Patient Eligibility under Ontario Drug Benefit Act (ODBA)

Seniors automatically enrolled 1st day of the month following their ______ birthday

Single senior (lives alone) with annual income of $22,220 or less is considered a ______ income senior

Senior couple with combined annual income of $37,100 or less is considered a ______ income senior

Seniors must pay $2 ______ for all eligible Rx's

High income seniors can fill out an application form to be considered ______ income seniors

Single senior with annual income of more than $22,200 must pay a $100 deductible every year starting August 1, once deductible is reached, they pay a $6.11 co-pay for all eligible Rx's. Pharmacy can wave it from $6 to $4 per Rx for ALL ODB patients. Each and every drug that’s filled, they get to pay back for each one. 10 drugs, each drug $2 -> owe $20. Can't pay $6 for 25 drugs in 3 months -> may apply to low income but also that’s the _______ decision, not ours.

OHIP+ provides prescription drug coverage for individuals 24 years of age and younger WITHOUT private drug coverage. No enrollment or application needed. Must present valid health care to pharmacy. No deductible or co-pay. Responsibility belongs to pharmacy team to confirm whether patient has other coverage before filling Rx. Special Service Code (SSC) = U (No Private Insurance Attestation). Communicated to ODB that patient does not have other coverage & is eligible for OHIP+ benefits. Required to be included on ALL claims for an eligible patient. Failure to include code will result in claim being rejected. Parents can either have private insurances for their kids from work or to buy their own insurance plans from their own self-employment. If they have private insurance, but that insurance doesn’t cover for the drug. Private plan has deductible, co-pay, or premium. Annual maximum coverage has been reached & patient has no further drug coverage for the remaining time-period. All still not covered by OHIP. Some patients might lie about not having private insurance but pharmacy can't possibly detect about it.

For a single senior with an annual income of more than $22,200, they must pay a $100 deductible every year starting August 1. Once the deductible is reached, they pay a $6.11 co-pay for all eligible Rx's. The pharmacy can waive it from $6 to $4 per Rx for ALL ODB patients. Each and every drug that’s filled, they get to pay back for each one. 10 drugs, each drug $2 -> owe $20. Can't pay $6 for 25 drugs in 3 months -> may apply to low income but also that’s the _______ decision, not ours.

OHIP+ provides prescription drug coverage for individuals 24 years of age and younger WITHOUT private drug coverage. No enrollment or application needed. Must present valid health care to pharmacy. No deductible or co-pay. Responsibility belongs to pharmacy team to confirm whether the patient has other coverage before filling Rx. Special Service Code (SSC) = U (No Private Insurance Attestation). Communicated to ODB that the patient does not have other coverage & is eligible for OHIP+ benefits. Required to be included on ALL claims for an eligible patient. Failure to include code will result in claim being rejected. Parents can either have private insurances for their kids from work or to buy their own insurance plans from their own self-employment. If they have private insurance, but that insurance doesn’t cover for the drug. Private plan has deductible, co-pay, or premium. Annual maximum coverage has been reached & the patient has no further drug coverage for the remaining time-period. All still not covered by OHIP. Some patients might lie about not having private insurance but the pharmacy can't possibly detect about it.

Single senior with annual income of more than $22,200 Senior couple with combined annual income of more than $37,100 Pay $100 deductible every year starting August 1 Once deductible is reached, pay $6.11 co-pay for all eligible Rx's Pharmacy can wave it from 6 dollars to 4 dollars per Rx for ALL ODB patients (no biased), it’s a store policy or it’s not. Each and every drug that’s filled, they get to pay back for each one. 10 drugs, each drug 2 dollars -> owe 20 dollars. Can't pay 6 dollars for 25 drugs in 3 months -> may apply to low income but also that’s the _______ decision, not ours.

OHIP+ provides prescription drug coverage for individuals 24 years of age and younger WITHOUT private drug coverage. No enrollment or application needed. Must present valid health care to ______. No deductible or co-pay. Responsibility belongs to ______ team to confirm whether patient has other coverage before filling Rx. Special Service Code (SSC) = U (No Private Insurance Attestation). Communicated to ODB that patient does not have other coverage & is eligible for OHIP+ benefits. Required to be included on ALL claims for an eligible patient. Failure to include code will result in claim being rejected. Parents can either have private insurances for their kids from work or to buy their own insurance plans from their own self-employment. If they have private insurance, but that insurance doesn’t cover for the drug. Private plan has deductible, co-pay, or premium. Annual maximum coverage has been reached & patient has no further drug coverage for the remaining time-period. All still not covered by OHIP. Some patients might lie about not having private insurance but ______ cant possible detect about it.

Provides prescription drug coverage for individuals 24 years of age and younger WITHOUT private drug coverage. No enrollment or application needed. Must present valid health care to ______. No deductible or co-pay. Responsibility belongs to pharmacy team to confirm whether patient has other coverage before filling Rx. Special Service Code (SSC) = U (No Private Insurance Attestation). Communicated to ODB that patient does not have other coverage & is eligible for OHIP+ benefits. Required to be included on ALL claims for an eligible patient. Failure to include code will result in claim being rejected. Parents can either have private insurances for their kids from work or to buy their own insurance plans from their own self-employment. If they have private insurance, but that insurance doesn’t cover for the drug. Private plan has deductible, co-pay, or premium. Annual maximum coverage has been reached & patient has no further drug coverage for the remaining time-period. All still not covered by OHIP. Some patients might lie about not having private insurance but pharmacy cant possible detect about it.

Failure to include code will result in claim being ______.

Parents can either have private insurances for their kids from work or to buy their own insurance plans from their own ______.

Some patients might lie about not having private insurance but ______ cant possible detect about it.

Annual maximum coverage has been reached & patient has no further drug coverage for the remaining ______.