O. Reg. 133/09: GENERAL


Published: 2009-04-01

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ontario regulation 133/09

made under the

health insurance act

Made: March 25, 2009
Filed: April 1, 2009
Published on e-Laws: April 2, 2009
Printed in The Ontario Gazette: April 18, 2009

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

(General)

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

“mobile student” means a person who attends as a student a full-time academic program at an educational institution in Ontario and who is engaged in a component of that program that requires travel outside Ontario;

“mobile worker” means a person whose work requires frequent travel outside Ontario;

“physical presence requirement” means the requirement set out in paragraph 3 of subsection 1.5 (1);

“primary place of residence” means the place with which a person has the greatest connection in terms of present and anticipated future living arrangements, the activities of daily living, family connections, financial connections and social connections, and for greater certainty a person only has one primary place of residence, no matter how many dwelling places he or she may have, inside or outside Ontario;

“publicly funded health care insurance plan” means the province or territory’s health insurance plan that is required under the Canada Health Act in order for the province or territory to qualify for a full cash contribution under that Act;

“three-month waiting period” means the three-month period specified under subsection 5 (1).

2. Sections 1.1 and 1.2 of the Regulation are revoked and the following substituted:

1.1 For the purposes of subsection 11 (2.1) of the Act,

“dependant” means a dependent child who is,

(a) under 22 years of age, or

(b) 22 years of age or older, but dependent on the member of the Canadian Forces due to a mental or physical disability;

“member of the Canadian forces” means,

(a) a regular force member, or

(b) a member of the reserve force of the Canadian Forces referred to in subsection 15 (3) of the National Defence Act (Canada) who falls within the circumstances described in clause 50.2 (1) (a) or (b) of the Employment Standards Act, 2000;

“spouse” has the meaning set out in subsection 1 (1) of this Regulation.

1.2 For the purposes of the Act and any regulation made under the Act, and despite any other meaning of the term “resident”, resident means a person described in sections 1.3 to 1.14 who meets the requirements set out in this Regulation to be recognized as a resident, and for greater certainty, a person whose primary place of residence ceases to be Ontario ceases to be a resident, unless subsection 1.3 (2) applies.

1.3 (1) Upon application to be an insured person, a person must meet the following requirements in order to be considered a resident, unless subsection (2) or another provision of this Regulation provides otherwise:

1. The person must possess an eligible status set out in section 1.4.  A person who has an eligible status, then loses it, is no longer a resident, but may regain resident status at a later date by meeting the necessary requirements at that time.

2. The person’s primary place of residence must be in Ontario.  For this purpose, the General Manager will consider a child under 16 years old to have the primary place of residence of a person who has lawful custody of the child unless the General Manager has information to the contrary.

(2) The following persons are residents, even if they do not meet the other requirements in this Regulation, and they are not affected by any of the other rules in this Regulation regarding recognition as a resident, other than the requirements under sections 3 and 4:

1. Inmates at a correctional institution that is established or designated under Part II of the Ministry of Correctional Services Act.

2. Children who are in the care of a children’s aid society under the Child and Family Services Act.

3. Young persons who are detained in a place of temporary detention or committed to a place of secure or open custody under Part IV of the Child and Family Services Act

or Part V of the Ministry of Correctional Services Act.

4. People who are present in Ontario because they have a work permit issued under the program of the Government of Canada known as the “Seasonal Agricultural Worker Program”.

1.4 A person cannot be recognized as a resident, unless the person has one of the following eligible statuses:

1. Being a Canadian citizen.

2. Being a landed immigrant under the former Immigration Act (Canada), or a permanent resident under the Immigration and Refugee Protection Act

(Canada).

3. Being registered as an Indian under the Indian Act (Canada).

4. Being a “protected person”,

as that term is used in the Immigration and Refugee Protection Act (Canada).

5. Being a person who has submitted an application for permanent residence in Canada to the proper federal government authority, even if the application has not yet been approved, as long as Citizenship and Immigration Canada has confirmed that the person meets the eligibility requirements to apply for permanent residency in Canada, and the application has not yet been denied.

6. Being a person who holds a valid work permit or other document issued under the Immigration and Refugee Protection Act (Canada) that permits the person to work in Canada, if the person also has a formal agreement in place to work full-time for an employer in Ontario and is working under that agreement, and if the work permit or other document issued under that Act or a letter provided by the employer or other document provided by the employer,

i. sets out the employer’s name,

ii. states the person’s occupation with the employer, and

iii. states that the person will be working for the employer for no less than six consecutive months.

7. Being a person who holds a valid work permit or other document issued under the Immigration and Refugee Protection Act (Canada) that permits the person to work at an occupation in Canada while self-employed, if the person is self-employed full-time in that occupation in Ontario and will continue to be so for no less than six consecutive months.

8. Being a member of the clergy of a religious denomination, if the member has finalized an agreement to minister to a religious congregation or group in Ontario for at least six months, as long as the member is legally entitled to stay in Canada.  The main duties of ministering to the congregation or group must be preaching doctrine, performing functions related to gatherings of the congregation or group or providing spiritual counselling.

9. Being the spouse or a dependant of a person who meets the requirements under paragraph 6 or 7 or of a member of the clergy who meets the requirements provided for in paragraph 8, as long as the spouse or dependant is legally entitled to stay in Canada.

10. Having a valid “temporary resident permit” under the Immigration and Refugee Protection Act (Canada), if the permit is for a member of an “inadmissible class”, with a “case type” of 86, 87, 88, 89, 90, 91, 92, 93, 94 or 95, or, if the permit is issued for the purpose of adoption to a child mentioned in subsection 6 (2), “case type 80”.

11. Being a person who has submitted an application for Canadian citizenship under section 5.1 of the Citizenship Act (Canada) to the proper federal government authority, even if the application has not yet been approved, as long as Citizenship and Immigration Canada has confirmed that the person meets the eligibility requirements to apply for citizenship under that section and the application has not yet been denied.

12. Having a valid work permit under the Government of Canada program known as “Live-in Caregiver Program”.

13. Being a child born out of country to a mother who is receiving insured services referred to in section 1.9, if at the time the mother left Ontario to receive those insured services she was pregnant with that child and if at the time of the child’s birth the mother was receiving the insured services out of country.

1.5 (1) The following requirements must be met for a person to be continued to be recognized as a resident:

1. The person must be in Ontario for at least 153 of the first 183 days after becoming a resident, except for,

i. a person who has moved to Ontario directly from another province or territory of Canada where he or she was insured under a publicly funded health care insurance plan,

ii. a mobile student or a mobile worker,

iii. a child to whom section 6 applies, or

iv. a person who is exempt from the waiting period under subsection 11 (2.1) of the Act.

2. Except for those persons listed in subsection 1.3 (2), the person must continue to maintain his or her primary place of residence in Ontario. 

3. Subject to sections 1.6 to 1.14, the person must be physically present in Ontario for at least 153 days in any given 12-month period. 

4. The person must continue to hold an eligible status as listed in section 1.4.  However, in order to maintain their eligible status as a resident, a person referred to in paragraph 13 of section 1.4 must be legally entitled to remain in Canada and will only maintain their eligible status under that paragraph as long as reasonable efforts are being made for the person to obtain one of the other eligible statuses under section 1.4.

(2) For the purposes of subsection (1), the General Manager will consider a child under 16 years old to be physically present with and have the primary place of residence of a person who has lawful custody of the child unless the General Manager has information to the contrary.

(3) Despite subsection (1), a resident who leaves Ontario permanently to reside in another province or territory of Canada remains a resident, even though he or she is not physically present in Ontario or does not have Ontario as his or her primary place of residence, as long as he or she continues to have an eligible status, but only until the end of the last day of the second full month after leaving Ontario.

1.6 (1) A resident is considered to meet the physical presence requirement for up to 12 full months, if he or she temporarily goes to another province or territory of Canada. 

(2) A person mentioned in subsection (1) ceases to be a resident on the last day of his or her 12th consecutive month of absence from Ontario, or, if the move becomes permanent, the last day of the second full month after the move becomes permanent, whichever occurs first.

