Effective April 1, 2019 – Changes to OHIP+ for individuals under 25 years of age

April 1, 2019

Starting April 1, 2019, OHIP+ will no longer provide prescription drug coverage for individuals 24 years old and younger if they have drug coverage through a private insurance plan.

What you need to do

If you, your spouse or your children are 24 years old or younger, let your pharmacist know you have coverage under a group benefits plan. To make things easier, have your benefits card handy next time you fill a prescription. You can print a copy of your benefits card online when you sign in to the OTIP plan member secure site at www.otip.com.

If you or an eligible member of your family is taking a high cost drug

 Some high cost prescription drugs require prior authorization under your group benefits plan.
To see if a drug requires prior authorization:

  • Log in at otip.com and click on My Claims.
  • Under My benefits select My drug plan and search for the prescribed drug.

 If the drug being prescribed is eligible for coverage, requires prior authorization and is not being administered in a hospital, here’s what you need to do:

Scenario What you need to do How to submit
If your pre-authorized drug was approved and paid for by OHIP+ Simply send OTIP the OHIP+ approval letter or a prescription receipt and phone number.
·       The letter will show it’s been approved under the Exceptional Access Program (EAP).
·       Your pharmacist can give you a copy of the receipt. It will show it was paid for under the Ontario Drug Benefit program.
Please include:

·       The patient’s name
·       Your plan number and OTIP ID  (found on your benefits card)

Submit by mail or fax to:
OTIP Benefits Services
Attention: Prior Authorization Team
PO Box 1653
Waterloo ON N2J 4W1
Fax: 1-855-752-0404

Submit online:
·       Visit otip.com and log in to Health and Dental
·       Click on My Claims
·       Click on Contact us
·       Select Send documents and then complete the steps

If your doctor has recently prescribed a high cost drug and you haven’t started taking it You’ll need to fill out and submit a Drug Prior Authorization form found at www.otip.com/forms.

 

Submit by mail or fax to:
OTIP Benefits Services
Attention: Prior Authorization Team
PO Box 1653
Waterloo ON N2J 4W1
Fax: 1-855-752-0404

Submit online:
·       Visit otip.com and log in to  Health and Dental
·       Click on My Claims
·       Click on Contact us
·       Select Send documents and then complete the steps

Questions?

If you have questions, please call or email OTIP Benefits Services:

  • Phone: 1-866-783-6847
  • Email:  Sign in to your OTIP plan member secure site, click on My Claims, and send OTIP a note.

For more information on OHIP+, visit the Ontario government website.

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