OHIP pays for medically necessary care — appointments, examinations, most bloodwork and imaging ordered by your doctor, referrals to specialists, and the vast majority of what happens in a family practice. It does not pay for anything that is not medically necessary or is requested by a third party: sick notes and forms for employers, insurance and travel medicals, most vaccines for travel, cosmetic procedures, prescription drugs outside the public programs, dental, eye exams for most adults, physiotherapy, massage, and missed appointments. Clinics are permitted to charge for these uninsured services, and they are required to tell you the price before you agree. Nothing a clinic charges you should ever be for something OHIP already covers — that is not allowed.
The confusion is understandable. The same doctor, in the same room, on the same day, can give you something free and something you pay for.
What OHIP covers at a family clinic
| Covered | Notes |
|---|---|
| Office appointments for a medical problem | Any number of them, as medically needed |
| Annual or periodic health visits | Scope varies by age and risk |
| Diagnosis, examination and treatment | Including minor procedures like stitches and abscess drainage |
| Bloodwork and lab tests ordered by your doctor | At community labs, by requisition |
| X-rays, ultrasounds, CT and MRI when medically indicated | Ordered by requisition |
| ECGs | When clinically indicated |
| Referrals to specialists | The specialist visit is covered too |
| Prenatal and postnatal care | |
| Pap tests, breast and colon cancer screening | Within program guidelines |
| Childhood immunisations on the publicly funded schedule | |
| Flu shots, and other publicly funded vaccines | |
| Chronic disease management — diabetes, blood pressure, asthma | |
| Mental health assessment and treatment by your physician | |
| Prescriptions being written | The medication itself is separate |
| Family planning, contraception counselling, IUD insertion visits | The device may be a separate cost |
| Diabetes-related foot checks and most wound care |
You must have a valid Ontario health card. Expired cards are the most common reason a covered visit suddenly becomes a bill.
What OHIP does not cover
Notes, forms and documentation
This is the largest single category of fees in any family practice, and the most resented.
- Sick notes for an employer or school
- Return-to-work and fitness-to-work letters
- Insurance forms, short- and long-term disability forms
- Gym, camp, sports and daycare medical forms
- Driver’s licence and commercial driving medicals
- Pre-employment medicals
- Immigration medicals
- Letters for housing, travel, courts, airlines or pet accommodation
- Transfer of records
- Forms for private insurers, employers or lawyers of any kind
Why: OHIP pays doctors to treat patients, not to produce documents for third parties. The employer or insurer asking for the form is who benefits, but the patient is usually who gets billed.
Travel health
- Travel consultations
- Travel vaccines — yellow fever, typhoid, rabies, hepatitis A and B in most cases
- Malaria prescriptions and advice
- Yellow fever certificates
- Traveller’s diarrhoea kits
Cosmetic and elective
- Cosmetic procedures and injectables
- Removing skin tags, benign moles and lesions for appearance rather than medical reasons
- Ear piercing, tattoo removal
- Non-medical circumcision in many cases
Other common uninsured items
| Item | Who pays |
|---|---|
| Prescription medication | You, your private plan, or a public drug program |
| Dental care | You or your plan |
| Eye exams for most adults aged 20–64 | You — covered for children, seniors, and certain medical conditions |
| Physiotherapy, chiropractic, massage, psychotherapy by a non-physician | You or your plan, with some publicly funded exceptions |
| Ambulance | A co-payment, waived in some circumstances |
| Crutches, braces, equipment | You, with some programs available |
| Telephone or email advice outside an insured visit | Varies by clinic |
| Missed appointments and late cancellations | You |
| Copies of your own records | Cost-recovery fee |
Block fees
Some Ontario practices offer an annual block fee — a single yearly amount that covers a bundle of uninsured services instead of paying per item.
The rules:
- It must be entirely optional. No clinic may require a block fee as a condition of being a patient or of receiving insured care.
- You must be given a written list of exactly what it includes.
- It cannot include anything OHIP already covers.
- Refusing it cannot affect the care you receive.
Whether it is worth it depends on you. A healthy adult who needs one sick note every three years should pay per item. A family that needs camp forms, school forms and multiple notes each year often comes out ahead.
