ARM Health Insurance – Frequently Asked Questions

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If you don't see the answer to your question, please contact an OTIP life and living benefits sales representative at 1-800-267-6847.

Prescription Drugs Questions

What is the deductible?

The deductible is the maximum amount you must pay out of your own pocket in addition to your plan premium before your prescription drugs become eligible for reimbursement.

 

If your drug plan carries a $25 deductible, this means you will be required to spend $25 of your own money on prescriptions before your drug expenses become eligible for reimbursement.


Are dispensing fees covered?

Although dispensing fees are usually included in the total cost of purchasing drugs, they are your responsibility under the ARM plans. Charged by pharmacies to prepare your prescription, dispensing fees can reach as high as $12 per prescription. Some pharmacies have lower dispensing fees, so shop around to see where you can get the best rate.
 
By signing up for the Express Scripts Canada Pharmacy home delivery program, not only will you benefit from a low dispensing fee of $9, but you will also receive 100% coverage for your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). Visit www.member.express-scripts.ca/ for more information and to register for home delivery.


Do I have to pay upfront for prescription drugs and wait for reimbursement?

No – all ARM health plans provide you with a pay-direct drug plan. You will receive a benefits card that you can present to your pharmacist. The pharmacist will bill the Insurer electronically for their portion of the drug costs. You need only pay for your portion, the dispensing fee and any deductible that applies if you choose ARM Economy or ARM Original.


What if I have high drug costs?

Ontario's Trillium Drug Plan provides prescription drug coverage to individuals/families that have high drug costs in relation to their income and do not meet the eligibility criteria for the Ontario Drug Benefit Program.

View our information flyer on the Trillium Drug Program.


Why do I need drug coverage over age 65?

All ARM plans will pay for a portion of the $100 Ontario Drug Benefit (ODB) deductible charged to most Ontario residents under the ODB program. The ARM health plans pay for several hundred more prescription drugs that are not covered by the government formulary.

 
 

OSSTF   60 Mobile Drive, Toronto, ON   M4A 2P3   1-800-267-7867  |  www.osstf.on.ca
OTIP   125 Northfield Drive West, Waterloo, ON   N2L 6K4   1-800-267-6847  |  www.otip.com