Trillium and private-plan vacation supply
TDP vacation claim calendar
For travel outside Ontario lasting 100–200 days.
- One per benefit year One early vacation supply under this rule.
- Up to 100 extra days Beyond the regular maximum.
- Keep travel proof Signed dates or accepted travel documents.
Regular ODB and quarter rules
Most ODB prescriptions can be dispensed for up to 100 days at one time; some first fills or trial supplies are limited to 30 days. The TDP vacation provision is a separate exception for a specific long absence outside Ontario.
ODB does not pay pharmacies outside Ontario. Resolve the supply and documentation before departure whenever possible.
Private-plan routes: TELUS and ESI
| Network | Current manual route | If the plan limits the claim |
|---|---|---|
| TELUS Health Assure | Submit one claim with the correct quantity and day supply using MV. Many plans use maintenance and non-maintenance day-supply limits, but group settings can differ. | The response may reduce the payable quantity. Explain the remaining cost and follow the plan's manual-submission route when applicable. |
| Express Scripts Canada | The member should obtain Sponsor authorization before the vacation claim where the plan requires it. | Without approval, the excess supply may need to be paid by the member and submitted manually, subject to plan rules. |
Calculate and document the travel gap
Simple calculation
Supply on departure = quantity supplied − estimated quantity used.
Uncovered travel days = days away − supply on departure.
-
Travel dates.
Record departure, return, and whether the patient leaves Ontario. -
Medication on hand.
Confirm the last fill, directions, remaining quantity, and real gap. -
Payer requirement.
Keep the letter, itinerary, authorization, or call reference the plan requires. -
Final response.
Record the quantity submitted, amount paid, cutback, and patient explanation.