Fee rules every patient should know
- You must be told the price in advance. Fees for uninsured services must be disclosed before the service is provided, and most clinics post a list.
- You cannot be charged for insured care. If a clinic bills you for a regular appointment while you hold a valid health card, that is not permitted.
- You cannot be charged for faster access to insured care. Paying to jump a queue for something OHIP covers is prohibited.
- Insured and uninsured can happen in one visit. Your doctor treats your chest infection — covered. You then ask for a sick note — not covered. Both are legitimate.
- You can ask what is covered before agreeing. Always a fair question.
- If you think you were wrongly billed, raise it with the clinic manager first; if unresolved, the Ministry of Health and the CPSO both accept inquiries.
How to pay less
- Do not ask for a sick note you do not need. Many Ontario employers cannot require one for short absences — check your workplace policy first.
- Bundle your forms. Bring everything needing a signature to one appointment rather than five.
- Ask your insurer whether they accept a simpler letter than the long form.
- Check whether your benefits plan reimburses form fees. Many do.
- Keep your health card valid. Set a renewal reminder.
- Use public drug programs if eligible — ODB, OHIP+ for those under 25 without private coverage, the Trillium Drug Program for high drug costs relative to income.
- Ask the pharmacist about minor ailments they can assess, and about generic alternatives.
- Cancel appointments with proper notice to avoid no-show fees.
- Ask whether a block fee would save you money, if your family needs forms regularly.
If you do not have OHIP coverage
| Situation | Where you stand |
|---|---|
| New to Ontario | Apply for OHIP as soon as you arrive; coverage may begin after a waiting period, so interim private insurance is worth having |
| Waiting out a period before coverage starts | Visits are paid out of pocket; ask the clinic for its uninsured visit rate upfront |
| Newcomer, refugee claimant or protected person | The Interim Federal Health Program may cover you |
| International student | Usually covered by a mandatory university or college plan — check what it includes |
| Visitor or temporary worker | Travel or employer insurance, or self-pay |
| Card lost or expired | Renew immediately; the clinic may bill you and reimburse once you provide a valid card, depending on their policy |
Do not avoid care because you lack a card. Ask the clinic what a visit costs — it is usually far less than an uninsured emergency department visit, which can be very expensive.
FAQ
Why am I being charged for a note when the appointment was free?
The appointment treated your illness, which OHIP pays for. The note is a document for your employer, which OHIP does not pay for. They are two different services.
Is it legal for my doctor to charge me?
For genuinely uninsured services, yes — and the price must be disclosed in advance. For insured services while you hold a valid health card, no.
Do I have to pay a block fee?
Never. It must be optional, and declining it cannot affect your care.
Is my annual physical covered?
Periodic health visits are covered, though their recommended frequency and content depend on your age and health. Extras requested for non-medical reasons — an employer’s medical form, for example — are not.
Are vaccines free?
Those on Ontario’s publicly funded schedule are, including childhood immunisations and the flu shot. Travel and most occupational vaccines are not.
Is virtual care covered?
Many virtual visits with your own doctor are covered under current rules. Coverage for virtual care has changed several times, so ask your clinic how it applies now.
Can I claim fees on my taxes?
Many uninsured medical expenses qualify for the medical expense tax credit. Keep your receipts and ask your tax preparer.
Our fees
Milton Health Centre posts its uninsured service fees and will always tell you the cost before providing one. If you are unsure whether something is covered, ask at reception — you will never be charged for care OHIP pays for. See Milton Health Centre for services and new patient registration.
Related reading
- How to Find a Family Doctor in Milton, Ontario: A Complete Guide for New Patients
- Do You Need an OHIP Card to Book Your First Appointment?
- How Specialist Referrals Work in Ontario, Step by Step
- What to Bring to Your First Appointment With a New Family Doctor
This article provides general health information for Ontario residents and is not medical or financial advice. OHIP coverage, fees and drug program eligibility change. For what applies to you, speak with your clinic or contact the Ministry of Health. For health advice at any hour, call Health811 at 811.