In January 2018, the Ontario government rolled out a new, enhanced provincial healthcare plan known as OHIP+.
What is OHIP+?
OHIP+ is designed to extend healthcare coverage under the provincial plan, although the extensions are not universal. Under OHIP+, Ontarians under the age of 25 were originally supposed to have drug coverage from the province, with the province being the first payor for young Ontarians.
With the election of a new provincial government in June, however, people began to speculate that OHIP+ would be changing again. This was confirmed when the new government announced revisions at the end of June.
What Did OHIP+ Cover?
OHIP+ made a few changes to the provincial healthcare program, but the most notable of these was an extension to drug coverage for young Ontarians. Under the program, children and young Ontarians under the age of 25 would be eligible to receive drug coverage from the province.
This was designed to provide universal coverage for young people who may have lacked the ability to secure their own private drug coverage through their parents. Most young Ontarians rely on their parents to cover the costs of their medications, whether through private insurance or out of pocket.
Many parents, however, do not have private coverage, and many young people over the age of 21 also do not have drug coverage benefits provided by an employer. The intention was to create universal coverage for this group. It also reduced the burden of being first payor on insurance companies and the financial strain on parents with sick children.
Changing the Rules
When the new provincial government came to power at the end of June, they announced changes to the OHIP+ program. Many feared a more extensive rollback of the new program, but the changes have been relatively mild.
Under the revised program, however, Ontarians aged 21 to 25 will no longer turn to the province as the first payor for medications. Instead, private insurance issued through an employer or a school, or provided by a parent or spouse, will be first payor. The province will pay remaining fees or pay the full cost if the medication is not covered by the first payor but is covered by the province.
What Does This Mean for Parents?
Parents who have private coverage will return to making claims for medication costs from their insurer first. The province will only step in when the child is not covered or does not have access to a benefits program.
For parents of children aged 21 to 25, this means they’ll need to re-enroll their children in their benefits program. Employees should check with their employers and insurers, as many plans were changed as OHIP+ was rolled out.
Other Options for University Students
Young Ontarians who are enrolled in college or university programs may have another option for private drug coverage. Parents may want to explore the options offered by their children’s colleges or universities.
This may be especially helpful if the parent’s benefits plan has changed or if the child has been unenrolled in the program. For some students, this may be the only form of private insurance available to them.
The Province as a Fallback
If there is no other option available or the coverage provided under an employer’s program is inadequate, the province still offers healthcare coverage for young Ontarians who lack private insurance. The difference now is that the province will not act as the first payor.