Bulletin 220201 — Accepting Expired Photo Health Cards and Red and White Cards
Use the ministry's automated health card validation services to check your patient's OHIP eligibility and health card validity.
To: All Providers
Category: Dentist Services, Fertility Clinics, Independent Health Facilities, Midwife Services, Optometrist Services, Physician Services, Physiotherapy Facilities, Podiatrist Services, Primary Health Care Services, Registered Nurse with Extended Class
Written by: Health Insurance Branch; OHIP, Pharmaceuticals and Devices Division
Date issued: February 18, 2022
Expired photo health cards and red and white health cards
Expired photo health cards and red and white health cards should continue to be accepted when presented for insured health services as long as the card is valid and belongs to the person presenting the card (see section below on Health Card Validation).
Expired photo health cards
Claims submitted for insured services using an expired photo health card that passes Health Card Validation will be accepted by MOH for consideration of payment until September 30, 2022.
See the ministry’s news release at Ontario Extending Health Card Renewal Requirement | Ontario Newsroom.
Red and white health cards
Claims submitted for insured services using a red and white health card that passes Health Card Validation will be accepted by MOH for consideration of payment until further notice.
Health card validation
Presenting and validating the health card
It is the patient’s responsibility to show their health card to the health care provider at each visit. To ensure consideration for payment of insured services billed, providers are encouraged to validate health cards.
Use the same health card validation method you would ordinarily use to check the status of your patient’s health number and version code.
Checking to see if a patient’s health card is still valid
The ministry offers several automated health card validation services to assist providers in determining a patient’s eligibility and the validity of an Ontario health card at the time a service is rendered including:
- Real Time Interactive Voice Response (IVR)
- Health Card Validation (HCV) Web Service
- Real Time Health Card Readers (HCRs)
- Overnight Batch Eligibility Checking (OBEC)
The Health Card Validation Reference Manual is available online at Health Card Validation Reference Manual (gov.on.ca). Additional resources can be found on the ministry website.
Accepting an expired photo health card or a red and white health card
If the card passes health card validation, you should accept:
- an expired photo health card until September 30, 2022; or
- a red and white health card until further notice.
As always providers are encouraged to ask for a patient’s most recent card and validate it each time the patient visits in order to reduce the risk of a claim being rejected because of invalidity.
Providing services to someone with an invalid health card
There is no change to the process of providing insured services to individuals with invalid cards.
If validation indicates the patient’s health card is invalid, the patient should be directed to a ServiceOntario centre where eligibility will be assessed and become effective retroactively, if the patient is eligible. The patient should then provide you with their valid health number/version code to facilitate billing to OHIP.
Alternatively, if a patient presents without a health card or with an invalid card, a provider may charge the patient for services provided.
However, if it is later determined that the patient was eligible for OHIP coverage on the service date, the patient may return to the provider requesting that they be reimbursed the full amount.
Keywords/tags
Health card; OHIP card; health card validation; HCV; eligibility
Contact information
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