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OMA Priority Insurance Plan (OPIP) 
            OPIP = PHBP + LEI

The OMA Priority Insurance Program (OPIP) is offered through OMA Insurance for Ontario physicians to conveniently access unique and valued plans created exclusively for them. For an annual contribution of $150 in 2014, eligible members have access to the following benefits:

Physician Health Benefits Program (PHBP)

PHBP, administered by Ontario Physician Services Inc. (OPSI), is a subsidized benefits program negotiated with the Ontario government to provide eligible physicians with affordable health insurance coverage: $50,000 in Critical Illness (CI) insurance, Extended Health Care (EHC) benefits and Health Spending Account credits.

Critical Illness Insurance (CI)

Critical Illness insurance provides for a lump-sum payment thirty days after surviving a diagnosis of one of the covered serious illnesses. This payment can be used as you see fit, intended to provide you with freedom and flexibility in time of need.

  • $50,000 lump sum payment
  • 25 covered conditions
  • Worldwide coverage
  • Coverage to age 70
  • No medical evidence required, subject to eligibility
  • After 12 months in the CI plan, you can maintain your coverage to age 70 even if you are no longer eligible for government subsidization

Extended Health Care (EHC)

This EHC plan provides you and your family with coverage for health-related services that are not covered by OHIP. Working with our insurer, Sun Life, this EHC plan has been customized specifically for Ontario physicians. The coverage provided through PHBP includes:

  • A Pay-Direct drug card that can easily be downloaded from www.sunlife.ca/member. Using this card means that when you visit a participating Ontario pharmacy, the portion of your prescription drugs covered by the EHC will be paid directly to the pharmacist
  • An improved deductible that will:
    • reimburse your eligible expenses 50% upfront, followed by 100% reimbursement after you have claimed $1,000 for yourself, and
    • reimburse your spouse and children’s eligible expenses 50% upfront, followed by 100% reimbursement after they have claimed $1,000 combined
  • Prescription Drug coverage with a $1 million lifetime maximum and a $25,000 annual reinstatement. This means that no matter what, you will always have coverage available for you every year even if you have previously reached the $1 million limit
  • Emergency out of country insurance maximum increased to $2 million
  • Semi-private hospital room
  • Paramedical Services (e.g. massage therapist, licensed psychologists, chiropractors, etc.)
  • Physiotherapists
  • Prosthetic appliances and other Medical Services
  • Hearing Aids

Health Spending Account (HSA)

If you are already covered by an existing Extended Health Care plan elsewhere, you can easily opt-out of the OPIP EHC and receive an HSA that offers flexible credits to get the health services that are important to you and your family. Any expense permitted by the Revenue Canada Agency as a deductible medical expense can be reimbursed through a HSA, including some insurance premiums, vision and dental expenses, deductibles paid under most EHC plans, and other medical needs.

Legal Expense Insurance (LEI)

Recently introduced to the Canadian marketplace, LEI provides OPIP members (as well as their spouses and children living at home) with convenient access to professional legal advice and representation. Provided through DAS Canada, the OPIP LEI provides members with practical advice and peace of mind. Your DASlive&drive plan includes access to free legal telephone advice and will also pay the legal fees from a variety of unexpected life events such as:

  • Contract disputes whereby a vendor or manufacturer refuses to repair a faulty product
  • A dispute with a neighbour who without permission had cut down a common hedge or is causing a nuisance
  • Pursuing a bodily injury claim resulting from a trip and fall in a store due to broken floor tiles
  • Defending highway traffic violations (e.g. speeding tickets).
  • Inappropriate severance if a spouse’s or at-home child’s employment is terminated
Published on: 4/28/2010 12:26 PM
Printed on: 04/18/2014 07:17 PM
Dedicated to Doctors, Committed to Patients