O. Reg. 374/05: GENERAL

 

ontario regulation 374/05

made under the

Health Insurance Act

Made: June 22, 2005
Filed: June 24, 2005
Printed in The Ontario Gazette: July 9, 2005

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

(General)

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 April 1, 2005;

2. Section 37.1 of the Regulation is amended by adding the following subsections:

(2.1) Despite subsection (2), the amount payable for a diagnostic service rendered on or after April 1, 2001 and before April 1, 2005 is nil if the service is an insured service rendered to an insured person who was, at the time he or she received the service,

(a) an inpatient of a hospital;

(b) a patient in the emergency department of a hospital; or

(c) a patient in a hospital for the purpose of receiving day care services.

(2.2) Subsection (2.1) does not apply in respect of a diagnostic service rendered to an insured person who was, at the time he or she received the service, a patient described in clause (2.1) (b) or (c) if,

(a) an account for the diagnostic service was submitted to the Plan for payment,

(i) on or before February 1, 2005 if the diagnostic service was rendered on or after April 1, 2001 and before August 1, 2004, or

(ii) not more than six months after the day on which the diagnostic service was rendered if the diagnostic service was rendered on or after August 1, 2004 and before April 1, 2005; and

(b) the insured person was not, within 24 hours after receiving the diagnostic service, admitted to the same hospital as an in-patient in connection with the condition, illness, injury or disease in relation to which the diagnostic service was rendered.

(2.3) In subsections (2.1) and (2.2),

“diagnostic service” means a service rendered by a physician in Ontario that is listed in the schedule of benefits with a technical and professional fee.

3. (1) Subject to subsection (3), if this Regulation is filed on or before April 1, 2005, it comes into force on April 1, 2005.

(2) Subject to subsection (3), if this Regulation is filed after April 1, 2005, it is  deemed to have come into force on April 1, 2005.

(3) Section 2 shall be deemed to have come into force on April 1, 2001.