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Special Offers
OMA Priority Insurance Program (OPIP)

OMA Priority Insurance Program (OPIP)

We're ready to help.

 

 

You can’t plan for everything*

*B​ut you can be p​repared w​​ith OPIP​​​

Make protection a priority with the OMA Priority Insurance Program (OPIP).

OPIP is designed to ensure that Ontario physicians have access to the type of benefits that many Ontarians receive as part of an employee benefits program, providing you and your family with unique protection solutions to. You can also upgrade your coverage with additional options that can be customized to your needs – all in one highly affordable package. 

OPIP includes Health Coverage or a Health Spending Account and Critical Illness coverage under the Physicians Health Benefit Program (PHBPiPHBP is a government subsidized benefit program for Ontario doctors.
See Subsidy tab.
) as well as Legal Expense Insurance (LEI), and Security Evacuation Coverage (SEC). Members can also upgrade coverage with additional and enhanced benefits for themselves and their family.

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Health

Health coverage will ensure that you and your family are covered for health-related services not covered by the Ontario Health Insurance Plan (OHIP) - including eligible drugs, hospitalization, paramedical services, assistive devices and more. Enjoy the added convenience of a pay-direct drug card as well as $2-million emergency out-of-country travel coverage. If you wish to upgrade your coverage at additional cost, Health Plus and Dental coverage is available as well.

If you already have Health Care coverage under an employer sponsored plan, you can easily opt out of OPIP Health and receive a Health Spending Account - flexible credits to pay for health services important to you and your family including some insurance premiums, vision and dental expenses. How you spend the credits is up to you – as long as the expenses qualify as a medical, dental or hospital expense under the Income Tax Act (Canada).



Health Spending Account (HSA)

The OMA Priority Insurance Program (OPIP) includes a Health Spending Account (HSA) as a feature. An HSA is like having an account to pay for eligible health and medical expenses. An HSA holds credits that can be used to reimburse a wide variety of eligible health-care services or supplies that are not already covered by OHIP or any other insurance plan.

For newly eligible and late applicants, an HSA is only available if you opt out of Health coverage because you or your spouse have coverage elsewhere.



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Critical Illness (CI)

OPIP coverage for members includes a Critical Illness benefit. If approved for a claim, you may receive $50,000 lump sum payment,1 after surviving a diagnosis of one of 25 covered serious illnesses.

At time of initial OPIP enrolment, OMA members can also purchase an additional $50,000 each for coverage for themselves and their spouse – with no medical evidence required.




1Based on the current tax laws, the cash benefit from a group critical illness insurance plan will not presently be taxed when the premiums are paid for by you and the benefit is payable to you. Diagnosis of a critical illness, such as cancer, heart attack or stroke must occur after the effective date of coverage and you must complete a Survival Period (usually 30 days).

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Legal Expense Insurance (LEI)

Legal Expense Insurance, provided by DAS Canada, protects you, your spouse and children living at home from unexpected legal issues. From small claims court disputes, to highway traffic violations, legal disputes can have a significant impact on your time and finances.

Have a personal legal issue and need to talk to an advice lawyer? Call 1.855.953.1433 from 8:00 a.m. to midnight, seven days a week. If you have questions about your coverage, please contact us at 1.800.758.1641 or email info@omainsurance.com.



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Security Evacuation Coverage (SEC)

Global Security Evacuation Coverage provided by Drum Cussac through Chubb Insurance assists you and your family while travelling outside of Canada, for either business or leisure travel, to be evacuated to the nearest place of safety in the event of a hostile or dangerous situation.

Register your itinerary with the Overwatch program and get additional peace of mind that if a travel alert is issued, you will be notified. State-of the-art services allows you to check the situation before, during and after your trip and be monitored and supported anywhere in the world at any moment, with over 200 languages spoken at Drum Cussac's 24/7 crisis response centre.



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Upgrades

OMA Insurance recognizes that doctors sometimes want their coverage to go beyond basic protection and offer more comprehensive coverage that includes enhanced benefits for themselves and their family. For this reason we offer exclusive optional upgrades which, when added to OPIP, go beyond basic coverage to offer added protection.

Your Subsidized Coverage You can purchase these
Upgraded Coverages
Health
Plus
Dental Dental
Plus
Additional
Critical Illness
Health & Critical Illness
(for Critical Illness you must be under 65)
Health -
$350 Health Spending Account (HSA) & Critical Illness
(if opted out of Health, and for Critical Illness you must be under age 65)
-
$500 HSA
(if opted out of Health)
- -




OPIP Simplified

OPIP is designed for you and your family to provide a strong foundation of coverage with subsidized health and critical illness premiums. Here are a few examples that we’ve prepared to help explain some of the coverage and the varying subsidies.

Single Coverage Couple Coverage Family Coverage Health Spending Account

The cost of OPIP is funded through a combination of government subsidy, OPIP reserves and member premiums.


