With the launch of OHIP+ by the Government of Ontario on January 1, 2018, all children and youth aged 24 years and under who are OHIP-insured are now automatically covered under the Ontario Drug Benefit (ODB) program for approximately 4400 drugs covered under their formulary. The member only needs to present their OHIP card at the pharmacy.
For plan members or their covered family dependents who meet these criteria, OHIP+ is now first payer (at 100%) for these drugs.
Applying Supplemental to Government opportunities such as this is an important element of our benefit management strategy. Our contract wording and consistent updating of our claims processes ensures we do not pay claims that would be eligible through a provincially funded program. Our expertise in this area also means we can apply these savings opportunities with minimal impact to members.
OHIP+ helps highlight the wide level of coverage plan sponsors provide. The majority of our clients offer coverage for an additional 10,000 drugs compared to OHIP+. Many also offer vision, hospital, dental and disability. In short, your members live in the comfort of knowing that their health is secure.
Member experience and coverage
We have been working closely with the Ontario Ministry of Health (MOH) and the Canadian Life and Health Insurance Association (CLHIA) to ensure a smooth transition for all impacted members of our plans.
For drugs and treatments that are part of the Ontario Drug Benefit (ODB) formulary with a regular benefit status, these claims will be sent to OHIP+ directly at pharmacy.
Additional drugs are also eligible for reimbursement through the Exceptional Access Program (EAP). To receive coverage for an EAP drug, a funding request must be submitted by the patient’s prescriber.
Through our Patient First Network, we have outreached to manufacturer Patient Support Programs to ensure that they engage with impacted members to submit an application through the EAP. We also mailed letters to all members currently taking an EAP drug to inform them of the process of transitioning their authorization to OHIP+.
In some cases, drugs approved for reimbursement under a private plan will not be approved by the EAP. Members will need to provide proof of EAP rejection before seeking reimbursement under the private plan.
We have worked closely with the Ontario government and the Canadian Life and Health Insurance Association (CLHIA) to ensure a smooth transition for all impacted members of our plans.
For drugs and treatments that are part of the ODB formulary with a regular benefit status, these claims will be sent to OHIP+ directly at pharmacy.
Additional drugs are also eligible for reimbursement through the Exceptional Access Program (EAP). To receive coverage for an EAP drug, a funding request must be submitted by the patient’s prescriber.
Through our Patient First Network, we have leveraged manufacturer Patient Support Programs to ensure that they engaged with impacted members to submit an application through the EAP. We also mailed letters to all members currently taking an EAP drug to inform them of the process of transitioning their authorization to OHIP+.
In some cases, drugs approved for reimbursement under a private plan will not be approved by the EAP. Members will need to provide proof of EAP rejection before seeking reimbursement under the private plan.
Medavie Blue Cross members will now be able to securely access their benefit information by glancing at their iPhone.
All our plan members with the new iPhone X will be able to use Face ID, Apple’s biometric facial authentication service, to login to the Medavie Mobile app. Activating this feature means members can now experience simpler, faster, and more secure logins when accessing their benefits and claim submissions.
The app currently utilizes the iPhone Touch ID fingerprint recognition for login which has continued to increase in popularity, particularly among our younger members. By now offering Face ID, our members will have even faster access anytime, anywhere.
Medavie Mobile is our members’ all-in-one digital environment for browsing benefit details, checking prescription drug coverage, submitting claims, getting paid faster, viewing claim history, finding health professionals in their area who offer ePay, and many more benefits all at their fingertips.
Investing in digital offerings is extremely important to us; we continue to review and improve the digital experience for our plan members across Canada. This is another example of our commitment to improve the mobile experience to our members.