As of April 1, 2019, Ontarians under age 25 with private drug coverage will no longer be eligible for OHIP+ In January 2018, the Ontario government launched OHIP+, a provincial drug program that provides coverage for over 4,400 drugs for all Ontarians under 25. The program is changing. Effective April 1, 2019, OHIP+ will only be available to Ontarians under 25 without a private drug plan or a health spending account.
Here are the key details about the OHIP+ legislative change: People with private drug plans or health spending accounts will no longer be eligible for OHIP+. The Ontario government defines a private plan as a drug plan or a health spending account that provides coverage for a prescription drug claim. If the drug is not covered by a private drug plan, the member will not be eligible to claim the drug under OHIP+. People with high out-of-pocket prescription drug expenses will have the option to apply to the Trillium Drug Program. Pharmacists will be responsible for asking individuals if they have private drug insurance and submitting the claim accordingly.
We’re actively working with CLHIA on a process that will ensure a smooth transition for impacted individuals. We’ll communicate more details in the coming weeks and update you to ensure compliance with the legislation as plan members will need to rely upon your plan for prescription drug coverage for eligible Ontario children and youth under 25. Insurure’s will also be adjusting the Extended Health Care (EHC) rates at renewal time to reflect the change.