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Health Services and Review Board

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At this time, only forms for appeals under the Health Insurance Act are available electronically. You may print and complete the form; however, it must be mailed or faxed to the Appeal Board.

For appeals under any of the other 13 statutes, forms are not available on this website. You must send a written request for a hearing to the Appeal Board and the necessary forms will be sent to you.

For information with respect to the statutory requirements, please check the appropriate Act under Legal section.

INSTRUCTIONS ON COMPLETING THE PACKAGE

  1. Organize your submission
  2. Print or type your submission. Supply additional pages where there is insufficient room on the form for your information. If you spoil a page, substitute your own page.Write the question at the top and continue.
  3. Starting from the beginning, number each page sequentially (ie. 1, 2, 3, ...etc.). Ignore any existing page numbers even if they coincide with your numbering scheme. A hand-written number in a circle is an excellent choice.
  4. If you make a mistake in the numbering and have to add a page in the middle, use a letter to show its order. For example, the added page after page 3 is page 3a. If you add five pages after page 10, they are 10a, 10b, 10c, 10d, 10e. Then comes page 11.
  5. Make three copies of your submission. (Number the pages first!)
  6. After everything is complete, numbered and duplicated, deliver two (2) copies to the Appeal Board and one (1) copy to OHIP at the address on form 2a or 2b (whichever you have been supplied.)

SUGGESTIONS YOU MAY WANT TO CONSIDER

  1. Take the time to think about your answers. Write notes and organize yourself so that the submission is clear, direct and to the point. Use short sentences whereever possible.

 
  • CONTACT INFORMATION SHEET

  • MS Word | Adobe PDF (Fillable Form) 192KB

  • FORM 1 - REQUEST FOR A HEARING & APPELLANT'S SUBMISSIONS (Health Insurance Act only)


  • This form must be completed before your appeal will be heard by the Appeal Board.

    MS Word | Adobe PDF (Fillable Form) 82KB

  • FORM 2a - CONFIRMATION OF SERVICE (Health Insurance Act only)


  • This form is to confirm that you have sent Form 1 to OHIP (Subscriber Appeal).

    MS Word | Adobe PDF (Fillable Form) 206KB

  • FORM 2b - CONFIRMATION OF SERVICE (Health Insurance Act only)


  • This form is to confirm that you have sent Form 1 to OHIP (Eligibility Appeals).

    MS Word | Adobe PDF (Fillable Form) 207KB

  • FORM G - AUTHORIZATION OF AGENT (Health Insurance Act only)


  • If you decide that you would like to be represented by a family member or a friend at the hearing, complete this form and mail to the Board.

    MS Word | Adobe PDF (Fillable Form) 203KB

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