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.
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).
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.
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).
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 email@example.com.
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.
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.
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.
The cost of OPIP is funded through a combination of government subsidy, OPIP reserves and member premiums.
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.
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.
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.
You have three upgrade options to enhance you and your family's protection:
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.
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.
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.
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.
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.
Critical Illness Definitions
"Age" means attained age as of Policy Anniversary (Jan 01).
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.
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:
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:
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.
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:
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.
Let us know.
If you meet any of the following criteria occur you will no longer qualify for the subsidized portion of OPIP.
Continuing Your Coverage
To continue your coverage once you have ceased active practice you must:
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: