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What's New for 2018

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What's New for 2018

It's about balance

As more doctors join the OMA and discover the incredible value and benefits of the OMA health plans, the number of participants and claims submitted continues to increase every year. This combined with advances in healthcare, diagnostics and pharmaceutical treatments have had a profound impact on the cost of health benefit plans.

Health and Health Plus

The following changes apply to Health and Health Plus both as stand-alone products and as part of OPIP:

  • Co-insurance for some expenses in excess of $1,000 - reduced to 90%
  • Breast Prosthetics - increased to $500 every 2 benefit years
  • Psychotherapy - added to the psychologist benefit under paramedical services
  • Physiotherapy - now limited to $1,000 per person per benefit year

As the size of the program has grown and health claims costs have risen, we have reached and surpassed the cap on the $25 million subsidy provided by the Ontario government.

OPIP remains a fantastic deal – the subsidy still covers over 70% of the total program cost – but the rising costs of health care does change the contribution from each member. For 2018 the annual OPIP contribution is $350.

OPIP Examples

Here are a few examples that we’ve prepared to help explain some of the various coverages and subsidies.

Newly Graduated Resident Starting Practice Late Entrant with Medical Evidence New to Practice in Ontario

The OHIP+ Program

Effective January 1st, 2018, all children and youth aged 24 and under who have Ontario Health Insurance Program (OHIP) coverage will be covered by OHIP+ for many prescription drugs.

Enrolment in OHIP+ will be automatic and eligible medications will be covered at no cost. OHIP+ coverage stops on the patient’s 25th birthday. Find out more.