Restoration of Hard Cap threshold limits effective October 1, 2021

To: Primary Care Patient Enrolment Model (PEM) Physicians
Blended Salary Model (BSM), Family Health Network (FHN), Family Health Organization (FHO), and Group Health Centre (GHC)
Category: Primary Health Care Services
Written by: Negotiations Branch, OHIP, Pharmaceuticals and Devices Division
Date Issued: October 7, 2021

Temporary Physician Funding Related to COVID-19

To ensure patients continue to access the heath care they need through the gradual reopening of the province and roll out of the COVID-19 vaccine, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) have reached an agreement to extend existing temporary physician funding initiatives under the Ontario Health Insurance Plan (OHIP) to September 30, 2022, as outlined below.

Further to INFOBulletin #210704, this INFOBulletin is intended to advise of the changes to Fee-For-Service Ceiling (Hard Cap) threshold limits in Primary Care agreements for physicians in the Blended Salary Model (BSM), Family Health Network (FHN), Family Health Organization (FHO), and Group Health Centre (GHC) Primary Care Patient Enrolment Models (PEMs).

Hard Cap Threshold Limits

Effective October 1, 2021 the Fee-For-Service billing limits for core services provided to non-enrolled patients (the Hard Cap) will be applied in the Blended Salary Model, Family Health Network, Family Health Organization and Group Health Centre patient enrolment models.

The Fiscal Year 2021-2022 pro-rated hard cap ceiling amounts are shown on the Fee for Service Core Service Ceiling Report on the solo Remittance Advice (RA). This pro-rated Hard Cap ceiling amount will remain in place until the end of the fiscal period (March 31, 2022). The Hard Cap ceiling prior to October 1, 2021 remains unlimited.


OHIP; Primary Care Physicians; COVID-19; Hard Cap; Fee-For-Service Ceiling

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.