O. Reg. 22/02: SUBMISSION OF ACCOUNTS

Health Insurance Act

ONTARIO REGULATION 22/02

submission of accounts

Historical version for the period September 29, 2022 to March 31, 2023.

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;

“schedule of benefits” means the schedule of benefits as defined in subsection 1 (1) of Regulation 552 of the Revised Regulations of Ontario, 1990 (General) made under the Act.  O. Reg. 22/02, s. 1; O. Reg. 539/06, s. 1.

Note: On April 1, 2023, the definition of “schedule of benefits” in section 1 of the Regulation is revoked. (See: 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 six months after the service is rendered.

Note: On April 1, 2023, paragraph 1 of section 2 of the Regulation is revoked and the following substituted: (See: O. Reg. 494/22, s. 2 (1))

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.  For an insured service described in the schedule of benefits by the insured service code S596, no later than 12 months after December 8, 2006, if,

i.  the service is rendered on or after May 12, 2006 and before December 8, 2006, or

ii.  the service is an insured service rendered by a physician or health facility in connection with a service described in subparagraph i.  O. Reg. 22/02, s. 2; O. Reg. 539/06, s. 2.

Note: On April 1, 2023, paragraph 3 of section 2 of the Regulation is revoked. (See: O. Reg. 494/22, s. 2 (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. This Regulation applies to accounts submitted on or after January 1, 2002.  O. Reg. 22/02, s. 4; O. Reg. 46/04, s. 1.

Note: On April 1, 2023, section 4 of the Regulation is amended by adding the following subsection: (See: O. Reg. 494/22, s. 3)

(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.