Extended Health Benefits

Ontario Regulation 134/98

57.1 If a person is not eligible for income assistance for a month because the income of the person’s benefit unit, as determined under this Regulation, exceeds or is equal to the benefit unit’s budgetary requirements, as determined under this Regulation, the benefit set out in each subparagraph of paragraph 1 and in paragraph 1.1 of subsection 55 (1) shall be paid with respect to each member of the person’s benefit unit if,

  • the person is a recipient in the month immediately before becoming eligible for this benefit;
  • the person is otherwise eligible for income assistance;
  • the administrator is satisfied that the member of the benefit unit meets the criteria for the benefit, as set out in the subparagraph or paragraph, as the case may be; and
  • the benefit unit’s income, as determined under this Regulation, is less than the sum of its budgetary requirements, as determined under this Regulation, and the value of its benefits under paragraphs 1 and 1.1 of subsection 55(1).

Highlights

Eligibility

  • Eligible for social assistance in the month preceding application for these benefits;
  • Left social assistance system with income (any source); and
  • Cost of the requested health benefit exceeds the amount of excess income.

Health Benefits

  • Prescription drugs, not including the co-payment that a member of the benefit unit is charged under the Ontario Drug Benefit Act;
  • Vision care for dependent children;
  • Cost of diabetic supplies, surgical supplies and dressings, and medical transportation costs over $15;
  • Consumer co-payment for Assistive Device Program (ADP);
  • Cost of assessment to determine eligibility for ADP;
  • Cost of batteries and necessary repairs for mobility devices; and
  • Routine eye examinations once in every 24 month period.

Note: Dental coverage for dependent children aged 0 – 17 is provided through the Healthy Smiles Ontario program.

Trillium Drug Plan

People receiving assistance with prescription drug costs should apply to the Trillium Drug Plan (TDP) administered by the Ministry of Health and Long-Term Care for on-going needs.

Read a summary of the Extended Health Benefit and how to apply.

Ontario Regulation 134/98

57.2 (1) This section applies where a person in receipt of income assistance one month ceases to be eligible for income assistance the following month due to the fact that,

a. a member of the person’s benefit unit has begun employment or there has otherwise been an increase in the income from employment of a member of the benefit unit; and

b. as a result of the increase in income from employment, the income of the benefit unit, as determined under this Regulation, has exceeded or become equal to the benefit unit’s budgetary requirements, as determined under this Regulation.

(2) The benefit set out in each subparagraph of paragraph 1 and in paragraph 1.1 of subsection 55 (1) shall be paid to or on behalf of a person referred to in subsection (1) with respect to each member of the person’s benefit unit for the period referred to in subsection (5) if,

a. the person meets the conditions relating to eligibility for income assistance referred to in clauses 7 (3) (a), (c) and (d) of the Act;

b. the person is not eligible to receive a benefit under section 57.1;

c. the administrator is satisfied that the member of the benefit unit meets the criteria for the benefit, as set out in the subparagraph or paragraph, as the case may be; and

d. the costs of the services, supplies, appliances, drugs, items or of other payments described in the subparagraph or paragraph, as the case may be, and incurred with respect to the member of the benefit unit in question are not recoverable, in whole or in part, under a benefit plan available from an employer of a member of the benefit unit.

(3) A delivery agent may pay or provide one or more of the discretionary benefits described in subsection (4) to or on behalf of a person referred to in subsection (1) if,

a. the person meets the conditions relating to eligibility for income assistance referred to in clauses 7 (3) (a), (c) and (d) of the Act; and
b. the discretionary benefits are not recoverable, in whole or in part, under a benefit plan available from an employer of a member of the benefit unit. O. Reg. 360/05, s. 3.

(4) The following are the discretionary benefits that may be paid or provided under subsection (3):

  1. The cost of dental services provided to members of the benefit unit other than dependent children.
  2. The cost of eye-glasses for members of the benefit unit other than dependent children.
  3. The cost of one or more prosthetic appliances, other than eye-glasses, for members of the benefit unit.
  4. Any other special service, item or payment authorized by the Director if the service or item are related to the health of a member of the benefit unit or the payment is for the benefit of the health of a member of the benefit unit.

(5) The period during which a person is eligible to receive benefits under this section begins on the day on which the person ceases to be eligible for income assistance in accordance with subsection (1) and ends on the last day of the month that is six months after the month in which the period began.

(6) Despite subsection (5) and subject to subsection (7), the administrator may extend the period during which a person is eligible to receive benefits under this section by an additional six months if the administrator is satisfied that not to do so may be harmful to the health of a member of the benefit unit or may jeopardize the employment of a member of the benefit unit.

