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New Edition of the OHIP+ for Ontario Residents

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Ontario residents have had medical coverage under the Ontario Health Insurance Plan (OHIP) for quite a few years. This plan has always covered hospital services, physician fees, and eye exams for children and seniors, along with the Ontario Drug Benefit for lower income families and seniors.

On January 1, 2018, the Ontario government introduced a new pharmacare plan called “OHIP+,” allowing prescription drug coverage for eligible Ontario residents aged 24 and below. Rather than paying for drugs out of pocket or through a supplemental healthcare plan, the patient would present their Ontario health card for payment.

Coverage for this program is automatic and does not require you to sign up for it. It will cover eligible medications and all the costs that come with them, including the dispensing fee. There is no co-pay or deductible and no need to report your household income.

Ideally, Ontario should have a program in place to cover all residents, and while this plan does not include everyone, it is definitely progress.

For many families, this coverage will be a saving grace, especially for those with children out of high school or post-secondary schooling with no coverage of their own. Young people aged 18–24 are especially vulnerable, as they may not be covered under their parents’ plans unless they’re a full-time student.

Get the Correct Information

If you have a health insurance plan through your employer, or one you buy for yourself, you may find some things have changed. Previously, a child’s medication would automatically be eligible under their parents’ plan, but now, if they have a prescription, OHIP+ will reimburse first. If there is a remaining amount to be claimed, it can then be submitted to the private insurance plan.

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There seems to be some misinformation going around and many policyholders have been led to believe that they should remove their children from their coverage. There is a misconception that if the province will pay for drugs, there’s no need to have children on private insurance plans.

This is not an advisable course of action. While OHIP+ will pay for over 4,400 drugs listed in a formulary, there are still over 10,000 drugs that would not be eligible for reimbursement. To learn more about what OHIP+ will cover, or to search for a drug to see if it is eligible, please see OHIP’s website here.

Other Health Insurance Benefits

Additionally, your private plan may cover more than just prescription drugs. There may be coverage for physiotherapy, vision care, or dental services for which your child may be eligible, or really need. By removing a child or children from your plan, you would inadvertently deny them access to potentially necessary treatment or items.

Before doing anything drastic with your insurance policy, it’s recommended that you consult with your benefits provider and ask them any questions you may have. They may be able to dispel any myths and give you important information.

What This Means for Insurance Carriers

As it is still very early in the year, many private insurance carriers are waiting to see what happens before adjusting their rates. If any rates do change, it will likely be sometime next year, and after Ontarians have had a better idea of how the new pharmacare system works and what effects, if any, it may have on private insurance plans.

If you already have a health insurance plan and would like to know how these changes may affect it, or if you are thinking about purchasing a policy, call our office today. A knowledgeable customer service representative will be happy to walk you through everything and will identify any changes to your plan.

2 Responses

  1. Hi. I just wanted to know if a person already diagnosed type1 diabetes eligible for an insurance that covers prescribed drugs like insulin? And what could be the most affordable scheme? And if there are other medications like creon capsule included in the medications? All this if the condition of the patient is extremely well and controlled.

    1. Some plans do cover pre-existing conditions, not all. Some require you to come off a company group plan and others do not. As for your questions about specific prescriptions covered, each insurance company has it’s own drug formulary, or list of drugs, that they will cover. It’s best you get the Drug Identification Number (DIN) and provide it to us to find out if that specific drug would be covered by the insurance companies that we offer.

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