O. Reg. 86/03: GENERAL

 

ONTARIO regulation 86/03

made under the

health insurance Act

Made: March 19, 2003
Filed: March 21, 2003
Printed in The Ontario Gazette: April 5, 2003

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

(General)

Note: Since the end of 2002, Regulation 552 has been amended by Ontario Regulations 18/03, 50/03 and 62/03.  Previous amendments are listed in the Table of Regulations published in The Ontario Gazette dated January 18, 2003.

1. Subsection 16 (5.1) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by striking out “or” at the end of clause (a), by adding “or” at the end of clause (b) and by adding the following clause:

(c) 2 per cent if the service is rendered on or after April 1, 2002 but before April 1, 2003.

2. Section 16 of the Regulation is revoked and the following substituted:

16. (1) The services rendered by dental surgeons that are prescribed as insured services are the services set out in Column 1 of Parts I, II and III of the schedule of dental benefits.

(2) It is a condition for the performance and for payment of the insured services set out in the schedule of dental benefits, that they be performed in a hospital by a dental surgeon who has been appointed to the dental staff by the hospital on the recommendation of the chief of the surgical staff and the agreement of the Medical Advisory Committee of the hospital. 

(3) It is a condition for the performance and for payment of the insured services set out in Part II of the schedule of dental benefits that they be performed in conjunction with one or more of the insured services set out in Part I or III of that schedule.

(4) It is a condition for the performance and for payment of the insured services set out in Part III of the schedule of dental benefits that,

(a) hospitalization is medically necessary; and

(b) there is prior approval by the General Manager of the provision of the service. 

(5) The amount payable by the Plan for a service set out in Column 1 of Part I, II or III of the schedule of dental benefits is the amount set out opposite the service in Column 2 where the service is performed by a dental surgeon or the amount set out opposite the service in Column 3 where the service is performed by an oral and maxillofacial surgeon. 

(6) The following services are prescribed as insured services under the Plan:

1. All services rendered by a hospital in connection with dental surgical procedures not specified in subsection (1), (3) or (5). 

(7) It is a condition for the performance and for payment of the insured services prescribed under subsection (6) that hospitalization is medically necessary.

(8) In this section,

“schedule of dental benefits” means 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, 2003)”.

(9) This section, as it read immediately before April 1, 2003, continues to apply with respect to payments for services rendered before April 1, 2003.

3. Schedules 13, 14 and 15 to the Regulation are revoked.

4. (1) Section 1 shall be deemed to have come into force on April 1, 2002.

(2) Sections 2 and 3 come into force on April 1, 2003.