On April 1st, 2019, the Ontario provincial government shifted their focus of OHIP+ benefits to prioritize youth without a private plan. Ontarians aged 24 and under who are insured under a private drug benefit plan are no longer eligible for medication coverage through OHIP+. Those without access to private coverage will continue to be OHIP+ insured and eligible for prescription medication coverage funded by the province.
There is some confusion over the definition of a private plan, so here is a quick summary:
Private insurance is defined as any type of private plan, program or account which could contribute to the cost of any drug product, regardless of whether:
- the private insurance plan covers the particular drug for which coverage is sought,
- the child or youth or another person captured under the private insurance plan is required to pay a co-payment, deductible, or premium, or,
- the child or youth has reached their annual maximum under the private insurance plan and no further coverage is available.
Those facing significant out of pocket expenses for prescription medications, despite having private insurance, may instead be eligible for assistance through the province’s Trillium Drug Program.
- The Trillium Drug Program is an application-based, income-tested program that is available to all OHIP-insured Ontarians, which helps with prescription drug costs for those with high drug costs compared to their household income.
- Households enrolled in the Trillium Drug Program would have an annual deductible (divided into quarters) based on their household income, which must be paid before benefits would be funded through the Ontario Drug Benefit program.
Please feel free to contact one of our benefits consultants for more information about OHIP+ and what impact these changes will have on your benefits plan.
Click below for the official notice from the government:
http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/exec_office_20190227.pdf
Common FAQ’s
http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/fq_pat_exec_office_20190311.pdf
