OHIP+ No Longer Covers Kids and Young Adults with Private Insurance

Christine Elliott unveiled the PCs ‘cost-effective’ changes to free prescriptions for people under 25.

Children, teens and young adults with private health benefits will no longer be eligible to receive free prescriptions through OHIP+, newly appointed Health Minister Christine Elliott announced on Saturday.

The “cost-effective” changes to the province’s current pharmacare program are part of the Ontario Progressive Conservative government’s pledge to save billions each year by finding “efficiencies” in government spending, Elliott said in a news release.

OHIP+ coverage will now focus on Ontario residents “who do not have existing prescription drug benefits” while also “saving the taxpayers money,” she explained.

The province’s current youth pharmacare program effective January 1, 2018 provides free coverage on more than 4,400 drugs to children and youth aged 24 and under — will continue to ensure that eligible Ontarians not covered by private health benefits will receive their prescriptions for free, said Elliott.

“Those who are covered by private plans would bill those plans first, with the government covering all remaining eligible costs of prescriptions. We look forward to working with insurance groups to ensure a smooth transition to this updated system,” said Elliott. Her announcement didn’t specify a timeline for implementing the latest changes.

In a statement, the Canadian Life and Health Insurance Association said it welcomed the changes to the youth pharmacare program, which only took effect on Jan. 1, 2018.

“The life and health insurance industry is committed to working with the government of Ontario to ensure a smooth transition and is pleased to extend the transition period agreed to with the previous government beyond July 1,” said Stephen Frank, president and chief executive officer of the CLHIA.

“We will work closely with the new government to ensure that all those who are eligible for coverage under an employer-sponsored health benefit plan are transitioned back from the OHIP+ children and youth pharmacare program with minimal disruption.”

With this change in OHIP+ costs will revert back to employers.  However, we do not believe that it will have significant impact on your overall benefit cost.  However, it is a lost savings opportunity for employers.


Should you wish additional information on this topic, please contact your benefits consultant at 1-800-661-1518 or fill out the contact form below.

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