How Provincial Drug Plans Work
Ontario’s Trillium Drug Program helps cover the cost of drugs for those who don’t have coverage under a benefits plan. It reimburses any drug expenses above and beyond a deductible equal to 4% of the family’s after-tax household income.
Let's say an Ontario family's after-tax household income is $100,000 a year. This means their total annual Trillium deductible (the amount they have to pay before coverage kicks in) would be $4,000.
The Trillium deductible is split quarterly, so this family would have to pay $1,000 of their drug costs out-of-pocket each quarter. Trillium would cover the rest.
For example, if their drug cost ends up being $20,000 for the first quarter, they would still only pay $1,000 out of pocket.
Compare that to an insured drug plan
Now, let's say this family had an insured drug plan through one of their employers. They would no longer be eligible for the Trillium plan, which changes this scenario.
Ready for some more numbers?
More often than not, group benefits plans require employees pay 20% of the drug costs out of pocket, while the employer pays 80%. This means that if the drug expense was $20,000 in the first quarter, the family would have to pay $4,000 out of pocket before their coverage kicks in.
That’s right. With a group benefits plan they have to pay it all up front, and certainly aren’t getting any savings.
If the family had a lower household income, their out-of-pocket costs under the Trillium program would be lower (because their deductible is based on income) while their costs under a group benefits plan would be the same (because they’re based on the drug cost).
Say what!? We bet you thought group benefits plans were supposed to save you money…
The more you know…
As you can see from the above scenario, insured drug plans in Canada aren't always the best choice. That's why we're here to help.
We'll show you how to get drug costs covered without unexpected price increases with our Group Benefits plans.
That's how we're made for you.
