OHIP eligibility for newborns

"Receiving a health card at birth is crucial for protecting the health of our youngest Ontarians. Not providing OHIP to eligible babies in a timely way can lead to delayed care, high costs for families and potentially adverse health outcomes for these children." - Wellesley Institute

An infant is eligible for the Ontario Health Insurance Plan (OHIP) if they:

  • are born in Ontario, 

  • have at least one parent/custodian who is a resident of Ontario and 

  • will be staying in the province for 153 days in the following year. 

The parent/custodian does NOT need to have permanent resident immigration status in Canada for their baby to be eligible for OHIP, but they need to live primarily in Ontario. In the six weeks of postpartum midwifery care, clients in precarious situations may not be able to predict where they may be in six months or at one year. It is up to the parents to maintain the child's OHIP and show primary residence beyond this time.

For newborns who meet all three requirements above, midwives can provide the parent/custodian the Ontario Health Coverage Infant Registration. The three-month OHIP wait period does not apply to infants. 

Families are not required to provide proof of residency at the hospital where a newborn was delivered. However, OHIP may require documentation that contains an Ontario address (such as housing, employment, banking, or educational documents) to determine residency. 

If in doubt, you can write a letter confirming the birth and leave the determination of eligibility to OHIP. Midwives that observe clients regularly facing barriers in their hospital may meet with hospital administrators to evaluate admissions and billing forms to advocate for consistent processes. If your client requires more information, you can refer them to Service Ontario. 

The Health Network for Uninsured Clients at the Wellesley Institute has developed tools for care providers and hospital staff responsible for issuing the Ontario Health Coverage Infant Registration including:

  • Guide for Hospital Staff regarding OHIP registration for newborns of uninsured parents. 
  • Guide to Implementing Change at Your Hospital with practical, step-by-step suggestions and success stories from midwives.
  • Sample Advocacy Letter template that can be used as a starting point for engaging with stakeholders at your hospital.
  • Sample slide deck to use during meetings or rounds on your unit, complete with presentation scripts and prompts for customization.
  • Service Ontario Infant Registration Program Manual for Birthing Hospitals 
  • Quick Reference Card outlining OHIP eligibility criteria. They recommend printing copies to keep at administrative stations within birthing, postpartum and neonatal units.
  • Has your client experienced a denial for their newborns OHIP? Consider completing this quick HNUC reporting form that should take less than 1 minute long! HNUC is gathering this information to learn more about what is happening in our communities, with the goal of reducing barriers to newborn care