Ontario Disability Support Program health and disability benefits

Overview

ODSP provides many health benefits and disability-related benefits. These benefits can help you with many different types of costs, including health, dental, vision, assistive devices, and other expenses related to disability or medical conditions.

If you need to apply for ODSP, you can find out if you are eligible and how to apply.

Prescription drug coverage

If you receive ODSP income support, you and your family will get coverage for prescription drugs that are both:

• listed in the Ontario Drug Benefit Formulary
• prescribed by an approved health care professional

Going to the pharmacy

You can use your benefits by showing your:

• Ontario health card
• valid driver’s licence
• Ontario photo identification card
• passport
• monthly ODSP statement of assistance

Co-payment fee

Some pharmacists may ask you to pay a fee (co-payment) of up to $2 per prescription if you are 25 or older.

Drugs not listed in the Ontario Drug Benefit Formulary

Your doctor can ask the Ministry of Health to cover the cost of the prescription drug. The Ministry of Health will review the request and tell your doctor its decision.

Contact your doctor to find out how to ask for coverage for a prescription drug that is not in the Ontario Drug Benefit Formulary.

Dental coverage

You and your spouse may get coverage for:

• basic dental services
• additional services if your disability, prescribed medications or prescribed treatment affects your oral health

Anyone under 18 years old in your family will automatically get coverage through the government’s Healthy Smiles Ontario program.

If you have dependants 18 years of age or older, they may be able to get dental coverage through Ontario Works discretionary benefits.

How to access your dental benefits

Make sure that your dentist or dental hygienist accepts ODSP recipients.

Show them your ODSP monthly statement or government ID to verify your eligibility.

For coverage of anyone under 18 years old, find out how Healthy Smiles Ontario provides dental services.

If you already have private dental coverage

Your dentist or dental hygienist may contact the ODSP dental benefits administrator (Accerta) for more information about the coordination of dental benefits.

Vision coverage and glasses

If you do not have vision care coverage under the Ontario Health Insurance Plan (OHIP), you and your family may be able to get help with costs of:

• routine eye examinations (once every two years) for you and your family if coverage under OHIP is not available
• assistance with the cost of prescription eyeglasses (once every three years) for you, your spouse and your children under 18 years of age
• assistance with the cost of eyeglass repairs for you, your spouse and your children under 18 years of age

The vision care benefit covers prescription eyeglasses up to a maximum amount. If you choose to get more expensive lenses or frames, you will need to pay the difference directly to the optometrist or optician.

Dependent adults18 years of age or older may receive vision care under discretionary benefits through Ontario Works. Contact your local Ontario Works office for more information about discretionary benefits.

How to use your vision benefits

To use your benefits for eyeglasses, frames or repairs

Step 1

Contact your local ODSP office and ask for a vision care benefit authorization form

Step 2

Give the form to your vision care provider, and show them:

• your ODSP statement of assistance
• health card
• other government ID

Step 3

Ask your vision care provider to fill in the form

Step 4

Sign the form.

• The vision care provider will send your completed form to the government for their reimbursement. You do not need to pay for eyeglasses up front.

Mandatory Special Necessities Benefit

You and your family may be able to get help with the cost of:

• transportation for medical appointments and treatment
• diabetic supplies, such as syringes, alcohol swabs and blood glucose monitors
• surgical supplies, surgical dressings and incontinence supplies

Assistance with these costs is provided under ODSP's Mandatory Special Necessities Benefit.

How to get this benefit

Step 1

Contact your local ODSP office to tell your caseworker what you want to buy and ask for a Mandatory Special Necessities benefit request form.

Step 2

Take this form to your family doctor's or health care professional's office and ask to have it filled in.

Step 3

Return the form to your local ODSP office in person or by mail. We will review your form and send you a letter to tell you if you have been approved.

You should not pay a fee to have the form filled out. We pay for the cost of filling out the form. The form tells the health care professional how to get paid for filling it out.

