Which OHIP Special Visit Premium? (Quick Decision Guide)

Which OHIP Special Visit Premium time period applies? (Quick Decision Guide)

Summary / Description
 Use this quick decision guide to choose the correct OHIP Special Visit Premium time window (weekdays daytime, sacrifice of office hours, weekday evening, weekend/holiday, or night). Then select the matching Travel Premium and First/Additional Person Seen K-codes.

Step 1 — Is the visit during the NIGHT period?
If the visit starts between 00:00 and 07:00, it is the NIGHT time period.
Use these codes:
  • Travel Premium: K964 ($36.40, no max)
    First person seen: K996 ($100.00, no max)
  • Additional persons seen: K997 ($100.00, no max)
  • If NO (not 00:00–07:00), go to Step 2.
Step 2 — Is today Saturday, Sunday, or a HOLIDAY?
If the visit starts between 07:00 and 24:00 on Saturday, Sunday, or a Holiday, it is the Sat/Sun/Holiday time period.
Use these codes:
  • Travel Premium: K963 ($36.40, max 6 per time period)
    First person seen: K998 ($75.00, max 20 total per time period)
  • Additional persons seen: K999 ($75.00, max 20 total per time period)
  • Important “max” rule:
The max 20 is the combined total of first + additional persons seen in that time period.
If NO (not Sat/Sun/holiday 07:00–24:00), go to Step 3.
Step 3 — Is it a WEEKDAY evening?
If the visit starts between 17:00 and 24:00 Monday–Friday, it is the Weekday Evening time period.
Use these codes:
  • Travel Premium: K962 ($36.40, max 2 per time period)
    First person seen: K994 ($60.00, max 10 total per time period)
  • moh-schedule-benefit-2025-03-19
  • Additional persons seen: K995 ($60.00, max 10 total per time period)
    Important “max” rule:
The max 10 is the combined total of first + additional persons seen in that time period.
If NO (not weekday 17:00–24:00), go to Step 4.
Step 4 — It’s WEEKDAY daytime (07:00–17:00). Do you meet “Sacrifice of Office Hours”?
If the visit starts between 07:00 and 17:00 Monday–Friday, it is Weekday Daytime.
Now choose one of these two daytime categories:
A) Standard Weekday Daytime (07:00–17:00)
Use these codes:
  • Travel Premium: K960 ($36.40, max 2 per time period)
    First person seen: K990 ($20.00, max 10 total per time period)
  • Additional persons seen: K991 ($20.00, max 10 total per time period)
  • B) Weekday Daytime with Sacrifice of Office Hours (07:00–17:00)
Use these codes:
  • Travel Premium: K961 ($36.40, max 2 per time period)
    First person seen: K992 ($40.00, max 10 total per time period)
  • Additional persons seen: K993 ($40.00, max 10 total per time period)
Important “max” rule:
For weekday daytime categories, the max 10 is the combined total of first + additional persons seen in that time period.
Documentation reminder (required for premiums)
The SoB requires that the time of the special visit be documented to support eligibility for the premium.