OMA Priority Insurance Program (OPIP)
Learn about OPIP, created just for OMA members.
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.
What’s included in the OMA Priority Insurance Program?
Prescription drugs, hospitalization, paramedical services, assistive devices and more.
$2-million emergency out-of-country travel coverage.
A Health Spending Account is available to those members who opt out of health insurance if they have health coverage elsewhere.
If you wish to upgrade your coverage at additional cost, Health Plus and Dental coverage is also available.
|Critical Illness benefit||
Tax-free lump sum payment1 of $50,000 after 30 days of surviving a diagnosis of one of 25 covered serious illnesses.
Members under age 65 can also purchase an additional $50,000 each for coverage for themselves and their spouse.
|Legal Expense Insurance||
Protects you, your spouse and children living at home from unexpected legal issues and costs.
Unlimited access to a Legal Helpline.
|Security Evacuation coverage||
Evacuation to the nearest place of safety in the event of a hostile or dangerous situation.
Expenses for such evacuation up to a maximum of $100,000 per trip outside of Canada.
Cancellation and trip delay coverage, payments for lost baggage or passports and for loss of personal property when travelling outside of Canada.
OMA Insurance recognizes 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 that, when added to OPIP, go beyond basic coverage to offer more protection.
To access OPIP without having to answer medical questions, you must enrol within 90 days (about three months) 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:
A member in good standing of the Ontario Medical Association or, if not a member, have paid all dues and assessments owed under the Ontario Medical Association Dues Act, 1991
Registered with the College of Physicians and Surgeons of Ontario and have acquired an independent practice license
Actively engaged in providing medical services2 in the province of Ontario for at least 15 hours per week on average and is remunerated by the Ministry through OHIP, including Alternate Payment Plans and/or Alternate Funding Plans; or by an employer for providing insured clinical services
Residing in Canada. Residents of Quebec are eligible if they practice 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
If you are not currently enrolled in OPIP and are a newly practicing physician, an enrolment form will be sent to you. A newly practicing physician includes:
An OMA member beginning to practice in Ontario
A newly graduating resident who has become a practicing physician in Ontario
You will be eligible to enrol without medical evidence within 90 days (about three months) from the date you receive notification of your eligibility. After this date, medical evidence will be required to apply.
If you were ineligible at the time of the initial offer, you may be eligible to enrol for OPIP without medical evidence if you are returning to work from:
Parental leave of absence
Opting out because you moved to another province to practice and have now returned to Ontario
If 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 due to reasons other than total disability
Absent from practice for more than 18 months (about one and a half years) due to a parental leave of absence
To continue your coverage once you have ceased active practice, you must:
Have been covered by the program for at least 12 months
Provide written notification of your change in eligibility and your intent to continue the coverage within 60 days (about two months)
Pay the full cost of the plan
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.
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 sex at birth, family status, age, and smoking status. The difference between the actual cost of OPIP and your annual contribution is paid for in two ways: government subsidy and OPIP reserve.
The Physician 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 depending on the amount of government funding, the number 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 OPIP tax considerations page.
Under the supervision of the OMA Insurance Committee, the OPIP reserve is used to build reserves for future stability as well as providing other cost-effective and value-added protection: Legal Expense Insurance and Security Evacuation coverage.
Frequently asked questions
If you are currently enrolled in OPIP, and you do not work the minimum 15 hours per week on average required because you are on parental leave, your OPIP subsidy may be extended up to 18 months from the date your parental leave commences. Email us for details.
If you are currently enrolled in OPIP, and you do not work the minimum 15 hours per week on average required because you are disabled and receiving disability benefits from an insurer or through Canada Pension Plan disability program, your OPIP subsidy may be extended until such time as you are no longer disabled. Email us for details.
Need advice? Our expert insurance advisors are here to help.
How much will it cost?
1 Based 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).
2 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 and WSIB (Workplace Safety and Insurance Board) physicians, hospital and medical clinic administrators, medical schoolteachers, medical researchers and hospital committee work.
OMA Priority Insurance Program is underwritten by Sun Life Assurance Company of Canada. Sun Life Assurance Company of Canada is the insurer of this product and is a member of the Sun Life group of companies. For inquiries, please call Sun Life’s Client Care Centre at 1-800-758-1641, Monday to Friday, 8 a.m. to 8 p.m. ET. or visit www.sunlife.ca.
For complete details regarding coverage, please see the terms and conditions of Policies 50130 and 50131. If there is any conflict between this document and the wording of the policies (or the certificate), the wording of the policies will govern. A copy of the policy may be requested.
Premium rates and discounts are not guaranteed and are subject to change upon notice.
Exclusions and limitations may apply.