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.

Laser Eye Surgery (Benefit Tips ® - © 1999)

Laser eye surgery reduces or eliminates dependency on corrective lenses by changing the shape of the patient’s eyes. Please note the risks associated with eye surgery include under-correction, over-correction, loss of sharpness and degradation of night vision.

Now that laser eye surgery has become more affordable ($2,000) and main-stream, benefit plan have included it as an eligible expense. Since vision claims are controlled through the spending limit rather the eligibility of expenses, there should not be any cost associated with extending your vision care benefit to include laser eye surgery.

Employees with a health spending account have always been able to claim the full cost of laser eye surgery by budgeting their medical and dental expenses.