Coverage Tips

OHIP+ Drug Coverage Age 0-24 (Benefit Tips ® - © 2017)

Beginning in 2018, OHIP+ will cover the cost of most drugs for anyone under the age of 25 without any deductible, coinsurance or income test.

Publicly funded drug programs in Ontario are based on the Ontario Drug Benefit (ODB) formulary which was established in 1970 and covers all Ontarians with deductibles that vary based on their income and circumstances.  The ODB covers 4,400 drug products, including some nutrition products and diabetic testing agents.  In addition, drugs that are not listed in the Formulary are considered for coverage, on a case-by-case basis, through the Ministry of Health's Exceptional Access Program (EAP). 

Benefit Plan Impact:

  • Employers can expect their prescription drug claims to reduce by 10% for Ontario staff, reducing overall health care costs by 3% for this group of employees.
  • Employees will have fewer claims count against their health spending account or drug insurance maximum and coinsurance if they and/or any of their dependents are younger than age 25.  This will free up limited resources that can be reallocated to other benefit priorities.
  • Children will have direct access to medication without going through their parent's benefit plan.

Societal Impact:

  • Empowers children and youth to receive the medication they deem necessary directly from the state without regard to family finances, priorities and values.

Benefits for Part-time Staff (Benefit Tips ® - © 2018)

Many employers accumulate a contingent work force of part-time staff to manage labour demand fluctuations.  This practice became more expensive on January 1, 2018 when the Employment Standards Act was updated to increase the holiday pay for part-time staff from a prorated amount to the employee’s average daily wage.

The significance of this additional cost burden will likely prompt employers to consolidate their part-time workforce.  For example, if the average daily pay is $100, the statutory holiday pay for…

  • one full-time employee is $900 per year ($100 x 9 days),
  • five part-time employees is $4,500 per year ($100 x 9 days x 5 employees).

Pay equity for casual, part-time, temporary and seasonal employees was also introduced to the Ontario’s Employment Standards Act.  This expansion of wage parity to employment status further erodes the historical advantage of maintaining a pool of part-time staff.  These employees are now required to have the same wages as their full-time counterparts.

You are ill-prepared if your employee benefit plans do not align with the stratification of your workforce.  The impact on employee benefit costs can be managed effectively by varying coverage based on compensable factors such as seniority, occupation and income.  An independent benefit consultant can help you design a benefit plan that is suitable for your entire workforce.