General Preamble premium
OHIP age-based fee premiums
Age premiums are not billing codes. When the patient is in an age group the General Preamble lists, the amount payable for the service is increased by a percentage. OHIP applies it to the fee of the service you bill; there is no separate code to add.
Schedule of Benefits, General Preamble (July 2026 edition)
Patients under 16: the Age Premium Table
Rule 1: despite any other provision in the Schedule, the amount payable for the services below to an insured person in an age group of the table is increased by the percentage opposite the age group.
| Item | Age group | Percentage increase |
|---|---|---|
| 1 | Less than 30 days of age | 30% |
| 2 | At least 30 days but less than one year of age | 25% |
| 3 | At least one year but less than two years of age | 20% |
| 4 | At least two years but less than five years of age | 15% |
| 5 | At least five years but less than 16 years of age | 10% |
Services the table applies to
- a.A consultation, limited consultation or repeat consultation rendered by a specialist, as those services are defined in this Schedule.
- b.A surgical procedure listed in Parts K to Z inclusive of this Schedule.
- c.Basic and time unit surgical assistant services listed in Parts K to Z inclusive of this Schedule.
- d.Clinical Procedures associated with Diagnostic Radiological Examinations.
- e.
- f.A Midwife or Aboriginal Midwife-Requested Special Assessment (A815, C815 or A817) or a Midwife or Aboriginal Midwife-Requested Assessment (A813, C813 or A814) rendered by a specialist.A815Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA)C815Midwife or Aboriginal Midwife-Requested Special AssessmentA817Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA) by VideoA813Midwife or Aboriginal Midwife-Requested Assessment (MAMRA)C813Midwife or Aboriginal Midwife-Requested AssessmentA814Midwife or Aboriginal Midwife-Requested Assessment (MAMRA) by Video
Patients 65 and over: +15%
Rule 2: despite any other provision in the Schedule, the amount payable for the services below to an insured person who is at least 65 years of age is increased by 15 per cent.
- a.
- b.
- c.An intermediate assessment
- d.
- e.A periodic health visit
- f.
- g.
Age premiums on code pages
A code page links here when the Schedule settles it from the code alone: the assessments rule 2 names, A233 and A234, and the procedures and surgical assistant services listed in the surgical parts of the Schedule (Integumentary to Spinal). Consultations and midwife-requested assessments depend on whether a specialist renders them, so their pages do not carry the line; the rule above still applies when they are.Premiums tied to the time and place of a visit are a separate set of rules: special visit premiums.
Common questions
Is there a billing code for the OHIP age premium?
No. Under the General Preamble () the amount payable for the listed services is increased by a percentage when the patient is in a listed age group. OHIP applies it to the fee of the service itself; there is no separate premium code to add.What is the OHIP age premium for patients 65 and over?
The amount payable is increased by 15 per cent for an insured person at least 65 years of age, on: a general assessment (A003, C003, W102, W109); a general re-assessment (A004, C004, W004); an intermediate assessment (A007); a focused practice assessment (A917, A927, A937, A947, A957, A967); a periodic health visit (K132); comprehensive assessment and care (H102, H122, H132, H152); a multiple systems assessment (H103, H123, H133, H153).What are the OHIP age premiums for children?
The Age Premium Table increases the amount payable by 30% (less than 30 days of age); 25% (at least 30 days but less than one year of age); 20% (at least one year but less than two years of age); 15% (at least two years but less than five years of age); 10% (at least five years but less than 16 years of age). It applies to specialist consultations, surgical procedures and surgical assistant services listed in Parts K to Z, clinical procedures associated with diagnostic radiological examinations, A233 and A234 by an ophthalmologist, and midwife-requested assessments rendered by a specialist.Bill the service, not the premium
SnapBill checks each claim against the Schedule of Benefits before it goes to OHIP.