Important Information: OHIP+



Dear partners,

The Ontario government will introduce a new pharmacare program for children and youth aged 24 and under effective January 1, 2018 under the name OHIP+. OHIP+ will cover more than 4,400 eligible medications, on the Ontario Drug Benefit (ODB) list at no cost for children and youth aged 24 and under, including: ODB general formulary medications, 'limited use' drugs under the program and drugs under the ODB Exceptional Access program. Out of country claims are not eligible under OHIP+. Enrollment in this program is automatic. Patients will not have to pay any upfront costs; they will simply need to present their valid health card and a valid prescription. For people who have private health insurance plans in place, the Ontario government will become first payor for many drugs for people age 24 and younger. The introduction of OHIP+ will reduce prescription drug premiums for many Ontario families. While OHIP+ will cover many drugs for Ontario children and youth, it does not replace the need for traditional private extended health care plans, as not all prescription drugs are included on the Ontario Drug Benefit list.

Below are details on how policy holders will be notified of this upcoming change and what options are available to them. POLICY HOLDER COMMUNICATION PACKAGE

Policy holder's will be mailed a communication package outlining how they will be impacted by this change this week (see policy holder package samples). You will also receive a copy of the client letter in the mail, for your in-force clients. These documents will provide you with information regarding any potential impact on the policy premium and what options are available to clients. We suggest that once you receive a copy of your client's information package, you contact them to provide them with advice regarding which option is best suited for them. Please see the coverage selection form in the policy holder package samples which outlines the options available to your client with the corresponding premium. EXISTING POLICY HOLDERS

To help manage this important change, we are providing clients with the following options:

1. Express Plan clients with drug coverage can choose one of 2 (two) options:

a) Remove the prescription drug benefit for individuals aged 24 and under. A premium reduction will be reflected on the coverage selection form.

b) Maintain drug coverage for individuals aged 24 and under to cover drugs not covered under OHIP+.

IMPORTANT: This option includes a ‘Guaranteed Insurability Option’, by which the individual can purchase their own health plan, including prescription drug coverage at age 25 without underwriting up to 30 days after their 25th birthday.

2. Global Plan clients with drug coverage will have 3 (three) options:

a) Remove the prescription drug benefit for individuals aged 24 and under. A premium reduction will be reflected on the coverage selection form.

b) Maintain drug coverage for individuals aged 24 and under to cover drugs not covered under OHIP+. IMPORTANT: This option includes a ‘Guaranteed Insurability Option’, by which the individual can purchase their own health plan, including prescription drug coverage at age 25 without underwriting up to 30 days after their 25th birthday.

c) Replace current drug coverage with a Children’s Critical Illness package. IMPORTANT: This option includes a ‘Guaranteed Insurability Option’, by which the individual can purchase their own health plan, including prescription drug coverage at age 25 without underwriting up to 60 days after their 25th birthday, provided no Children's Critical Illness claim has been made. If a Children's Critical Illness claim is made, an individual may still be able to purchase an Express Plan Health Insurance policy at age 25, provided they are able satisfy the required declaration.

If no claim has been made under the Children's Critical Illness package before the age of 25, the individual could purchase our Express Plan Critical Illness coverage at age 25, without having to complete a health declaration.

The coverage maximums for Children's Critical Illness packages are as follows:

1. Global Plan Basic Drug Coverage - Basic Children’s Critical Illness Package - $15,000

2. Global Plan Deluxe Drug Coverage – Enhanced Children’s Critical Illness Package - $25,000

Please review the details of the Children's Critical Illness packages.

NEW BUSINESS - effective January 1st, 2018

Any new business submitted after January 1st, 2018 that includes the Children's Critical Illness packages in lieu of basic or deluxe drug coverage for people 24 years of age or under will require the signing of a short declaration to qualify for coverage. Our software and marketing material will be updated effective January 3rd, 2018. COMMISSION

Effective January 1st, 2018, any impact on your commissions as a result of these changes will be indicated on your weekly commission statements as 'adjustment'. You may also review your commission statements once you login at www.info-partners.ca. If you wish to make alternate arrangements to manage these adjustments, please contact info-partners at: 1-800-361-2538.


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(416) 630-4022

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