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OHIP Plus... What's it got to do with you?

By Dilesha Stelmach

Posted Feb 15th, 2019

OHIP Plus... What's it got to do with you? In 2017, the government announced the introduction of a drug program in its budget. They named this program OHIP+ and proposed that all individuals, ages 24 and under, covered by OHIP would be eligible. Since its inception in January 2018 people have been… well … confused.  So, we took it upon ourselves to put together some key pieces of information regarding the OHIP+ pharmacare program.

What is OHIP+?
OHIP+ is an auto-enrolled drug support plan for all Ontario children and youth, under the age of 25. This plan follows the principles of the province’s Ontario Drug Benefit program (ODB) and covers a formulary of about 4,400 drugs and medications. However, this benefit is not income-tested (i.e., children belonging to both high- and low-income families are eligible) and there is no upfront cost to the insured child/youth. There is also no co-payment or annual deductible amount to be borne.

Sounds simple enough, but there’s more.

What is the latest information regarding OHIP+?
The most recent changes to OHIP+ comes into effect on March 1, 2019 and now only children/youth not currently insured by a private plan will receive OHIP+ coverage. Parents are NOT required to enrol their children in the OHIP+ program in order for their children to receive the OHIP+ benefit.

But here’s what hasn’t changed:

Who is covered?
Children and youth, 24 and under, who are not currently covered under a private plan.

What is covered?
The complete cost of the select 4,400 drugs currently allowed under the ODB program. This includes and is not limited to:
  • Antibiotics
  • Asthma inhalers
  • Attention deficit hyperactivity disorder (ADHD) drugs
  • Drugs to treat arthritis, epilepsy and other chronic conditions
  • Epinephrine auto-injectors (EPIPENs)

How do I enrol my child?
Enrollment and removal are automatic. All babies, children and youth aged 24 and under who are OHIP eligible may automatically access OHIP+ if they are not currently enrolled under their parents’ or guardians’ plan.
 
In conclusion, let’s recap this mystery of a plan…

Summary of timelines
April 2017 – Plans for OHIP+ were announced in the Liberal budget.
January 2018 – OHIP+ came into effect for all youth aged 24 or under, including those who had coverage under a private plan.
June 2018 – The conservative government announced that they will put restrictions on OHIP+ coverage.
March 2019 – The proposed changes take effect whereby youth under 25, not covered by private plans, may utilize OHIP+ coverage.

As we move through legislative changes, RIS will continue to monitor how they will impact carriers and business owners. We will continue to work with insurers to provide more timely updates and practical information on the workings of OHIP+. Although these new changes do not result in any savings for plan sponsors, it is encouraging to know that the government is providing access to medical care for children whose parents do not have benefits packages - or are waiting for their's to kick in. 

Interested in staying up-to-date on these updates yourself? Visit the Ministry of Health and Long-Term Care website for more information.

Adapted from https://www.ontario.ca/page/learn-about-ohip-plus and http://www.health.gov.on.ca/en/pro/programs/drugs/ohipplus/

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