Uninsured Clients FAQ

Who is Eligible for the Uninsured Midwifery Funding?

There are people who do not have OHIP who would be eligible for uninsured midwifery funding because they are residents of Ontario. Most often these individuals live, work and pay taxes in Ontario and as a result are residents of Ontario who are eligible for the uninsured midwifery funding. This may include migrant workers, undocumented individuals, people experiencing precarious housing or significant mental health issues who may have difficulty obtaining or maintaining a health card. Old Order Mennonites/Amish communities are eligible for OHIP, but may choose not to access OHIP for religious reasons. In these cases they are eligible for the uninsured midwifery funding however, they may also choose not to access this funding and pay out-of-pocket instead. 

Who is NOT Eligible for the Uninsured Midwifery Funding?

Obstetrical tourists and visitors with the intention of coming to Canada only to deliver their babies and then leaving are not residents and are not eligible for this funding. Persons with existing private health insurance that covers pregnancy care are also not eligible for uninsured midwifery funding.

Are Refugees Eligible for the Uninsured Midwifery Funding?

Some people who are undocumented/without status may be eligible to apply for refugee status. Once a person has made a refugee claim, they will be given an Interim Federal Health Program (IFHP) card which qualifies them for health care while their claim is being processed, meaning they would not typically require using the uninsured midwifery funding program however, they may still face some barriers to accessing care. The IFHP provides limited, temporary coverage of health-care benefits to people in the following groups who are not eligible for provincial or territorial health insurance including:

• protected persons such as resettled refugees;
• refugee claimants; and
• other groups (see here for a list of IFHP eligible groups) 

Refer to the Claiming Refugee Protection page for information on applying for refugee status.

Midwives can refer to Information for Healthcare Professionals in Canada regarding the IFHP.

Are People from Other Canadian Provinces and Territories Eligible for the Uninsured Midwifery Funding?

If a person moved from another Canadian province or territory to Ontario but did not previously have provincial or territorial health insurance coverage (e.g. they were undocumented), then they would be eligible for this funding as long as they meet residency requirements. 

For Canadians with a provincial/territorial health insurance coverage who are not Ontario residents, most provinces and territories have existing reciprocal billing agreements (except Quebec) that allow persons with a provincial/territorial health card to receive treatment without paying upfront for medically necessary clinic visits and public hospital care. ​​​​​​Healthcare providers can bill a persons home province/territory directly. These individuals should not be accessing Ontario uninsured midwifery funding because they are insured. In certain cases, including for people with Quebec health cards, individuals may be asked to pay up front and seek reimbursement from their provincial/territorial insurance plan. However, medically necessary care cannot be denied if the person is unable to pay up front. More information regarding health coverage for people moving between Canadian provinces/territories can be found here.

What reciprocal billing covers out of province or territory:

• Physician services (walk-in clinics, specialists); and

• Medically necessary services at publicly funded hospitals

What it does NOT cover out of province or territory:

• Ambulance and paramedic transport;

• Prescription drugs outside a hospital;

• Dental, vision, and paramedical services;

• Private clinics or diagnostic facilities; and

• Services your home province/territory does not cover (e.g., cosmetic procedures)

Source: Canada Health Act — Health Canada

Which Services are Covered?

Only services that are covered by OHIP and directly related to pregnancy are covered. The funding is tied to the OHIP Schedule of Benefits.

Services that are funded include:

• Referrals, consultation, transfer with obstetrician-gynecologist in prenatal, intrapartum, and/or postpartum periods;
• Referrals, consultation with anesthesiologists in prenatal, intrapartum and/or postpartum periods;
• Costs associated with a surgical assist;
• Referrals to specialist physicians (e.g., pediatrics/neonatalogy, endocrinology, hematology, urology, cardiology);
• Lab work (e.g., routine prenatal blood work, glucose testing, GBS testing);
• Prenatal genetic testing (IPS/FTS);
• Ultrasound

Which Services are NOT Covered?

Not all aspects of care are funded under the uninsured midwifery funding program. Uninsured midwifery clients will typically be required to pay out-of-pocket for:

• Hospital and facility fees including drugs and supplies.These are sometimes called administrative fees or triage fees;
• Any prescription drug not directly administered by the care provider as well as over-the-counter medications;
• Supplemental supplies (i.e. those not directly used by the care provider); and
• Supplies or tests that are not eligible under OHIP (e.g., 3D ultrasound) 

These aspects of care not covered under the midwifery uninsured program. If you are unable to pay out-of-pocket, speak with your midwife for help with asking hospital administration or finance department for a manageable payment plan. 

What Happens if an Uninsured Midwifery Client's Immigration Status Changes During their Care?

Immigration status for those with a visa or in the process of refugee claims may change. During the course of care, a client may go from having legal status in Ontario to losing their status and becoming uninsured or undocumented. They also may be granted an OHIP card and no longer be uninsured. If a client obtains health insurance while in midwifery care, they are no longer eligible for uninsured midwifery funding.

Client Resources

• This client handout provides information to Ontario residents on uninsured midwifery care