O. Reg. 259/19: GENERAL

 

ontario regulation 259/19

made under the

Health Insurance Act

Made: June 28, 2019
Filed: August 8, 2019
Published on e-Laws: August 8, 2019
Printed in The Ontario Gazette: August 24, 2019

Amending Reg. 552 of R.R.O. 1990

(GENERAL)

1. The definition of “oral and maxillofacial surgeon” in subsection 1 (1) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by adding “or” at the end of clause (a), by striking out “or” at the end of clause (b) and by striking out clause (c).

2. Clause 11 (1) (c) of the Regulation is amended by adding “or” at the end of subclause (i) and by striking out subclause (ii).

3. Clause (f) of the definition of “schedule of dental benefits” in subsection 16 (8) of the Regulation is revoked and the following substituted:

(f) the document published by the Ministry of Health and Long-Term Care titled “Schedule of Benefits — Dental Services under the Health Insurance Act (April 1, 2012)”, but does not include the “[Commentary…]” portions of the document, if the service is performed on or after October 1, 2012 but before January 1, 2020,

(g) the document published by the Ministry of Health and Long-Term Care titled “Schedule of Benefits — Dental Services under the Health Insurance Act (May 1, 2019)”, but does not include the “[Commentary…]” portions of the document, if the service is performed on or after January 1, 2020.

4. Section 19 of the Regulation is revoked.

5. Paragraph 2 of subsection 20 (1) of the Regulation is amended by striking out “outside Ontario” at the end and substituting “outside Ontario but within Canada”.

6. Clause 27 (4) (a) of the Regulation is revoked and the following substituted:

(a) a preferred provider arrangement is a written agreement between the Minister and a physician or practitioner outside Ontario but within Canada for the delivery of specified insured services to insured persons; and

7. Sections 28.1, 28.2 and 28.3 of the Regulation are revoked.

8. (1) Subsection 28.6 (1) of the Regulation is amended by striking out “28.3 or” in the portion before clause (a).

(2) Subsection 28.6 (2) of the Regulation is amended by striking out “28.2 or” in the portion before clause (a).

(3) Subsection 28.6 (3) of the Regulation is amended by striking out “28.2, 28.3 or” in the portion before clause (a).

9. Section 29 of the Regulation is revoked and the following substituted:

29. (1) A service rendered by a physician outside Ontario but within Canada is an insured service if it is referred to in the schedule of benefits and rendered in such circumstances and under such conditions as may be specified in the schedule of benefits.

(2) The amount payable by the Plan for an insured service rendered by a physician outside Ontario but within Canada to an insured person is as follows:

1. If payment for the service is provided for in a preferred provider arrangement, the amount payable is the amount provided for in the preferred provider arrangement.

2. In all other cases, the amount payable is the lesser of the following:

i. The amount actually billed by the physician.

ii. The amount payable for the service in the schedule of benefits.

(3) The amount payable by the Plan for an insured service specified in sections 16 to 20 rendered by a practitioner outside Ontario but within Canada to an insured person is as follows:

1. If payment for the service is provided for in a preferred provider arrangement, the amount payable is the amount provided for in the preferred provider arrangement.

2. In all other cases, the amount payable is the lesser of the following:

i. The amount actually billed by the practitioner.

ii. The amounts prescribed under sections 16 to 20.

10. Subparagraph 14 iv of subsection 38.4 (1) of the Regulation is amended by striking out “or by an osteopath” at the end.

Commencement

11. This Regulation comes into force on January 1, 2020 or, if this Regulation is filed after that date, it is deemed to have come into force on that date.