NIPT Funding Criteria

NIPT is available to all pregnant individuals in Ontario but will only be publicly funded if one of the specific criteria is met at the time of blood draw. If you do not meet any of the requirements, NIPT can be paid for out-of-pocket. Some personal health insurance plans cover the cost of NIPT. 

NIPT is publicly funded if:

Category I criteria (can be ordered by any physician or nurse practitioner)

• 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
• there is an ongoing twin pregnancy 

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

Category II criteria (must be ordered by a genetics or maternal-fetal medicine specialist)

• 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 practitioner can use the publicly-funded requisition for testing.

Please note that you must meet the eligibility criteria at the time that the testing is performed in order for NIPT to be publicly funded. 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.

More Information

If you have questions regarding eligibility for publicly-funded NIPT, please contact Prenatal Screening Ontario toll-free at 1-833-351-6490 or by email at PSO@BORNOntario.ca.

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. If you feel that you have been charged for an insured service, you may contact the CFMA program at 1-888-662-6613 or by email at protectpublichealthcare@ontario.ca.