OPIP is designed to provide you and your family with unique protection solutions including Health and Critical Illness insurance, Legal Expense Insurance and Security Evacuation Coverage. If you are an Eligible Physician (see Eligibility tab), OPIP's strong foundation of coverage is available to you for an annual contribution of only $350. You can also top up with additional self-funded coverage options that can be customized to your needs – all in one highly affordable package.
The OMA Priority Insurance Program (OPIP) was designed to ensure that Ontario physicians have access to the type of benefits that many Ontarians receive as part of an employee benefits program.
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 OPIP Subsidy tab.) as well as Legal Expense Insurance (LEI), and Security Evacuation Coverage (SEC).
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 Extended Health Care coverage, 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).
OPIP coverage also includes a Critical Illness benefit of up to $50,000 lump sum payment,1 if, after the effective date, you are diagnosed with or have surgery for one of the 25 covered conditions.
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 Life 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.
Members can also upgrade their coverage with Optional Self-Funded (OSF) benefits such as Dental Care.
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 for an annual contribution of $350.
Here are a few examples that we’ve prepared to help explain some of the various coverages and subsidies.
As an Eligible Physician, your annual contribution to OPIP is only $350, plus the cost of whatever optional self-funded coverages (OSF) you may have selected.
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.
PHBP is included in OPIP and, if you are an Eligible Physician, a portion of your OPIP contribution is designated toward PHBP. $50 of your annual contribution is collected at the direction of OPSI to help pay for your PHBP benefits. The balance of your PHBP premium (that is, all but $50) is paid through the government subsidy, up to a maximum set in the OPSI agreement. The government-funded amount may need to be reported as income for tax purposes on your income tax return.
Under the supervision of the OMA Board Insurance Committee, the OPIP Reserve provides for LEI and SEC coverages and accumulates funds for future use. If the PHBP government subsidy maximum (set in the OPSI agreement) is exceeded, the OPIP Reserve will also contribute to paying for PHBP.
For both Eligible and Non-Eligible Physicians optional self-funded coverages (OSF) are charged at actual cost.
All members and their families who participate in OPIP are covered for health benefits as part of this bundle of benefits.
The level of coverage (single, single +1 dependent child, couple, or family) varies according to your family situation but the cost to each member is an annual contribution of only $350 per year. That’s because of the subsidy OMA negotiated on your behalf with the government.
What is the subsidized amount?
The real cost of just the Health benefit portion of OPIP can range between $435 and $14,000 per year, depending on your age and whether you choose single, single + 1, couple or family coverage. Visit the OPIP Subsidy tab to calculate the approximate amount of your subsidy.
Final year-end actual costs are provided to members in the annual Premium Summary Statement that is sent to all OPIP participants. Learn more about the tax considerations of OPIP.
You can top up your health coverage with additional self-funded 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 of up to $50,000 lump sum payment2 after surviving a diagnosis of one of
25 covered serious illnesses.
This coverage is included in your $350 annual contribution.
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.
Changes in Your Life Requiring Notice
Please remember that once you are enroled in the program you must notify the program administrator, Sun Life, if you are:
Subsidy through Physician Health Benefit Program (PHBP)
If you no longer qualify for government subsidization you may be permitted to continue your coverage (with the exception of the Health Spending Account) on a non-subsidized basis. You are required to notify the program administrator to obtain approval to continue coverage on a premium paying basis, or to discontinue your participation in OPIP.
If at a later date you meet the basic eligibility requirements and have continued paying the premiums so that your coverage was maintained consistently, you may become eligible to re-apply for government subsidization.
Contact the program administrator at 1.800.758.1641 or info@OMAinsurance.com.
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: