ontario regulation 326/26

made under the

Health Insurance Act

Made: October 6, 2026
Filed: October 6, 2026
Published on e-Laws: October 6, 2026
Published in The Ontario Gazette: October 24, 2026

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

(GENERAL)

1. (1) Subsection 28.4 (2) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by adding the following clause:

(b.1)  in the case of a service that consists primarily of the administration of a drug, including the provision of the drug that is administered,

(i)  the identical or equivalent service is performed in Ontario,

(ii)  the drug and the administration of the drug are publicly funded in Ontario, in whole or in part, for a person in the same medical circumstances as the insured person,

(iii)  access to the drug in Ontario is temporarily unavailable, and

(iv)  the delay in access to the drug makes it necessary that the insured person travel out of Canada to avoid death or medically significant irreversible tissue damage;

(2) Clause 28.4 (2) (c) of the Regulation is amended by adding “in the case of a service that is not described in clause (b.1)” at the beginning of the portion before subclause (i).

(3) Paragraph 2 of subsection 28.4 (7) of the Regulation is amended by striking out “and one of the conditions set out in clause (2) (c)” in the portion before subparagraph i and substituting “and either all of the conditions set out in clause (2) (b.1) or one of the conditions set out in clause (2) (c), as applicable”.

(4) Paragraph 4 of subsection 28.4 (7) of the Regulation is revoked.

(5) Subsection 28.4 (7.1) of the Regulation is amended by striking out “subclause (2) (c) (i)” and substituting “subclauses (2) (b.1) (i) and (c) (i)”.

(6) Section 28.4 of the Regulation is amended by adding the following subsection:

(10) The following rules apply with respect to the amendments made to this section by Ontario Regulation 326/26:

1.  Any service that is rendered outside of Canada at a hospital or health facility that would have met the condition set out in paragraph 4 of subsection (7), as it read before it was revoked by Ontario Regulation 326/26, is not an insured service and no amount is payable unless the service meets the requirements established in clause (2) (b.1).

2.  Paragraph 1 applies to every service rendered on or after October 1, 2011 and, for greater certainty, applies regardless of whether,

i.  an application for approval of payment for the service has been submitted to the General Manager, or

ii.  an appeal to the Appeal Board in relation to payment for the service has been made.

3.  Despite paragraphs 1 and 2, if, on or before October 6, 2026, the General Manager provided written prior approval of payment for a service primarily for the administration of a drug under this section, as it read before it was amended by Ontario Regulation 326/26, the approved services are deemed to be insured services.

Commencement

2. This Regulation is deemed to have come into force on October 1, 2011.