NIPT Funding Criteria | Prenatal Screening Ontario

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. In Ontario, LifeLabs and Dynacare offer publicly-covered NIPT. Your health-care provider will give you a requisition form to take to the lab for testing.

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, midwife or nurse practitioner)

there is 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 provider 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 provider 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.

Private-Pay NIPT

You can choose to pay for private-pay NIPT if you do not meet any of the criteria. This means that you would pay for this testing yourself, or you may get it covered through your private health insurance.

If you have not had any screening in your pregnancy, you can consider starting with an publicly-funded prenatal screening test (eFTS or STS) before deciding to pay out-of-pocket for NIPT. A "screen positive" result from one of these other tests would make it possible for you to have publicly-funded NIPT.

Take note that if you are paying for NIPT out-of-pocket, and later in the pregnancy you meet one of the funding criteria, you will not be able to get a refund.

In Ontario, private-pay NIPT is available through the Ontario-based laboratories (LifeLabs or Dynacare), as well as through other laboratories based outside of Canada (blood samples and personal health information is sent out of the country, where the testing is performed).

Prenatal Screening Ontario is unable to endorse any specific private-pay test or laboratory. If you are interested in pursuing private-pay NIPT, please talk to your health-care practitioner about which test might be best for you.

Here are some questions you or your provider can ask if you are thinking to have private-pay NIPT:

Does the laboratory have information available on how well the test performs for each of the screened chromosome differences? Has this information been published in a trusted scientific journal where it was reviewed by other experts?
What is the process for ordering NIPT at the laboratory? Can the blood draw be done in your area?
Can the testing be limited to trisomy 21, trisomy 18, trisomy 13 and sex chromosome differences? Canadian and international guidelines do not currently support the use of NIPT to screen for other conditions because the accuracy is less well known.
What is the cost of NIPT?
Is genetic counselling available by the NIPT testing company before and/or after you have NIPT to help you understand the test and results?
If the testing is performed outside of Canada, how does the out-of-country laboratory manage and protect your personal health information?

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.