ONTARIO REGULATION 267/13

made under the

HEALTH INSURANCE ACT

Made: September 25, 2013
Filed: September 27, 2013
Published on e-Laws: September 27, 2013
Printed in The Ontario Gazette: October 12, 2013


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

(GENERAL)

1. (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:

23. Amendments dated September 1, 2013 (effective as of April 1, 2013);

(2) The definition of “schedule of benefits” in subsection 1 (1) of the Regulation is amended by adding the following paragraph:

24. Amendments dated September 1, 2013 (effective as of October 1, 2013).

(3) The definition of “schedule of benefits” in subsection 1 (1) of the Regulation is amended by adding the following paragraph:

25. Amendments dated September 1, 2013 (effective as of January 1, 2014).

2. Subsection 28.0.3 (4) of the Regulation is revoked and the following substituted:

(4) Where an insured service prescribed by subsection (1) is a genetic service or test, an amount is not payable for the insured service unless,

(a) in the case of an insured person who is an exempt resident,

(i) an application for approval of payment is submitted to the General Manager on behalf of the insured person by a physician who practices medicine in the jurisdiction where the service is rendered, and

(ii) the application includes written confirmation from a specialist that, in the specialist’s opinion, the conditions in clause (1) (a) are satisfied, where the specialist is certified as a specialist in treating the medical condition to which the test or service relates and the specialist is a specialist in the jurisdiction where the service or test for which approval for payment is sought is to be rendered; or

(b) in the case of an insured person who is not an exempt resident, the application under clause (3) (b) includes written confirmation from an Ontario physician who is a specialist, as defined in the schedule of benefits, in treating the medical condition to which the test or service for which approval of payment is sought relates that, in that specialist’s opinion, the conditions in clause (1) (a) are satisfied.

3. Subsection 28.5 (4.1) of the Regulation is revoked and the following substituted:

(4.1) Where an insured service prescribed by subsection (1) is a genetic service or test, an amount is not payable for the insured service unless, in addition to the written confirmation required under paragraph 2 of subsection (4), there is written confirmation from an Ontario physician who is a specialist, as defined in the schedule of benefits, in treating the medical condition to which the service or test for which approval of payment is sought relates that, in that specialist’s opinion, the conditions in subsection (1) are satisfied.

Commencement

4. (1) Subject to subsections (2), (3), (4), (5) and (6), this Regulation comes into force on the day it is filed.

(2) Subsection 1 (1) is deemed to have come into force on April 1, 2013.

(3) Subsection 1 (2) comes into force on October 1, 2013.

(4) Subsection 1 (3) comes into force on January 1, 2014.

(5) Section 2 comes into force on April 1, 2014.

(6) Section 3 comes into force on October 1, 2013.