(3) This section only applies if the resident meets any of the following requirements, or any combination of the following requirements, for at least 153 days out of the 12 months immediately before he or she leaves Ontario:

1. Being physically present in Ontario.

2. Being a mobile student or mobile worker.

(4) This section does not apply if subsection 1.8 (1) applies to the person.

1.7 (1) A resident is considered to meet the physical presence requirement during a maximum of five 12-month periods if he or she leaves Canada in order to either work full-time for payment for an employer with whom he or she has a contract of employment, or to serve full-time for a charity that is registered under the

Income Tax Act (Canada).

(2) Subsection (1) only applies if the resident meets any of the following requirements, or any combination of the following requirements, for at least 153 days in each of the two consecutive 12-month periods immediately before he or she leaves Canada to work or serve:

1. Being physically present in Ontario.

2. Being a mobile student or mobile worker.

1.8 (1) A resident who goes to another province or territory of Canada to attend as a student one or more full-time academic programs in an educational institution in that province or territory is considered to meet the physical presence requirement as long as he or she maintains continuous full-time enrolment. 

(2) Subsection (1) only applies if the resident meets any of the following requirements, or any combination of the following requirements, for at least 153 days in the 12 months immediately before going to the other province or territory:

1. Being physically present in Ontario.

2. Being a mobile student or mobile worker.

3. Remaining a resident by virtue of subsection (3).

(3) A resident who goes to another jurisdiction outside Canada to attend as a student one or more full-time academic programs in an educational institution in that jurisdiction is considered to meet the physical presence requirement as long as he or she maintains continuous full-time enrolment. 

(4) Subsection (3) only applies if the resident meets any of the following requirements, or any combination of the following requirements, for at least 153 days in each of the two consecutive 12-month periods immediately before going to the other jurisdiction:

1. Being physically present in Ontario.

2. Being a mobile student or mobile worker.

3. Remaining a resident by virtue of subsection (1).

1.9 A resident who leaves Ontario is considered to meet the physical presence requirement during the time that he or she is out of Ontario receiving insured services for which an application for approval for payment by the General Manager is required to be submitted by this Regulation, and for which payment has been approved.

1.10 A resident who is a member of the Canadian Forces or Royal Canadian Mounted Police or who is a Canadian diplomat and who was a resident immediately before leaving for a posting outside Canada is considered to meet the physical presence requirement during the time he or she is posted outside of Canada. 

1.11 (1) In addition to the other circumstances in which a resident is also considered to meet the physical presence requirement, a resident who travels outside Ontario is considered to meet the physical presence requirement for a maximum of two 12-month periods if the resident meets any of the following requirements, or any combination of the following requirements, for at least 153 days in each of the two consecutive 12-month periods immediately before he or she leaves Ontario:

1. Being physically present in Ontario.

2. Being a mobile student or mobile worker.

(2) Subsection (1) does not apply to a person more than once unless he or she has been physically present in Ontario or a mobile student or mobile worker for at least 153 days in each of at least five consecutive 12-month periods before each subsequent time that subsection (1) applies.

1.12 (1) A resident who is the spouse or a dependant of someone who continues to be a resident under sections 1.7 or 1.8 and who accompanies that person while they are in another province, territory or jurisdiction, as the case may be, is considered to meet the physical presence requirement while they are accompanying the person to whom section 1.7 or 1.8 applies, if they met the applicable requirements under those sections that applied to the person they are accompanying immediately before going to the other province, territory or jurisdiction.

(2) A resident who is the spouse or a dependant of someone who continues to be a resident under section 1.9 and who accompanies that person while they are out of Ontario is considered to meet the physical presence requirement while they are accompanying the person.

(3) A resident who is the spouse or a dependant of a member of the Canadian Forces or Royal Canadian Mounted Police who continues to be a resident under section 1.10 or of a Canadian diplomat who continues to be a resident under that section and who accompanies that member or diplomat while they are out of Canada is considered to meet the physical presence requirement while they are accompanying the person.

1.13 A resident is considered to meet the physical presence requirement during any period of time where that person is unable to return to Ontario as a result of activity by another person that would be considered to be unlawful in Canada.

