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Fair PharmaCare - Monthly Deductible Payment Option
Many individuals and families do not have a deductible under the Fair PharmaCare plan and PharmaCare assists them with their eligible prescription costs right away.
However, some families have a deductible based on their family net income. PharmaCare offers a payment option to help these individuals and families.
Once enrolled in the Monthly Deductible Payment Option, families pay their Fair PharmaCare deductible in monthly installments and receive PharmaCare assistance with eligible prescription costs right away. This opportunity is entirely optional.
Information on the Monthly Deductible Payment Option is available in English, French, Chinese and Punjabi.
Who is eligible to enrol in the Monthly Deductible Payment Option?
Families who:
- are registered for Fair PharmaCare
- do not have private health insurance that includes a drug benefit plan
- have a deductible greater than $0
Note that the option will not benefit you if your annual prescription costs are less than your deductible or if your deductible is $0.
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Enrolment in the Monthly Deductible Payment Option is not permitted for families who have private health insurance coverage that includes a drug benefit plan. If your private health insurer contributes to your prescription costs, enrolling in the Monthly Deductible Payment Option could complicate or delay your private health benefits. |
If you enrol and later begin receiving private health insurance that includes a drug benefit plan, you need to cancel your enrolment.
How does the payment option work?
Here is an example of how the Monthly Deductible Payment Option might benefit a family:
Brenda and John's prescription costs are about $2,200 each year. Their Fair PharmaCare deductible, based on their combined annual income, is $1,200. Currently, Brenda and John have to pay the $1,200 deductible towards eligible prescription costs before PharmaCare begins contributing 70% of the cost of each prescription.
Under the Monthly Deductible Payment Option, Brenda and John would pay $100 towards their deductible each month. PharmaCare would begin paying 70% of eligible prescription costs from the date their enrollment was processed. Brenda and John would pay only 30% of their eligible prescription costs at the pharmacy until their annual family maximum is reached
What will I pay at the pharmacy after I enrol?
Once you are enrolled, your prescription claims will be processed as though you had met your deductible; that is, you will be responsible for the co-payment amountuntil your payments towards eligible prescription costs reaches your annual family maximum. Note: Patients remain responsible for payment for non-benefit products.
What if I get private health insurance with a drug benefit plan partway through the year?
You need to cancel your enrolment by contacting PharmaCare
If I enrol but then discover the option is not to my benefit, can I cancel my enrolment?
Yes. You can cancel your enrolment at any time by contacting PharmaCare.
If you cancel, early in the following year, PharmaCare will reconcile your account for the preceding year and a statement will be issued. You will receive a refund if you have paid more than your required contribution under the Fair PharmaCare plan. You must keep both the statement and your prescription receipts if you wish to submit your prescription costs as medical expenses on your income tax return.
What happens if my prescription costs end up being lower than my deductible?
Early in the following year, PharmaCare will reconcile your account for the preceding year and a statement will be issued. You will receive a refund if you have paid more than your required contribution under the Fair PharmaCare plan. You must keep both the statement and your prescription receipts if you wish to submit your prescription costs as medical expenses on your income tax return.
What methods of payment can I use to make monthly payments?
If you choose to enrol in the Monthly Deductible Payment Option, you can elect to:
- receive a bill each month (payable on the 15th of the month); or
- have your monthly payment automatically debited from your account at a bank or financial institution.
If I enrol, do I need to report changes in my family structure to PharmaCare?
Yes. In cases of marriage, separation or divorce, advise PharmaCare of the change in your family structure. Our staff will review the options with you (for example, modification to your monthly payment amount or account reconciliation).
When should I enrol?
You may enrol in the Monthly Deductible Payment Option for the current calendar year by contacting PharmaCare anytime up to September 30.
After September 30, you can request enrollment for the following year.
How long does it take to enrol?
When you call PharmaCare, our staff will first help you to ensure that the Monthly Deductible Payment Option is right for you. If it is, we will mail you an enrolment package. After you receive and review the enrolment documents, you will then mail or fax the necessary form(s) to PharmaCare.
Your enrolment will be processed two to three business days after we receive the forms.
How do I enrol?
For more information, or to enrol in the Monthly Deductible Payment Option, contact PharmaCare.
Last Revised: August 22, 2008
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