Health Insurance Act

ONTARIO REGULATION 22/02

submission of accounts

Consolidation Period: From April 1, 2023 to the e-Laws currency date.

Last amendment: 494/22.

Legislative History: 46/04, 539/06, 494/22.

This is the English version of a bilingual regulation.

Definition

1. In this Regulation,

“in-patient” means a person admitted to and assigned a bed in a hospital in-patient area. O. Reg. 22/02, s. 1; O. Reg. 539/06, s. 1; O. Reg. 494/22, s. 1.

Time limits for submitting accounts

2. A physician, practitioner, health facility or, in the case of a patient who is billed directly, the patient shall submit an account for an insured service to the General Manager no later than the following:

1.  For insured services rendered in Ontario, no later than three months after the service is rendered.

2.  For insured services rendered outside Ontario,

i.  no later than 12 months after the date of the patient’s discharge for services rendered to in-patients, and

ii.  in all other cases, no later than 12 months after the service is rendered.

3.  Revoked: O. Reg. 494/22, s. 2 (2).

O. Reg. 494/22, s. 2.

Exception

3. Paragraph 2 of section 2 does not apply to services rendered outside Ontario that are approved by the General Manager for payment before the service is rendered.  O. Reg. 22/02, s. 3.

Transition

4. (1) This Regulation applies to accounts submitted on or after January 1, 2002. O. Reg. 22/02, s. 4; O. Reg. 46/04, s. 1.

(2) Paragraph 1 of section 2 does not apply to an insured service that was rendered in Ontario before April 1, 2023, and instead the account for the insured service must be submitted to the General Manager no later than six months after the service was rendered. O. Reg. 494/22, s. 3.

5. Omitted (provides for coming into force of provisions of this Regulation).  O. Reg. 22/02, s. 5.