Cost

The actual cost of your OPIP coverage is much higher than your annual contribution and is calculated based on gender, family status, age, and smoking status. The difference between the true cost of OPIP and your annual contribution is paid for in two ways.

Government Subsidy

Physicians Health Benefit Program (PHBP) is a program subsidized by the Ontario government through Ontario Physicians Services Inc. (OPSI), a wholly owned subsidiary of the OMA established solely to administer this government subsidy, to help provide Eligible Physicians with Health insurance (or a Health Spending Account) and Critical Illness insurance.

The percentage of your premium that is subsidized may vary from year to year (at least 70% for 2019) depending on the amount of government funding, the numbers of participants in the plan and the total amount of claims, up to a maximum set in the OPSI agreement.

The subsidized amount may need to be reported as income for tax purposes on your income tax return.

For a more detailed explanation of the tax implications, visit the Tax Considerations page.

OPIP Reserve

Under the supervision of the OMA Insurance Committee, the OPIP Reserve is used to build reserves for future plan stability as well as providing other cost-effective and value-add protection: Legal Expense Insurance and Security Evacuation Coverage.


Optional upgraded coverages are charged at actual cost.

Frequently Asked Questions Regarding OPIP

Top-up Rates

You have three upgrade options to enhance you and your family's protection:

1. OPIP Health Plus

You can top up your health coverage with additional coverage options that can be customized to you and your family’s needs – all in one highly affordable package.

Many members choose to upgrade their health coverage under OPIP to Health Plus which provides higher limits and additional benefits while still benefitting from a subsidized health plan. See a comparison of OPIP Health and OPIP Health Plus.

OPIP Health Plus Top-up Rates
Monthly Plan Costs
Age1 Single Single + 1 Dependent Child Couple Family
< 30 $21.34 $24.69 $41.06 $58.49
30 - 34 $23.55 $27.27 $45.71 $66.38
35 - 39 $26.35 $30.50 $51.62 $75.48
40 - 44 $28.80 $33.33 $56.69 $80.56
45 - 49 $31.68 $36.66 $62.77 $89.46
50 - 54 $35.04 $40.56 $69.87 $99.81
55 - 59 $39.03 $45.17 $78.23 $107.51
60 - 64 $45.68 $52.87 $92.18 $110.18
65 - 69 $45.68 $52.87 $92.18 $110.18
70 - 74 $48.98 $56.69 $99.15 $118.16
75 - 79 $52.32 $60.55 $106.12 $126.13
80 - 84 $55.63 $64.38 $113.10 $134.09
85 - 89 $55.63 $64.38 $113.10 $134.09
90 + $55.63 $64.38 $113.10 $134.09

1 Premium rates are subject to applicable sales tax. Rates are reviewed on an annual basis and are subject to change. Rates are based on option and coverage type selection.

Health Plan Definitions
"Age" means attained age as of Policy Anniversary (Jan 01).
"Single + 1" means you plus one dependent child.
"Couple" means you and your spouse.
"Family" means you plus two or more family members.


2. Critical Illness Top-up

OPIP coverage for members includes a Critical Illness benefit. If approved for a claim, you may receive $50,000 lump sum payment2 after surviving a diagnosis of one of 25 covered serious illnesses.

This coverage is included as part of your basic OPIP coverage.

Upgrading Your Critical Illness Coverage

At time of initial OPIP enrolment, OMA members under age 65 can also purchase an additional $50,000 each for coverage for themselves and their spouse - with no medical evidence required.

Monthly Plan Costs for additional $50,000 of Critical Illness Insurance3
Age Male
Non-Smoker
Female
Non-Smoker
Male
Smoker
Female
Smoker
< 30 $5.08 $4.41 $5.94 $5.32
30 - 34 $7.10 $8.22 $9.46 $11.21
35 - 39 $8.59 $10.33 $12.57 $16.56
40 - 44 $12.57 $14.07 $22.16 $26.64
45 - 49 $21.54 $20.42 $43.70 $42.58
50 - 54 $34.98 $27.27 $80.55 $59.51
55 - 59 $55.40 $36.73 $135.71 $77.56
60 - 64 $91.13 $52.04 $217.88 $99.72
65 - 694 $157.70 $85.18 $334.18 $141.31

2 Based on the current tax laws, the cash benefit from a group critical illness insurance plan will not be taxed when the premiums are paid by you and the benefit is payable to you. Diagnosis of a critical illness must occur after the effective date of coverage and the insured must complete a Survival Period (30 days).

3 Premiums are subject to applicable sales tax. Rates are reviewed on an annual basis and are subject to change. Rates are based on gender, age band and smoking status.

4 Members over age 65 may only be covered for critical illness insurance if they are renewing a current policy.

Critical Illness Definitions
"Age" means attained age as of Policy Anniversary (Jan 01).


