Bulletin 260404 — 2024 PSA emergency department visit premium
A new premium on eligible emergency department services at EDAFA Workload and Fee-For-Service emergency department sites is being implemented
To: Emergency Medicine physicians and Emergency Department Alternate Funding Agreement (EDAFA) groups
Category: Physician Services
Written by: Provider Negotiations Management Branch, Physician and Provider Services Division
Date issued: April 1, 2026
Bulletin Number: 260404
Overview
The Ministry of Health and the Ontario Medical Association have been working together to implement the 2024 Physician Services Agreement (PSA). Effective April 1, 2025, emergency department physicians will receive a premium, payable twice annually, for eligible services rendered in an emergency department site that has a workload model Emergency Department Alternative Funding Agreement (EDAFA) with the Ministry of Health or an emergency department site where physicians submit claims and receive remuneration only on a fee-for-service basis for insured services provided in the emergency department.
Payment and reporting
The first payment, for the period of April 1, 2025 to September 30, 2025, will be processed and paid on the April 2026 Remittance Advice (RA) to individual physicians.
The payment will appear under the accounting adjustment 'ED ENHANCED SHADOW-BILLING PREMIUM'.
The ministry will deposit the payments to the solo bank account on file where the bank account has remained open. Please ensure your banking information with the ministry is up to date.
Where bank account details are not available, a cheque will be issued payable to the solo physician or to the "Estate of" in the event the physician is deceased.
Cheques will be sent to the same address on file with the ministry that was used for the RA.
Please note, claims for services rendered on or after April 1, 2026 must contain the Ambulatory Care (AM) Master Number (MNI) of the emergency department site where the service was provided to be eligible for the premium.
A list of Master Numbers and their types are available online.
Methodology
Effective April 1, 2025, emergency department physicians will receive a premium, payable twice annually, for eligible services rendered in an emergency department site during the following applicable six-month periods each fiscal year:
- April 1 to September 30, and
- October 1 to March 31
For the purposes of this payment, an encounter is a direct physical interaction where a physician provides one or more unscheduled eligible service(s) to an insured person on a given day (limit one encounter per physician per patient per day).
Only encounters rendered in either an emergency department site that has a workload model EDAFA with the Ministry of Health or a fee for service emergency department site listed below are eligible for the premium.
| Hospital Site Name | Location |
|---|---|
| ST JOSEPH'S HEALTH CARE SYSTEM-HAMILTON | Hamilton |
| ST JOSEPH'S COMMUNITY HEALTH CENTRE | Hamilton |
| MACKENZIE HEALTH-RICHMOND HILL HOSPITAL | Richmond Hill |
| MACKENZIE HEALTH-CORTELLUCCI VAUGHAN HOSPITAL | Vaughan |
| JOSEPH BRANT HOSPITAL | Burlington |
| SOUTHLAKE REGIONAL HEALTH CENTRE | Newmarket |
| WILLIAM OSLER HEALTH SYSTEM-ETOBICOKE | Toronto |
| WILLIAM OSLER HEALTH SYSTEM-CIVIC SITE | Brampton |
| WILLIAM OSLER HEALTH SYSTEM-PEEL MEMORIAL | Brampton |
| LAKERIDGE HEALTH -OSHAWA SITE | Oshawa |
| NIAGARA HEALTH SYSTEM-GREATER NIAGARA | Niagara Falls |
| NIAGARA HEALTH SYSTEM-MAROTTA FAMILY HOSPITAL | St. Catharines |
| TRILLIUM HEALTH PARTNERS-MISSISSAUGA SITE | Mississauga |
| TRILLIUM HEALTH PARTNERS-QUEENSWAY HLTH | Toronto |
| UNITY HEALTH TORONTO - ST.JOSEPH'S | Toronto |
The percentage payable is determined incrementally by the cumulative number of encounters provided by a physician within the applicable six-month period, as set out below:
| Encounter Brackets | Applicable Premium |
|---|---|
| 1—250 | 0% |
| 251—500 | 6% |
| 501—750 | 8% |
| 751—1,000 | 10% |
| 1,001 or more | 12% |
The premium rate only applies to the visits within the bracket.
For example, if a physician has 725 visits in the first 6 months of a fiscal year, the first 250 visits are not paid a premium, the next 250 visits are paid a premium of 6%, and the last 250 visits are paid a premium of 8%.
| Visits | Applicable Premium | Fee Approved Total | Premium Payable |
|---|---|---|---|
| 1—250 | 0% | $16,500.00 | $0.00 |
| 251—500 | 6% | $17,500.00 | $1,050.00 |
| 501—750 | 8% | $16,000.00 | $1,280.00 |
| Total premium | - | - | $2,330.00 |
For a physician with 1,775 visits in the first 6 months of a fiscal year, the first 250 visits are not paid a premium, the next 250 visits are paid a premium of 6%, the next 250 visits are paid a premium of 8%, the next 250 visits are paid a premium of 10%, and the remaining 775 visits are paid a premium of 12%.
| Visits | Applicable Premium | Fee Approved Total | Premium Payable |
|---|---|---|---|
| 1—250 | 0% | $16,800.00 | $0.00 |
| 251—500 | 6% | $16,500.00 | $990.00 |
| 501—750 | 8% | $17,700.00 | $1,416.00 |
| 751—1,000 | 10% | $16,900.00 | $1,690.00 |
| 1,001—1,775 | 12% | $52,354.00 | $6,282.00 |
| Total premium | - | - | $10,378.00 |
The premium payable will be equal to the percentage payable determined for each physician, multiplied by the approved value of eligible services claimed during the applicable six-month period.
The total value of the premium payable to a physician in any single fiscal year (April 1 to March 31) will not exceed $40,000.
Please refer to the document available on the Ministry of Health's website at OHIP Schedule of Benefits and fees under Schedule of Benefits for Physician Services.
Keywords/Tags
Physician Services Agreement; PSA; Emergency Medicine
Contact information
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