(7) During the additional six-month period of eligibility for benefits under this section, the benefits which a person is eligible to receive shall be as provided in subsections (2) and (3) subject to the following changes:

  1. The cost of drugs referred to in subparagraph 1 i of subsection 55 (1) shall not be included in the benefits.
  2. The person shall be entitled to any amounts spent with respect to each member of the benefit unit that constitute allowable expenses within the meaning of paragraph 2 of subsection 3 (1) of Ontario Regulation 201/96 made under the Ontario Drug Benefit Act.

(8) A person who is entitled to receive a benefit under paragraph 2 of subsection (7) is not a person entitled to receive drug benefits under the Ontario Works Act, 1997 for the purposes of subsection 2 (2) of the Ontario Drug Benefit Act.

Highlights

Eligibility

  • Eligible for social assistance in the month preceding application for these benefits;
  • Left social assistance system with employment income; and
  • Items not covered through employee benefits at job.
  • Eligible for six months or receives employee benefits whichever comes first
  • EEHB can be extended for a further six months if item not covered through employment.
  • In second six months, eligible for health benefits and health-related discretionary benefits except for prescription drugs where only the cost of the deductible for Trillium Drug Plan (TDP) can be paid.

Health Benefits

  • Prescription drugs, not including the co-payment that a member of the benefit unit is charged under the Ontario Drug Benefit Act;
  • Vision care for dependent children;
  • Cost of diabetic supplies, surgical supplies and dressings, and medical transportation costs over $15;
  • Consumer co-payment for Assistive Device Program (ADP);
  • Cost of assessment to determine eligibility for ADP;
  • Cost of batteries and necessary repairs for mobility devices; and
  • Routine eye examinations once in every 24 month period.

Note: Dental coverage for dependent children aged 0 – 17 is provided through the Healthy Smiles Ontario program.

Health-Related Discretionary Items

  • Dental and vision care for adults;
  • Prosthetic appliances; and
  • Any other special service, item or payment if related to the health of a benefit member.

Trillium Drug Plan

People receiving assistance with prescription drug costs should apply to the Trillium Drug Plan (TDP) administered by the Ministry of Health and Long-Term Care for on-going needs.

Read a summary of the Extended Employment Health Benefit and how to apply

Ontario Regulation 134/98

58. If a person is not eligible for income assistance for a month because the income of the person’s benefit unit, as determined under this Regulation, exceeds or is equal to the benefit unit’s budgetary requirements, as determined under this Regulation, the benefit set out in subparagraph 1 i of subsection 55 (1) shall be paid with respect to each member of the person’s benefit unit if,

(a) the person is otherwise eligible for income assistance;

(a.1) the administrator is satisfied that the member of the benefit unit meets the criteria for the benefit, as set out in the subparagraph;

(b) the benefit unit’s income, as determined under this Regulation, is less than the sum of its budgetary requirements, as determined under this Regulation, and the value of its benefit under subparagraph 1 i of subsection 55 (1);

(c) the person or his or her spouse included in the benefit unit has applied for income support under the Ontario Disability Support Program Act, 1997 and that application has not been finally disposed of;

(d) the person or his or her spouse included in the benefit unit suffers from a condition listed in subsection 8 (2) of Regulation 552 of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act; and

(e) the person or his or her spouse included in the benefit unit has not previously applied for and been refused eligibility for benefits under,

(i) the Ontario Disability Support Program Act, 1997,

(ii) clause 7 (1) (a), (b), (c) or (e) of the Family Benefits Act, or

(iii) subsection 2 (5) of Regulation 366 of the Revised Regulations of Ontario, 1990 made under the Family Benefits Act.

Highlights

Eligibility

There is provision for Extended Health Benefit (high drug costs) for persons who meet all the following criteria:

  • their income exceeds budgetary requirements;
  • their income is less than the sum of their budgetary requirements and their monthly prescription drug costs;
  • they or their spouse has applied for Ontario Disability Support Program (ODSP);
  • they or their spouse suffers from a catastrophic illness listed in the Health Insurance Regulation and they have the matching prescribed drug. A complete listing can be found in OW Directive 11.0 ODSP Referrals.; and
  • they or their spouse have not been refused eligibility for benefits under ODSP Act, or as permanent ill health/disabled and aged under the Family Benefits Act (FBA).

Health Benefits

prescription drugs, not including the co-payment that a member of the benefit unit is charged under the Ontario Drug Benefit Act.

Trillium Drug Plan

People receiving assistance with prescription drug costs should apply to the Trillium Drug Plan (TDP) administered by the Ministry of Health and Long-Term Care for on-going needs.