For people with insulin-dependence

If you or a member of your family is insulin-dependent and needs injections, you may be eligible for traditional blood glucose monitors and lancets through Diabetes Canada.

For more information, Diabetes Canada’s telephone number is Toll-free: 1-800-361-0796.

Transportation for medical appointments and treatment

You may receive money to cover the cost of travel to and from a medical appointment with an approved healthcare professional if you and your family spend $15 or more a month on transportation. Approved health care professionals include doctors, dentists and nurses.

If you are attending mental health therapy, mental health counselling, or drug or alcohol recovery groups, the cost of transportation may also be covered under the Mandatory Special Necessities Benefit.

To find out if you are eligible for help with these transportation costs, please contact your ODSP worker before spending money.

Health emergencies

In an emergency when you are unable to apply for the benefit in advance and you must pay to get to emergency medical care, you may be able to get those transportation costs covered. Keep your receipts and show them to your worker.

Pregnancy and Breastfeeding Nutritional Allowance

If you are receiving ODSP income support and you or a family member is either pregnant or breastfeeding, you may be able to get assistance with your nutrition-related costs.

The Pregnancy and Breastfeeding Nutritional Allowance may provide you or a family member with either:

• $40 a month to assist with the costs of a regular diet
• $50 a month to assist with the costs of a non-dairy diet if you are lactose intolerant

The allowance may be paid until the baby reaches 12 months of age.

How to get this benefit

Contact your local ODSP office and ask for the Pregnancy and Breastfeeding Nutritional Allowance form.

Take this form to the relevant health care professional's office and ask to have it filled in.

Here are the kinds of healthcare professionals who can fill out the Pregnancy and Breastfeeding Nutritional Allowance form:

• your family doctor or physician
• a registered nurse in the extended class
• a registered dietitian
• a registered midwife
• a traditional aboriginal midwife

Return the form to your local ODSP office in person or by mail. We will review your form and send you a letter to tell you if you have been approved.

Coverage for assistive devices

If you have a long-term physical disability, you can get help paying for equipment and supplies when you qualify for the Assistive Devices Program. If you need an assistive device, you should contact your doctor who can help you apply.

ODSP can help with some of the costs that the Assistive Devices Program does not cover.

Here are some categories of assistive devices:

• mobility devices, such as wheeled walkers and wheelchairs
• visual aids, such as magnifiers
• hearing aids
• orthotic or prosthetic devices
• speech devices, such as teletypewriters
• certain medical supplies, such as ostomy supplies
• respiratory devices

The Assistive Devices Program sets out what assistive devices are covered and the maximum amount of coverage.

The Assistive Devices Program will not reimburse you for devices you buy before getting approval.

The Assistive Devices Program does not cover the assessment fee for assistive devices, but ODSP may cover the assessment fee if no other source covers it. You need to get pre-approval from your local ODSP office for all assessment fees over $500.

Find out more about the Assistive Devices Program.

Hearing aids and devices

The Ontario Disability Support Program may help with:

• purchasing a hearing aid or an alerting system (for example, a visual smoke alarm)
• repairing a hearing aid
• replacing a battery for a hearing aid

This benefit covers the cost of items if other funding is not available.

You, your spouse and children under 18 years of age are eligible for help with alerting systems, and batteries and repairs for hearing aids and devices. Dependent children 18 years of age or over are not eligible but may get help from Ontario Works discretionary benefits.

How to get this benefit

You need to contact your local ODSP office to get approval before you buy a hearing aid, an alerting system, batteries or get repairs.

Batteries and repairs for mobility devices

ODSP can also provide help with the cost of batteries and repairs for mobility devices if no other funding is available. Here are some examples of mobility devices:

• manual or electric wheelchairs
• scooters
• walkers
• lifting devices

You and your family members are eligible for help with batteries and repairs for mobility devices.

