O. Reg. 50/03: GENERAL

 

ONTARIO regulation 50/03

made under the

health insurance act

Made: March 5, 2003
Filed: March 6, 2003
Printed in The Ontario Gazette: March 22, 2003

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

(General)

Note: Since the end of 2002, Regulation 552 has been amended by Ontario Regulation 18/03.  Previous amendments are listed in the Table of Regulations published in The Ontario Gazette dated January 18, 2003.

1. The definition of “schedule of benefits” in subsection 1 (1) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by adding the following paragraph:

5. Amendments dated March 31, 2003.

2. Section 37.5 of the Regulation is revoked and the following substituted:

37.5 (1) The fee payable for an insured service rendered by a physician during a fiscal year referred to in Column 1 of the Table to this section shall be decreased in accordance with subsection (2) if the total amount payable for insured services rendered by the physician between the beginning of the fiscal year and the day the service is rendered exceeds the threshold amount set out opposite the fiscal year in Column 2 of the Table to this section. 

(2) For the purposes of subsection (1), in the case of an insured service rendered during a fiscal year referred to in Column 1 of the Table to this section, if the total amount payable for insured services rendered by the physician between the beginning of the fiscal year and the day the insured service is rendered is equal to or exceeds the threshold amount set out opposite the fiscal year in Column 2 of the Table, the fee payable for the insured service is one-third of the basic fee otherwise payable.

(3) For the purposes of this section, the total amount payable for insured services shall include the amounts payable for all insured services other than the following:

1. A service set out in Appendix E to the General Preamble to the schedule of benefits.

2. A service rendered under the Underserviced Area Program of the Ministry of Health.

(4) Despite subsection (1), the fee payable for the following insured services shall not be decreased under this section:

1. A service set out in Parts 1, 3, 4 and 5 of Appendix E to the General Preamble to the schedule of benefits.

2. A service rendered under the Underserviced Area Program of the Ministry of Health. 

(5) In this section,

“fiscal year” means the period from April 1 of each year to and including March 31 of the following year.

(6) This section, as it read immediately before April 1, 2002, continues to apply with respect to payments for services rendered before April 1, 2002.

TABLE

THRESHOLD AMOUNTS FOR physician providers

 

Column 1	Column 2
Fiscal year	Total amount payable
For the fiscal year beginning April 1, 2002, and any subsequent fiscal year	455,000

3. This Regulation shall be deemed to have come into force on April 1, 2002.