Read a summary of the Extended Health Benefit and how to apply

Ontario Regulation 134/98

58.1 If a person is not eligible for income assistance for a month because the income of the person’s benefit unit, as determined under this Regulation, exceeds or is equal to the benefit unit’s budgetary requirements, as determined under this Regulation, the benefit set out in each subparagraph of paragraph 1 and in paragraph 1.1 of subsection 55 (1) shall be paid with respect to each member of the person’s benefit unit if,

(a) the person is otherwise eligible for income assistance;

(a.1) the administrator is satisfied that the member of the benefit unit meets the criteria for the benefit, as set out in the subparagraph or paragraph;

(b) the reason income exceeds or is equal to budgetary requirements is that a member of the person’s benefit unit received a loss of income payment or a loss of support payment under the 1986-1990 Hepatitis C Settlement Agreement made as of June 15, 1999 among the Attorney General of Canada, Her Majesty the Queen in right of Ontario and others; and

(c) on April 1, 1999 the person was,

(i) a member of a benefit unit under this Act,

(ii) a member of a benefit unit under the Ontario Disability Support Program Act, 1997, or

(iii) a recipient or beneficiary under the Family Benefits Act

Highlights

Eligibility

A participant who receives payment for loss of income or support under the 1986-1990 Hepatitis C Settlement Agreement who as a result is ineligible for financial assistance will be eligible for extended health coverage if the following criteria are met:

  • the person’s ineligibility is the direct result of receiving payments for loss of income or loss of support under this Agreement;
  • the person is otherwise eligible for assistance in the month; and
  • on April 1, 1999, the person was a member of the benefit unit under the Ontario Works Act, the Ontario Disability Support Program Act or the Family Benefits Act.

Health Benefits

  • Prescription drugs, not including the co-payment that a member of the benefit unit is charged under the Ontario Drug Benefit Act;
  • Vision care for dependent children;
  • Cost of diabetic supplies, surgical supplies and dressings, and medical transportation costs over $15;
  • Consumer co-payment for Assistive Device Program (ADP);
  • Cost of assessment to determine eligibility for ADP; and
  • Cost of batteries and necessary repairs for mobility devices; and
  • Routine eye examinations once in every 24 month period.

Note: Dental coverage for dependent children aged 0 – 17 is provided through the Healthy Smiles Ontario program.

Trillium Drug Plan

People receiving assistance with prescription drug costs should apply to the Trillium Drug Plan (TDP) administered by the Ministry of Health and Long-Term Care for on-going needs.

Read a summary of the Extended Health Benefit and how to apply

Ontario Regulation 134/98

58.2 (1)    This section applies where a person in receipt of income assistance one month ceases to be eligible for income assistance the following month due to the fact that,

(a) a member of the person’s benefit unit has received a payment made under the Better Jobs Ontario program that is administered by the Ministry of Labour, Training and Skills Development; and

(b) as a result of the payment received under the Better Jobs Ontario program, the income of the person’s benefit unit, as determined under this Regulation, has exceeded or become equal to the benefit unit’s budgetary requirements, as determined under this Regulation.

(2)    The benefits set out in each subparagraph of paragraph 1 and in paragraph 1.1 of subsection 55 (1) shall be paid with respect to each member of the person’s benefit unit for the period described in subsection (3) of this section if,

(a) the person meets the conditions relating to eligibility for income assistance referred to in clauses 7 (3) (a), (c) and (d) of the Act;

(b) the administrator is satisfied that the member of the benefit unit meets the criteria for the benefit, as set out in the subparagraph or paragraph, as the case may be; and

(c) the costs of the benefits are not otherwise reimbursed or subject to reimbursement.

(3)    The period during which the person is eligible to receive benefits under subsection (2) begins on the day on which the person ceases to be eligible for income assistance in accordance with subsection (1) and ends on the earlier of,

(a) the last day of the month before the month in which the person becomes eligible for income assistance or income support under the Ontario Disability Support Program Act, 1997; and

(b) the last day of the month in which a member of the benefit unit receives their last payment under the Better Jobs Ontario program.

Highlights

Eligibility

  • Income from Better Jobs Ontario resulted in OW ineligibility
  • Other Ontario Works eligibility criteria, such as OW asset limits or income criteria, do not have to be met (i.e. no budgetary test for health care costs)
  • Eligible for the duration of the program, regardless of the individual’s ongoing medical needs (example: can have a month without any medical needs)

Health Benefits

  • Prescription drugs, not including the co-payment that a member of the benefit unit is charged under the Ontario Drug Benefit Act;
  • Vision care for dependent children
  • Cost of diabetic supplies, surgical supplies and dressings, and medical transportation costs over $15;
  • Consumer co-payment for Assistive Device Program (ADP);
  • Cost of assessment to determine eligibility for ADP;
  • Cost of batteries and necessary repairs for mobility devices; and
  • Routine eye examinations once in every 24 month period.

Note: Dental coverage for dependent children aged 0 – 17 is provided through the Healthy Smiles Ontario program.

People receiving Extended Health Benefits are not eligible for other benefits.

Trillium Drug Plan

People receiving assistance with prescription drug costs should apply to the Trillium Drug Plan (TDP) administered by the Ministry of Health and Long-Term Care for on-going needs.