An Update from GreenShield on OHIP+

The APUS Health and Dental Plan is provided through GreenShield Canada. Please see below for an update from GreenShield on recent changes to OHIP+. Please note the APUS Health and Dental Plan is considered a private plan.

From GreenShield Canada:

Change to prescription drug coverage under OHIP+ 

As you may know the Ontario government is making a significant change to OHIP+, which was implemented just over a year ago on January 1, 2018. This program paid 100 per cent of the cost of eligible prescription drugs for all children and youth under age 25. The new government is now changing focus and providing coverage only to those who do not have private drug plans available.

Effective April 1, 2019, children and youth under age 25 who have drug coverage under private plans will not have anycoverage under OHIP+. In other words, if you are under age 25, your prescription drug coverage will now be under your Green Shield Canada (GSC) benefits plan – as it was prior to when OHIP+ was first implemented. Similarly, if you have dependents who are under age 25, they will now be covered under your GSC drug benefits plan subject to dependent eligibility requirements. GSC has been updating our systems to reflect this change and ensure a smooth transition back to pre-OHIP+ status.

Here’s what you need to know…

  • On April 1, 2019, all your prescription drug claims should be submitted to GSC for reimbursement. Be sure to show your pharmacist your ID number.
  • If you or your eligible dependents were approved for a drug eligible under the Exceptional Access Program (EAP) before the original implementation of OHIP+ on January 1, 2018, these approvals have been retained on our claims system ensuring no interruption in coverage.
  • Anyone who started taking an EAP-eligible drug while covered by OHIP+ will be grandfathered under your GSC plan, subject to plan design and limitations – we just need to see proof of payment through OHIP+ for the drug within the past six months.
  • Anyone newly prescribed an EAP-eligible drug after April 1, 2019, will have to go through GSC’s standard prior authorization process.
  • If you have high out-of-pocket drug expenses due to a plan maximum or drugs that are not covered under your benefits plan, you may apply to the Trillium Drug Program, which offers additional coverage for eligible prescription drug costs that create a significant financial burden.