Can You Combine OHIP + Private Coverage? What Every Ontario Patient Should Know

Introduction: Why Pay Twice When You Can Coordinate Your Coverage?

In Ontario, we’re lucky to have OHIP — a publicly funded system that covers medical doctor visits, hospitals, and emergency care.

But for services like massage therapy, chiropractic care, physiotherapy, acupuncture, and mental health, most patients rely on private insurance — or worse, pay out of pocket.

The good news? In many cases, you can combine OHIP and private insurance to maximize what’s covered and minimize what you pay — if you know how.

🔍 What OHIP Covers — and What It Doesn’t

Let’s clarify some common myths:

Service	Covered by OHIP?	Notes
Family doctor visits	✅ Yes	Must be a registered Ontario doctor
Chiropractic	✅ Partial	Only X-rays and initial assessment for low-income seniors
Physiotherapy	✅ For eligible groups	Seniors, youth under 19, and people on ODSP/OW
Massage Therapy	❌ Not covered	Only private plans or out-of-pocket
Acupuncture	❌ Not covered	Private insurance only
Mental Health (Psychologist)	❌ Rarely	OHIP covers psychiatry only

💡 So if you’re getting hands-on care (RMT, chiro, physio, etc.) — it’s your private plan that kicks in.

✅ How Private Coverage Fills the Gaps

Your extended health benefits through work (or an individual plan) usually cover:

• $300–$1,200 annually for each service
• 80%–100% reimbursement depending on your plan
• Direct billing through platforms like Telus eClaims or ProviderConnect

That means:

• OHIP might cover part of an assessment, and
• Private coverage pays for your actual treatments

💡 Example:

Your physio consult is $120

• OHIP pays $25 (at select clinics)
• Private plan pays 80% of the remainder
• You pay the rest — only a small co-pay

🔁 Can You Combine OHIP + Private Plans? Yes — But With These Rules

To avoid overbilling or denial:

1. ✅ Use an OHIP-eligible provider first
   • Ask if they are a government-funded clinic
     
2. ✅ Request a clear receipt showing OHIP-paid portion
   • Your private insurer will want to know what OHIP covered
     
3. ✅ Submit the difference to your insurer as a “secondary claim”
   • Some insurers (Manulife, Canada Life) support split billing

🧠 Pro Tip: You must disclose that OHIP was used. Submitting the full bill to your insurer without deduction is insurance fraud — even if accidental.

🛑 Common Mistakes to Avoid

• ❌ Submitting a full invoice to private insurance when OHIP paid part
• ❌ Using an OHIP clinic that doesn’t issue proper receipts
• ❌ Not checking if your physio or chiro is eligible for OHIP + private blend
• ❌ Booking at a public hospital clinic and assuming it’s claimable privately (it usually isn’t)

✅ When You Can’t Combine OHIP + Insurance

• Most massage therapy clinics are 100% private
• Same with acupuncture and cupping
• If a public service is fully covered, your insurer won’t pay again

🧾 But in cases where OHIP pays partially, and your insurance covers the rest — you’re winning.

📣 Make Your Coverage Work Harder — Not You

Here’s how to make sure you’re never paying more than you should:

✅ Check your OHIP eligibility (age, income, referral needed)
✅ Ask your private plan about secondary submission after public coverage
✅ Use clinics that understand both billing systems — or better yet…

💬 Ask Ruby at insurance.rmtclinic.online to walk you through your plan.

🔗 Take Action Now

✅ Find para-medical clinics near you that accept insurance → RMTClinic.net
✅ Ask Ruby if your plan can combine with OHIP → insurance.rmtclinic.online
✅ Book before your plan resets on Dec 31 → RMTClinic.net/insurance