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Cathleen Wright

Did you know that Ontario is implementing changes to prescription drug coverage in the New Year?

On January 1, 2018, the provincial government will be introducing OHIP+. This program allows eligible Ontario residents under 24 years of age, who hold current health card number and valid prescription, to receive certain medications free of charge.

What does this mean for your private health and dental plan?

In wake of this announcement, we are seeing an unsettling trend of policyholders requesting that their children be removed from their private coverage. To us, that is the wrong course of action. We strongly recommend that everyone do their due diligence to ensure that they’re not jumping the gun and losing the coverage they will actually need, as once the coverage has been terminated, it is extremely difficult to get back.

To bring this into context, under OHIP+ there is a formulary of over 4,400 drugs that will be eligible for the province to become the first payer. While that number may seem like a lot, keep in mind that there are over 10,000 drugs NOT covered under this initiative.

Additionally, key elements that your private plan may cover including dental, orthodontics and extended coverage options such as prescription vision care, paramedical services, hospital stays, chiropractic/massage and physiotherapy, and medical items are not covered under this program.

We recommend sitting down with your benefits specialist, conducting independent research and reviewing the formulary and prescription drug needs with your primary care physician so that you can make an informed decision about your children’s health coverage.

How are private carriers responding?

In the wake of this announcement, we are seeing a trend in the vast majority of private insurance carriers holding in a ‘wait and see’ pattern before making determinations on a rate adjustment. To date, only one carrier has announced changes to their premiums ahead of the January 1st launch date.

As your trusted insurance brokerage, we’re always keeping on top of emerging trends and want you to have confidence in your benefits program and coverage options. We’ll keep you informed on the OHIP+ developments every step of the way.

Where can I get more information?

To learn more about OHIP+ and to review Ontario Drug Benefit Program formulary, visit https://www.ontario.ca/page/learn-about-ohip-plus

 

View the online formulary for the Ontario Drug Benefit Program at https://www.formulary.health.gov.on.ca/formulary/

 

Service Ontario general information call centre - 1.866.532.3161 or Toronto 416.314.5518

 

Specific drug coverage questions - call the Ontario Public Drug Programs at 1.866.811.9893 or Toronto 416.327.8109

 

Cathleen Wright

With over 30 years of experience, Cathleen possesses an ever-growing knowledge of all aspects of group employee benefits, combined with expertise in the evolving landscape of the insurance industry. She is HIAA and ADR certified, in addition to numerous other professional sales and service certifications. When not working, Cathleen can be found at home watching the Leafs or the Blue Jays, and if it’s summer, she’ll be unplugged at the cottage with a book. Year round yoga is a must to maintain serenity, and a glass of wine or a margarita doesn’t hurt!
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