OHIP Physiotherapy Services

Ontario Health Insurance Plan (OHIP) Funded Physiotherapy Services

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pt Health offers OHIP covered physiotherapy services in the following areas:

What Is Covered by OHIP

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The Ontario Health Insurance Plan (OHIP) covers the cost of in-clinic physiotherapy services for youth, seniors, and other patients that are recovering from illness, surgery or injury. The number of treatments you can receive is determined by your physiotherapist and is referred to as an Episode of Care.

What is Not Covered by OHIP

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OHIP does not cover physiotherapy treatment for an injury that is also being covered by another source (i.e. worker’s compensation or motor vehicle accident benefits). OHIP funded physiotherapy also does not cover the cost of:

  • Group exercise classes
  • Falls prevention classes
  • Treatment to maintain an existing level of function
  • The cost of equipment or supplies needed for home use
  • Physiotherapy treatment, at the same time, for an injury that is funded by another source (i.e. worker’s compensation, CCAC, motor vehicle accident benefits or private health insurance plans.)

Who is Eligible for OHIP Funded Physiotherapy

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You may be eligible for OHIP funded physiotherapy if you have a referral from a doctor or nurse practitioner, have a valid health card and meet one of the following requirements:

  • Age 65 or over
  • Age 19 or younger
  • Discharged from an overnight hospital stay for the same condition you’re seeking treatment for (with a referral from the hospital doctor within the last 12 months)
  • On Ontario Disability Support Program (ODSP) or Ontario Works (OW)
  • A refugee, on ODSP or OW (without a health card)

How Does OHIP Funded Physiotherapy Work?

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Each OHIP funded clinic is given a set number of Episodes of Care they can perform each year from April 1st to the next March 31st. The clinic must not go over this government set limit and will manage their schedule accordingly taking into account the severity or acuteness of each referral.

Accessing OHIP Funded Physiotherapy

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Many pt Health clinics across Ontario offer OHIP funded physiotherapy services. If you meet the above criteria, and have a referral, contact a pt Health clinic near you. Remember that your referral may only be used at one clinic.

When Will You Be Discharged from Physiotherapy?

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Discharge from an OHIP funded Episode of Care will occur:

  • Once the therapeutic goals outlined in your treatment plan have been reached, or
  • When improvements could be achieved through self-care or through an exercise, falls prevention or similar program, or
  • When no further gains are likely to be achieved from continuing physiotherapy

Common Questions

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The number, frequency and duration of visits offered during each episode of care must be necessary and reasonable for the treatment of your condition. Your Physiotherapist will use their clinical judgement and evidence-based best practices to make that decision. Keep in mind, this program does not cover services aimed to maintain an existing level of function. A referral from a physician or nurse practitioner is required for each episode of care.

If you are not covered for physiotherapy as a result of a car accident or work injury AND you fit the eligibility criteria, you may qualify for this type of funding. However, keep in mind this funding is limited and for treatment of a specific injury or condition. Your Physiotherapist will recommend the best plan for you. If there is a wait list to get assessed, you are welcome to use private funding to obtain treatment earlier.

At discharge, your Physiotherapist will provide you with information on self-management and local programs including exercise, falls prevention, activation, or similar programs, as appropriate. They will also send a discharge report to your doctor or nurse practitioner.

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