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January 2019

Further details on OHIP+

In June 2018, Ontario’s Health Minister announced the government’s position on OHIP+—the free universal drug program for all Ontarians under age 25—which had been implemented six months prior by the previous government. The new Ontario government was effectively seeking to become the second payer for individuals under age 25 covered by a private plan.

For more details, read our bulletin published in July 2018.

From intention to action, the following reimbursement measures will apply as of March 2019:

Ontarians under age 25 who are covered by a private plan*

  • Private plans: The private plans once again become the first payer, as was the case prior to the implementation of OHIP+ on January 1, 2018
  • Trillium: The Trillium Drug Program, the Ontario plan that provides benefits when a household’s drug costs are higher than 4% of the household income, becomes the second payer
  • OHIP+: No reimbursement

Ontarian under age 25 who are not covered by a private plan*

  • No changes were made to this component of the OHIP+ implemented on January 1, 2018: therefore, prescription drugs are fully covered

* Access to a private plan has a broader definition than just private health insurance coverage and includes any plan or program, including access to a health spending account (HSA), that contributes to the reimbursement of at least one prescription drug.

Therefore, medicines covered under OHIP+ cannot be excluded from a private plan in order to maintain public plan coverage for Ontarians under the age of 25.

Takeaways from the Ontario government’s reversal on OHIP+

Despite these modifications, the public plan will remain more generous as all individuals under the age of 25 not covered by a private plan will retain access to a public plan.

For private plans covering Ontario employees, the impact of these changes will materialize at the next renewal periods since private insurers will once again become the first payer, as was the case prior to the January 1, 2018 implementation of OHIP+.

For more information on how these changes will affect your plan, contact our experts.