Understanding Insurance

Key Takeaways

Felix provides direct billing to your benefits or insurance provider, so that you don’t have to worry about things like prescription receipts or submitting insurance claims.
Coverage varies greatly between providers and is different depending on your province. It’s best to upload any private benefit and provincial health card during your online visit, so Felix’s pharmacy partner can apply any coverage you may have.
In Canada, it’s not possible to pre-adjudicate to determine precise coverage, so you should speak to your insurance provider to determine coverage for specific medications.

At Felix, our mission is to make your life easier and that includes things like taking away the stress of holding onto prescription receipts and submitting insurance claims. We’ll take care of direct billing with your benefits/insurance provider (in accordance with your specific coverage), so all you have to do is provide us with your insurance information and we’ll take care of the rest!

We know health insurance isn’t necessarily a sexy topic but we’ve heard you loud and clear: it’s important when you’re thinking about personal health and medication. Take a look at our most commonly asked questions to better understand how insurance works when getting your medication through Felix.

Where can I add or update my insurance information?

Depending on what stage you are at in the process there are different ways to let us know that you have private or provincial coverage. We aim to make it as easy as possible to provide this information, but if you need a hand, here are the steps to follow.

If you’re submitting a new online visit:

If you’re new to Felix (welcome!) and are in the process of submitting a new online visit, you will be prompted during the assessment to provide your insurance details. Just upload a picture of your insurance card and this will be automatically applied while your prescription is processed by our pharmacy partner, once approved. If you don’t have your insurance information with you when you are completing your online visit, you can always add this to your profile later (prior to your first fill being processed) or pass it on to our pharmacy partner when they call you to discuss important health and safety information.

If you already have an active prescription with us:

If your insurance information has changed, you can let us know at any time by uploading this information to your account. This can be done from the Billing tab of your account, by scrolling down to the bottom of the page and uploading or taking a picture of the front and back of your insurance card in this space:

Once you have uploaded this, our pharmacy partner will be informed of this change and will apply your insurance for your next fill, in line with your coverage.

If your insurance provider needs a healthcare practitioner to fill out a form:

Your insurance provider requires a healthcare practitioner to fill out a form before they will cover your treatment. This can be done at the discretion of the Felix medical team. Please email hello@felixforyou.ca to make a request and attach all applicable forms with the Patient/Plan member sections filled out and signed. If the healthcare practitioner agrees to complete the form, a $25 fee per page to be completed will apply.

What's covered by my insurance or provincial health plan?

Medication coverage varies greatly between different plans, provinces and has specific criteria that determine eligibility. We recommend that you upload your private benefit card or provincial health card during the online visit so that our pharmacy partner can apply any coverage you are eligible for before shipping your meds. Unfortunately in Canada, it’s not possible to pre-adjudicate in order to determine your precise coverage, so we recommend that you check with your specific insurance provider to better understand your coverage.

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Some resources and information about provincial health plan coverage:

‍Did you know? As of April 1, 2019, OHIP now covers birth control for all women in Ontario who are under 25 years old that do not have private insurance. Make sure to upload your OHIP card during your Felix online visit so that the pharmacy can apply your coverage.