OHIP+
OHIP+ FAQ
- What are the changes to OHIP+ program?
The Ontario government has announced changes to OHIP+ starting April 1, 2019. Children and youth age 24 and under who are OHIP-insured, but who do not have a private plan will be eligible.
- What is a private plan?
A private plan means an employer, group or individual plan, program or account, that could provide coverage for drug products, including facilitating the funding that could be used to pay for drug products, regardless of the following:
- the private plan covers the particular drug for which coverage is sought,
- the child or youth or another person under the private plan is required to pay a co-payment, deductible, or premium, or,
- the child or youth has reached their annual maximum under the private plan and no further coverage is available.
- What will happen if my child is not covered for a specific drug through a private plan? Can they then access OHIP+?
Children and youth age 24 and under who have a private plan will not be eligible for OHIP+ regardless of whether:
the private plan covers the particular drug for which coverage is sought,
the child or youth or another person under the private plan is required to pay a co-payment, deductible, or premium, or,
the child or youth has reached their annual maximum under the private plan and no further coverage is available.
Children and youth age 24 and under who have a private plan will access drug coverage through their private plan, as they did prior to the launch of OHIP+.
Households with high out-of-pocket prescription drug expenses, including children and youth who are covered under a private plan, can apply to the Trillium Drug Program. The Trillium Drug Program is available to all OHIP-insured Ontarians who have high prescription drug costs in comparison to their household income. To find out more about the Trillium Drug Program and eligible prescription costs please visit: www.ontario.ca/trilliumdrugprogram or call the Trillium Drug Program toll free at 1-800-575-5386.
- If my child is entitled to receive drug benefits through Ontario Works or the Ontario Disability Support Program, will they be fully covered, or will they have a co-pay?
Children and youth age 24 and under who are eligible for the Ontario Drug Benefit (ODB) Program because they receive social assistance benefits, regardless of whether they have a private plan, will maintain their benefits through the ODB Program with no co-pay and no deductible.
- What medications are covered by OHIP+?
OHIP+ completely covers the cost of more than 4,400 drug products that are currently available through the Ontario Drug Benefit Program, including:
- Antibiotics to treat infections
- Inhalers for asthma
- Various insulins, oral diabetic medications and diabetes test strips
- Epinephrine auto-injectors (e.g. EPIPENs®)
- Medications to treat arthritis, epilepsy and other chronic conditions
- Antidepressants
- Attention deficit hyperactivity disorder (ADHD) medications
- Medications to treat some childhood cancers and other rare conditions
To find out if your medication is covered through the Ontario Drug Benefit Program visit www.ontario.ca/page/check-medication-coverage/ or ask your Guardian or I.D.A. pharmacist for more information.
Medications available through the Exceptional Access Program may also be covered if an individual qualifies
- What about medications not covered under OHIP+?
If the prescribed medication is not covered by OHIP+, your Guardian or I.D.A. pharmacist may be able to recommend alternative medications that are covered by OHIP+.
If you have private insurance, some drugs not covered by OHIP+ may be covered by your insurance plan.
The Exceptional Access Program (EAP) may enable access to some medications for which no appropriate alternative is covered by OHIP+. Your healthcare provider is required to submit a request on your behalf. If approved, the full cost of the medication will be covered. Visit www.ontario.ca/page/applying-exceptional-access-program for more information on EAP.
- How do I get an Ontario health card?
An Ontario health card is required to receive OHIP+ coverage. For more information on getting an Ontario health card, visit www.ontario.ca/page/health-cards or contact a ServiceOntario Centre at 1-800-268-1154 (toll-free in Ontario only), 416-314-5518 (Toronto and GTA) or 1-800-387-5559 (toll-free TTY).
- Where can I get additional information?
Please ask your Guardian or I.D.A. pharmacist, or:
Visit www.ontario.ca/page/learn-about-ohip-plus to learn more about OHIP+
Email OHIPplus@ontario.ca for general OHIP+ questions or comments
Visit www.ontario.ca/drugbenefit to learn more about the Ontario Drug Benefit Program