1.14 A resident is considered to meet the physical presence requirement during any period of time where he or she is out of Ontario because he or she is a mobile student or a mobile worker.

3. Sections 3, 3.1 and 5 of the Regulation and the headings preceding sections 3 and 3.1 and following section 3.1 are revoked and the following substituted:

Establishing Status

3. (1) Where any one asserts that he or she is a resident, or is entitled to any exemption from the requirements to be recognized as a resident, or in any other way is entitled to payment from the Plan, it is the obligation of the person making the assertion to prove to the General Manager that he or she meets the requirements to be an insured person. 

(2) The General Manager may require a person to submit any information, evidence or documents that the General Manager considers necessary to make a decision, whether the person is applying to be an insured person for the first time or seeking to re-establish coverage, and may either require the submission of original material, or permit the submission of copies.

Application

4. (1) An application to be an insured person must be in the form approved by the General Manager.

(2) A person must submit his or her application in person, unless subsection (3) applies.

(3) The following are the rules about submitting an application on someone else’s behalf:

1. If a person is under 16 years old, a parent who has legal custody, a children’s aid society, or anyone else who is legally authorized to act for the person may submit an application.

2. If there are reasonable grounds to believe that a person is incapable of consenting to the collection, use and disclosure of personal health information under the Personal Health Information Protection Act, 2004, a person who would be able to act for the person under section 26 of that Act may submit an application, and the rules of that section apply for the purposes of making the application, subject to any necessary modification.

3. In the case of a dead person, the person’s estate trustee may submit an application, or, if there is no estate trustee, the person who has assumed the responsibility for looking after the estate may submit the application.

4. A person who is legally authorized to act for another person for this purpose under a law of Ontario or Canada may submit an application.

(4) When a person is applying on someone else’s behalf, the General Manager may require them to attend in person to submit that application and to submit anything a person applying on their own behalf would have been required to submit.

Waiting Periods

5. (1) Subject to subsection (2) and sections 6 to 6.3, and to subsection 11 (2.1) of the Act, a person shall only start receiving insured services once the General Manager is satisfied that he or she has been a resident for three full consecutive months, and has not stopped being a resident since meeting that three-month waiting period requirement. 

(2) Subject to section 6.1, and to subsection 11 (2.1) of the Act, a person who takes up residence in Ontario immediately after residing in another province or territory of Canada where he or she was insured under a publicly funded health care insurance plan is subject to a waiting period that ends at the end of the last day of the second full month after he or she becomes a resident.

6. (1) A newborn, who, on the date of his or her birth, meets the requirements to be a resident is exempt from the three-month waiting period for the three months immediately following the date of birth. 

(2) A child under 16 years old who is adopted and who, on the date the adoption is finalized, meets the requirements to be a resident is exempt from the three-month waiting period, or from completing it if it has already begun, for the three months immediately following the date the child’s adoption is finalized.

6.1 If a person takes up residence in Ontario immediately after moving to Ontario from another province or territory of Canada where he or she was insured under a publicly funded health care insurance plan and is admitted to and moves into an approved charitable home for the aged under the Charitable Institutions Act, a home under the Homes for the Aged and Rest Homes Act or a nursing home under the Nursing Homes Act, the person,

(a) is exempt from the waiting period under subsection 5 (2), if he or she is admitted to and moves into that home immediately upon taking up residence in Ontario; or

(b) is exempt from completing the remainder of the waiting period, if applicable, when he or she is admitted to and moves into that home.

6.2 A person is exempt from the three-month waiting period if he or she is a Canadian citizen, a landed immigrant under the former Immigration Act

(Canada) or a permanent resident under the Immigration and Refugee Protection Act (Canada) who, after July 20, 2006 comes to Ontario promptly after leaving a foreign country where an evacuation effort is being undertaken or facilitated by the Government of Canada.

6.3 A person is exempt from the three-month waiting period if he or she is a “protected person” as that term is used in the Immigration and Refugee Protection Act (Canada).

4. This Regulation comes into force on the day it is filed.