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Employee benefits: Government health insurance and employer benefit plans

employee benefitsBenefits are always a hot topic in employment law. My 2012 post on benefits during the notice period remains my most read post.

On January 1, 2018 the Ontario Health Insurance Plan (OHIP) introduced Children and Youth Pharmacare, drug coverage for children and youth, who are otherwise covered by OHIP and aged 24 and under. In this post we will look at the intersection between government benefits and private drug plans and the impact of this change.

Our US readers may picture Canada as a free health care utopia with free medications, dentist visits and massages for everyone! While many health services are covered, many are not, which is where employee health benefits come in.

What does OHIP cover?

OHIP is the Ontario health insurer. Ontarians have health cards, which they present at the doctor, or x-ray clinic, or emergency room, etc., as proof that they are insured by the Province. Similar systems exist in Canada’s other provinces and territories. Delivery of health services is the jurisdiction of the provinces and territories and not the federal government. Using Ontario as an example, visitors and some categories of immigrants may not be able to access Ontario’s health care, because they are not insured by the province.  

OHIP covers most basic medical and emergency services. This includes visits to the family doctor, visits to the ER, walk-in clinic visits, necessary tests and surgeries. If you have to stay in the hospital OHIP will cover the cost of the stay and any medications administered to you in the hospital.

What does my employee need private health insurance for?

You might be thinking, that sounds pretty good and why would my Ontario employees need health benefits at all? The big categories of things that OHIP does not cover are prescription drugs once you are out of the hospital (though now just for those over 24), dental services and eyeglasses. In most cases, Ontarians who require an ambulance will also be required to pay a portion of the cost of the trip. Many depend on employer-provided health benefits to subsidize the costs of necessities that OHIP does not cover, which as our US readers well know, can be substantial.

Take aways

Health and Dental Benefits are valuable to employees, even in the land of free health care. This is especially true for those employees who have dependants, as benefit plans will typically insure the employee’s family. Now that most medications will be covered for OHIP insureds 24 and under, the necessity of private benefits for kids has gone down. However, employees will still depend on private benefits for dental care and eyeglasses for themselves and their children.

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Lisa Stam, Spring Law

Founder of Spring Law, Employment and Labour Lawyer at Spring Law
Lisa Stam is founder of Spring Law, a virtual law firm advising exclusively on workplace legal issues for employers and executives. She practices all aspects of employment, labour, privacy, and human rights law, with a particular interest in legal issues arising from technologyinthe workplace. Lisa’s practice includes a wide range of entrepreneurs in the tech space, as well as global companies with smaller operations in Canada. In addition to the day to day workplace issues from hiring to firing, Lisa frequently blogs and speaks on both the impact, risks and opportunities of social media andtechnology issues in (and out of) the workplace, as well as the novel ways in which changing expectations of privacy continues to evolve employment law. Read more here.
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