3. Dental and Dental Plus Coverage

Members can also purchase dental coverage for themselves and/or their families.

For this benefit, "Couple" means you and one family member and "Family" means you plus two or more family members.

Monthly Plan Costs5
Dental Dental Plus
Single $45.61 $70.70
Couple $91.25 $141.44
Family $174.34 $275.45

5 Premiums are subject to applicable sales tax. Rates are reviewed on an annual basis and are subject to change.

To access OPIP without having to answer medical questions, you must enrol within 90 days of your initial OPIP offer. If you do not choose to participate in OPIP within 90 days of receiving your initial offer, you can apply at any time with medical evidence.

If you are an Eligible Physician, the government subsidized Physician Health Benefit Program (PHBP) helps pay the cost of your critical illness insurance and health coverage (or HSA if you opt out of the health coverage) provided through OPIP. You are an Eligible Physician if you are:

  1. A member in good standing of the Ontario Medical Association or, if not a member, have paid all dues and assessments owing under the Ontario Medical Association Dues Act, 1991;
  2. Registered with the College of Physicians and Surgeons of Ontario and have acquired an independent practice license;
  3. Engaged in providing medical services1 in the province of Ontario for at least 15 hours per week on average.
  4. Residing in Canada. Residents of Quebec are eligible if
    • they practise in Ontario;
    • the enrolment/application form is signed in a province or territory other than Quebec; and
    • they agree that the certificate of insurance and all other communications will be delivered in a province or territory other than Quebec.

Newly Eligible Physicians

If you are not currently enroled in OPIP and are a newly practising physician, an
enrolment form will be sent to you. A newly practising physician includes:

  • An OMA member beginning to practise in Ontario
  • A newly graduating resident who has become a practising physician in Ontario

You will be eligible to enrol without medical evidence within 90 days from the date you receive notification of your eligibility. After this date, medical evidence will be required in order to apply.

Physicians Returning to Work

If you were ineligible at the time of initial offer, you may be eligible to enrol for OPIP without medical evidence if you are returning to work from:

  • Parental leave of absence
  • Total disability
  • Residual disability, or
  • Opting out because you moved to another province to practise and have now returned to Ontario

Physicians Not Currently In OPIP ("Late Entrants")

If you did not enrol in OPIP when initially eligible, you may be eligible to apply for OPIP but you will be required to provide medical evidence.

Thinking of retiring? Leaving the province?

Let us know.

If you meet any of the following criteria occur you will no longer qualify for the subsidized portion of OPIP.

  • No longer residing in Canada
  • No longer registered with the College of Physicians and Surgeons of Ontario
  • No longer providing medical services in the province of Ontario for at least 15 hours per week on average; or
  • Absent from practice for more than 18 months due to a parental leave of absence

Continuing Your Coverage

To continue your coverage once you have ceased active practice you must:

  1. have been covered by the program for at least 12 months
  2. provide written notification of your change in eligibility and your intent to continue the coverage within 60 days;
  3. pay the full cost of the plan; and
  4. be under age 70 for the Critical Illness coverage to continue.

If you do not meet criteria a) and b), then your coverage will terminate. If you do not meet d), your health insurance can continue but your Critical Illness insurance will stop at age 70.

With this continuance option you are still eligible for Legal Expense Insurance and Security Evacuation Coverage.

Contact Sun Life at 1.800.758.1641 (Option 2) or info@OMAinsurance.com to ask about the continuance program for OPIP.


1 Medical services include the provision, study and administration of medical care, and include but are not limited to: physicians in medical practice, laboratory physicians, company medical directors, insurance company physicians, OHIP & WSIB physicians, hospital & medical clinic administrators, medical school teachers, medical researchers, and hospital committee work.


OMA Insurance works to streamline the application process as much as possible, reducing the complexity and time required to arrange coverage. Answer the following question to get started.

Have you received your OPIP offer within the last 90 days?

You are eligible to enrol in OPIP without medical evidence within 90 days from the date you receive notification of your eligibility.

Get OPIP in 3 easy steps:

1

Complete your Enrolment Form

No medical evidence is required if you enrol within 90 days of receiving your OPIP offer. Complete the Enrolment Form and send it to OMA Insurance.
2

Received by Administrator

The forms are received by Sun Life, Administrator of the OMA Plan.
3

Receive your Certificates

Once your payment has been received, your Certificate of Insurance will be sent to you.


Enrol Now

If you did not enrol in OPIP when initially eligible, you may be eligible to apply for OPIP but you will be required to provide medical evidence.

Get OPIP in 3 easy steps:

1

Complete your Application Form

Complete a Late Entrant Application which includes medical questions and send it to OMA Insurance.
2

Received by Administrator

Sun Life will review your application and may contact you for further information. Learn more about what you can expect during the underwriting of your application.
3

Receive your Certificates

Once your payment has been received, your Certificate of Insurance will be sent to you.


Apply Now