or additional fees for covered services.

Can I see any doctor virtually, or do I need an existing relationship?

You can see any Ontario-licensed physician virtually, but the coverage differs. If you have an existing relationship (seen in-person within 24 months), you receive comprehensive coverage at full rates. Without an existing relationship, you can access limited virtual care services at $15-$20 per visit, still covered by OHIP.

What happens if I need a prescription during a virtual visit?

Licensed physicians providing OHIP-covered virtual care can prescribe most medications electronically. Prescriptions are typically sent directly to your chosen pharmacy for pickup or delivery. However, certain controlled substances may require in-person assessment.

Are virtual care services available 24/7 through OHIP?

While OHIP covers virtual care services regardless of the time they’re provided, the availability of physicians varies by platform. Some services like Ogaei offer extended hours including evenings and weekends, while others operate during regular business hours.

Can I get specialist referrals through virtual care visits?

Yes, physicians providing virtual care can make specialist referrals when clinically appropriate. However, some complex referrals may require in-person assessment first, depending on the condition and specialist requirements.

Conclusion

Telemedicine is indeed covered by OHIP for Ontario residents, offering accessible and cost-effective healthcare delivery. The current framework balances convenience with quality care by encouraging ongoing patient-physician relationships while still providing basic virtual care access for all residents.

Whether you need routine follow-up care, prescription renewals, or consultations for minor health concerns, OHIP-covered virtual care services provide a valuable healthcare option that saves time and money while maintaining high standards of medical care.

Sources:

• Ontario Ministry of Health – Schedule of Benefits for Physician Services

• Ontario Health – Virtual Visits Verification Program

• College of Physicians and Surgeons of Ontario – Virtual Care Policy

• Ontario Medical Association – Virtual Care Billing Guidelines

• Health Insurance Act Regulation 552