Ontario insures one periodic health visit a year, and what belongs in it is set by your age, your smoking history and what has happened in your family — not by a checklist that is the same for everyone.
What the visit covers
- A history, an examination guided by it, and a decision about what to test for
- Which of Ontario's screening programmes you are eligible for right now
- A FIT kit for colon screening, which somebody has to order for you first
- Blood work where your history gives a reason for it
- Cervical screening and mammogram dates, checked against when each was last done
- Vaccines your record is missing — ask the desk what is given here and what goes to a pharmacy
- Whether an eye examination is insured at your age, or something you pay for
Ages, tests and intervals, one by one
The visit first. Two fee codes cover it: K131, the periodic health visit for adults aged 18 to 64, and K132 for 65 and over. Only one of them is payable per patient, per physician, in any twelve-month period. It covers your history, an examination that follows from that history, and a decision about which of the programmes below you are eligible for.
Cervical. Eligibility is an OHIP number, age 25 or over, a cervix, and having ever had sexual contact with another person. Since March 2025 the test looks for HPV rather than reading cells, it is repeated every five years while the result stays negative, and there is no cost. Most people can stop somewhere between 65 and 69. The women's health page has the letters, and what a positive result leads to.
Breast. Between 50 and 74 the Ontario Breast Screening Program recommends a mammogram every two years, and OHIP pays for it. Screening starts earlier than that band; the rules from 40, the rules past 74 and the separate high-risk stream are on the women's health page. The programme takes calls on 1-800-668-9304.
Colon. At average risk, a FIT every two years from 45 to 74. The starting age came down from 50 on 1 July 2026, so 45 to 49 is newly eligible. It is free through ColonCancerCheck if you qualify and hold OHIP coverage, and the kit is posted out once a doctor or nurse practitioner orders it. Family history moves you off the FIT altogether: a first-degree relative diagnosed young, or more than one at any age, means a colonoscopy every five years and a start well before 45, so say at the visit how old each affected relative was.
Lung. A low-dose CT scan, for people 55 to 80 with valid OHIP coverage who have smoked tobacco daily for at least twenty years; it does not have to be twenty years in a row. You do not need a doctor to set it going: a clinician can refer you, or you can contact a screening site yourself.
Prostate. Ontario's advice is to talk to your doctor about your own level of risk and whether you should have a PSA test. Risk is higher over 50, with a family history of prostate cancer, or if you are of African ancestry.
Eyes. From 65, OHIP covers one major eye examination every eighteen months, plus two follow-up assessments. Between 20 and 64 you pay for it, unless you have one of the eligible medical conditions — diabetes, glaucoma, cataracts, retinal disease, corneal disease and uveitis are on that list — and with one of those it is one examination every twelve months. The coverage is an optometry benefit, so the appointment is with an optometrist.
What OHIP covers
The periodic health visit itself is insured. So is cervical screening, which costs nothing if you are eligible for the Ontario Cervical Screening Program; a screening mammogram at a publicly funded hospital or clinic through the Ontario Breast Screening Program; and the FIT kit, free if you qualify through ColonCancerCheck and hold OHIP coverage. Valid OHIP coverage is also one of the conditions for lung screening. A PSA test is insured where a doctor or nurse practitioner suspects prostate cancer and refers you, or where cancer is being treated or monitored; with no referral you pay. An examination or a report that an employer, an insurer or the Ministry of Transportation has asked for sits outside all of this — ask the desk what it involves and what it costs before you book.
Walk in, or book?
Book it. Screening is a conversation about dates and history rather than about a problem you have today, so say when you call that it is for a check-up, and ask the desk how long the appointment will be.
What to bring
- Your health card
- Dates of your last cervical screening, mammogram, FIT kit or colonoscopy, and where each was done
- Which cancers, heart disease and diabetes are in your family, and the age at each diagnosis
- Roughly how many years you smoked, if you did — it decides whether lung screening is open to you
- A current list of your prescriptions, or the bottles if the list is out of date
Questions people ask
I feel fine. Should I be asking for a physical every year?
Not a full examination every year. The Ministry of Health and Ontario Medical Association billing brief behind the periodic health visit fee codes says that annual physical examinations "are not considered beneficial for asymptomatic adults with no risk factors in the general population". The screening dates are the part that does go out of date: five years for cervical, two for a mammogram, two for a FIT kit. So ask for a periodic health visit, and say which of those you have never had.
I smoked for twenty years and stopped. Would I be turned away from lung screening?
Not for having stopped. Ontario Health's criteria are the age band, 55 to 80, valid OHIP coverage, and twenty years of daily tobacco use; whether you smoke now is not among them, and the twenty years do not have to be consecutive. What decides it after that is the risk assessment — a program navigator works out your chance of developing lung cancer within the next six years, and two per cent or higher makes you eligible for the scan.
I had a check-up with a different doctor last year. Does that use up this one?
No. The cap counts by physician, not by person, so a periodic health visit billed by another doctor in the past year does not close off one here. Bring what came out of it, though — the blood work, the requisitions, any letters — so the time goes on what is missing rather than on repeating what is not.
My employer wants a medical, and my licence renewal needs one. Is that this appointment?
No, it is a separate assessment, and it usually is not insured. Ontario is explicit about one of them: a functional driving assessment is funded neither by OHIP nor by the Ministry of Transportation, and the person being assessed pays. For an employer's or an insurer's examination it depends on the form, so bring every page of it and ask the desk whether it can be completed here, and at what cost, before you book anything.
Still have a question? Call the front desk.
Related
- Women's healthCervical screening, contraception, menopause
- Men's health and screeningScreening, prostate and heart questions
- Chronic care for diabetes, blood pressure and asthmaDiabetes, blood pressure, asthma, heart