How to get this benefit

You need to contact your local ODSP office before you get repairs or need batteries for your mobility device.

Special Diet Allowance

The Special Diet Allowance (SDA) helps eligible ODSP recipients and their family members with the extra costs of a special diet for an approved medical condition.

Find out if you are eligible for the SDA and how to apply.

Guide Dog Benefit

If you are receiving ODSP income support and you own a certified service or guide dog, you may receive $84 a month for each dog, to help pay for their care.

How to access this benefit

To qualify for this benefit, you need to give your local ODSP office proof that your service or guide dog has been trained at an accredited training facility. An accredited training facility is:

• a facility listed in the Blind Persons' Rights Act, Regulation 58
• an organization that is a member of Assistance Dogs International
• a school that is a member of the International Guide Dog Federation

You do not need to provide receipts for the daily care of your dog.

Health benefits for people leaving ODSP

If you leave ODSP because you are getting more money from somewhere else, such as from a job or the Canada Pension Plan (CPP), you may be able to continue to get some ODSP health benefits.

There are two types of ODSP health benefits for people who leave the program. The:

• Extended Health Benefit
• Transitional Health Benefit

Extended Health Benefit

This benefit may help you pay for your high health costs if you no longer qualify for ODSP because you get too much money from another source, such as Old Age Security (OAS).

You may be eligible if:

• you are no longer eligible for ODSP income support because your income is too high
• you and your family have high health costs

Depending on your health care needs, the Extended Health Benefit may help with the cost of:

• prescription drugs
• dental care
• vision care
• medical supplies, such as diabetic and incontinence supplies
• transportation to and from medical appointments
• assistive devices, including hearing aids

A child or spouse who is 17 years of age or younger will continue to receive dental coverage through Healthy Smiles Ontario.

To qualify for the Extended Health Benefit, your health costs must be higher than the difference between:

• your income (for example, money you get from your pension, your job or training after deductions like income tax)
• the amount of ODSP income support that you were receiving each month

You can get the Extended Health Benefit for as long as you are eligible for it. You will still have to qualify for ODSP in every other way, including your disability status and assets, and will have to tell us about changes to your situation.

How to get the Extended Health Benefit

Contact your local Ontario Disability Support Program office. You will have to provide proof of your health costs, such as a list of your prescription drug costs from your pharmacy and receipts for other health costs.

Based on this information, we will determine if you are eligible for the Extended Health Benefit. We will send you a letter to tell you if you have been approved.

If you do not qualify for the Extended Health Benefit

If you do not qualify for the Extended Health Benefit, you may still be eligible for the Transitional Health Benefit if you leave the Ontario Disability Support Program for paid work and do not have similar health coverage from your employer.

Transitional Health Benefit

This benefit can help you pay for your health costs if you have a job and:

• you don’t qualify for the Extended Health Benefit through ODSP
• you don’t get health benefits (or similar benefits) from your employer

A child or spouse who is 17 years of age or younger will continue to receive dental coverage through Healthy Smiles Ontario.

Qualifying for the Transitional Health Benefit

If you leave ODSP for a job and don’t receive the same level of health benefits from your employer, you may be eligible for the Transitional Health Benefit.

You can also get the Transitional Health Benefit if you leave ODSP because you make too much money from self-employment or from a training program.

You can get this benefit until you’re able to get similar benefits from your employer. As soon as you do, you need to tell your local ODSP office.

Other support

If you don’t qualify for either the Extended Health Benefit or the Transitional Health Benefit, you may be eligible for help with your prescription drug costs through the Trillium Drug Program. This program provides coverage for prescription drugs through the Ontario Drug Benefit.

Disagreeing with a decision

If you disagree with a decision on your ODSP case or an application, you can ask for an internal review and may be able to appeal.

More information

For more information, please contact your local ODSP office.

For general questions, please call ServiceOntario at:
Toll-free: 1-888-789-4199
Toll-free TTY: 1-800-387-5559