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OMA Priority Insurance Program (OPIP)

A doctor holds out a clipboard and pen to a patient

A ministry-subsidized health plan created just for OMA members.

OPIP gives physicians access to the type of benefits many Ontarians receive as part of an employee benefits program.

Learn about OPIP, created just for OMA members.

OPIP is a ministry-subsidized health plan designed for Ontario physicians that provides you and your family with unique protection solutions. Eligible members can enrol at a reduced rate.

What’s included in OPIP?

Coverage

Plan features
Health

Prescription drugs, hospitalization, paramedical services, assistive devices and more. 

$2-million emergency out-of-country travel coverage1.

A Health Care Spending Account is available if you opt out of Health insurance because you have other health coverage, or are covered under your spouse’s health plan. A benefit of enroling in the Health Care Spending Account is that if you lose your other health coverage, you can switch to Health insurance within 90 days without medical evidence.

If you wish to upgrade your coverage at additional cost, Health Plus and Dental coverage is also available.

Learn more about Health and Health Plus.
Critical Illness benefit

Tax-free lump sum payment2 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.

Learn more about the OPIP Critical Illness benefit.
Legal Expense Insurance

Protects you, your spouse and children living at home from unexpected legal issues and costs.

Unlimited access to a Legal Helpline.

Read about OPIP Legal Expense Insurance.
Optional upgrades

OMA Insurance offers optional upgrades for OPIP that go beyond basic coverage to provide added protection and extra benefits for you and your family. 

View the optional upgrades.

Eligibility

To access the ministry-subsidized health plan through OPIP without medical questions, you must enrol within 90 days of your initial OPIP offer. If you choose not to enrol within 90 days of receiving your initial offer, you can apply at any time with medical evidence.

If you are an eligible physician, OPIP subsidizes the cost of your Critical Illness insurance and Health coverage (or HCSA if you opt out of the Health coverage).

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

  • Licensed with the College of Physicians and Surgeons of Ontario to practice medicine in Ontario

  • Actively engaged in providing medical services3 in the province of Ontario for at least 15 hours per week on average and remunerated by the Ministry through OHIP, including Alternate Payment Plans and/or Alternate Funding Plans; or by an employer for providing insured clinical services

  • A Canadian resident who has submitted the application in a province or territory other than Quebec, and not a resident of Quebec at the time the application is submitted.

If you are not currently enroled in OPIP and are a newly practicing physician, an enrolment offer 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 from the date you receive your initial offer. After this date, medical evidence will be required to apply.

Enrol now

  • If you did not enrol in OPIP when initially eligible, you may be eligible to apply with medical evidence.
  • 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
    • Total disability
    • Residual disability
    • Having opted out because you moved to another province to practice and have now returned to Ontario

Apply now for OPIP

You must maintain eligibility for the ministry subsidy and notify OMA Insurance if your status changes. You may also be required to complete an annual attestation to confirm your continued eligibility. If any of the following occurs, you will no longer qualify for the subsidy:

  • No longer residing in Canada

  • No longer licensed 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 due to reasons other than total disability

  • Absent from practice for more than 18 months due to a parental leave of absence

Continuing 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 non-subsidized cost of the plan

  4. Be under age 70 for the Critical Illness coverage

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

Under Continuance, you are still eligible for Legal Expense Insurance.

Health Care Spending Account coverage is not available for Continuance and automatically terminates once the ministry subsidy ends.

Learn more or contact Manulife at 1-888-596-8881 to ask about the Continuance program for OPIP.

Affordability

OPIP is funded through a combination of the ministry subsidy, OPIP reserves and member premiums.

The actual cost of your OPIP coverage is higher than your premiums, which are calculated based on sex at birth, family status, age, and smoking status. The difference between the actual cost of OPIP and your premiums is covered by a combination of the ministry subsidy and OPIP reserves.

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 subsidy, to help provide eligible physicians with Health Insurance (or a Health Care 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.

Frequently asked questions

If you are currently enroled in OPIP and are on parental leave, your subsidy may be extended for up to 18 months from the start of your leave, even if you are not meeting the minimum average of 15 hours per week on average.

If you are currently enroled in OPIP and are not meeting the minimum average of 15 hours per week on average due to a disability, and you are receiving disability benefits through an insurer or the Canada Pension Plan, your OPIP subsidy may be extended for as long as you are considered disabled.

Emergency out of province/country travel medical coverage is only available with Health/Health Plus insurance.

Need advice? Our expert insurance advisors are here to help.

How much will it cost?

Get a quote and apply
Important forms and resources
Forms
OPIP Infographic
Submit a Health and Dental claim
Critical Illness Insurance sample certificate
Health, Health Plus & HCSA sample certificate

1 Emergency out of province/country travel medical coverage is only available with Health/Health Plus insurance.

2 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).

3 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 physicians, insurance company physicians, OHIP and WSIB (Workplace Safety and Insurance Board) physicians, physicians employed by the Federal or Provincial governments or Academic Institutions, hospital and medical clinic administrators, medical schoolteachers, medical researchers and hospital committee work.

This plan is underwritten by The Manufacturers Life Insurance Company (Manulife)
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