NIPT is available to all pregnant individuals in Ontario but will only be covered by Ontario Health Insurance Plan (OHIP) if one of the specific criteria is met at the time of blood draw. For patients that do not meet the requirements, NIPT can be paid for out of pocket. Some personal health insurance plans cover the cost of NIPT. 

Important:  Temporary changes to OHIP-funding for NIPT are in effect , and these will be applicable from April 6, 2020 until March 31, 2022. 

OHIP will fund NIPT if:

Category I criteria (can be ordered by any physician or nurse practitioner for singletons and temporarily for twin pregnancies)

• a positive prenatal screening result from multiple marker screening (MMS) for this pregnancy
• the maternal age will be 40 years or older at the expected date of delivery
  • in the context of in vitro fertilization,  the maternal age is guided by the age at egg retrieval (whether own egg or donor egg)
• the nuchal translucency (NT) measurement is ≥3.5mm
• there is a personal history of a previous pregnancy or child with Trisomy 21, 18 or 13
• exceptional funding due to COVID-19 pandemic for any twin pregnancy where either
  • NT ultrasound is unavailable OR
  • when the maternal age will be 35 years or older at the expected day of delivery. In the context of in vitro fertilization,  the maternal age is guided by the age at egg retrieval (whether own egg or donor egg)

If you meet one of these requirements, your health care provider can use the OHIP-funded requisition for testing. 

Please note that the requisitions have NOT been updated with the additional guidelines implemented due to the COVID-19 pandemic, since these changes are temporary. If your patient is eligible for OHIP-funded NIPT based on one of the temporary criteria, specify that on the MOH checklist section of the requisition. 

Category II criteria (must be ordered by a genetics or maternal-fetal medicine specialist for singletons and twin pregnancies)

• there are findings on ultrasound which are associated with an increased chance for trisomy 21, trisomy 18 or trisomy 13
• there is chance for a sex-linked genetic condition
• the ultrasound shows findings suggestive of a sex chromosome difference
• the ultrasound shows findings suggestive of a disorder of sex determination

If you meet one of these requirements, your health care provider can use the OHIP-funded requisition for testing.

Please note that in order for NIPT to be funded by OHIP, the pregnant person must meet the eligibility criteria at the time that the testing is performed. If none of the above funding criteria is met at the time of blood draw, the test is not medically necessary nor insured, and therefore reimbursement cannot be issued by the lab.

You can consider pursuing MMS (eFTS or MSS) as the first step before deciding to pay out-of-pocket for NIPT. A screen positive results from MMS prior to NIPT blood draw would allow for the NIPT to be funded by OHIP.

For additional information, the Health Insurance Act (HIA) and the Commitment to the Future of Medicare Act (CFMA) are available on the government website at www.e-laws.gov.on.ca. You may contact the CFMA program at 1-888-662-6613 or by email at protectpublichealthcare@ontario.ca if you have further questions or feel that you have been charged for a service that is insured.