OHIP+ Changes for those aged 24 and under

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Starting April 1, 2019, OHIP+ will no longer provide prescription drug coverage for individuals 24 years old and younger if they have drug coverage through a private insurance plan.

Here are the changes the Ontario Government made to OHIP+ that you should know about:

  • Children and youth aged 24 and under who have a private drug plan will no longer be eligible for OHIP+ and will access prescription medications through their private insurer, as they did prior to the launch of OHIP+.
  • Home care recipients and those eligible for the Ontario Drug Benefit Program through social assistance will continue to receive drug benefits through these existing streams, regardless of any private insurance.

What is a private drug plan?

A private drug plan means an employer-provided group health plan or health savings account, or an individual health insurance plan. These plans can provide coverage for drug products.

The OHIP+ guidelines are applicable regardless of whether or not the private drug plan

  • Covers the particular drug
  • Requires you to pay out of pocket for a deductible, co-payment or premium, or
  • Has reached its annual plan maximum and no further coverage is available.

What this means to you

Unpaid balances not reimbursed by your private plan cannot be submitted to OHIP+.  Likewise, an expense not paid for by OHIP+ cannot be submitted to your private plan. There is no coordination of benefits allowed with the provincial program.

If you, your spouse or your children are 24 years old or younger, let your pharmacist know you have coverage under a private health insurance plan. To make things easier, have your benefits card handy the next time you fill a prescription.

Your pharmacist will confirm the age of the individual getting the prescription and that they have a valid Ontario health card number. Just like in the ‘pre-OHIP+’ days, you will be responsible for any out-of-pocket expenses.

Do you need to get your private drug plan in place?

If you are worried about the out-of-pocket costs for prescription drugs for you and your family, talk to us today. It is important to know that OHIP+ covers approximately 4,400 drugs, while private drug plans cover over 11,000.

The biggest barrier for many families is selecting a drug and health plan best suited to their needs and budget. The choices, terminology, options and process can seem very confusing.

That’s why talking it over with an expert is a good way to get help. At SBIS, we have over 35 different health and dental plans to choose from, giving you plenty of options.

We can help you figure out what plan to choose and what coverage you may need based on your budget, and then we can assist you in applying for your plan. Give us a call.

Want more information on OHIP+ and Ontario government drug programs?

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