HEALTH INSURANCE ACT - O. Reg. 14/01

ONTARIO regulation 14/01

made under the

health insurance act

Made: January 24, 2001
Filed: January 26, 2001
Printed in The Ontario Gazette: February 10, 2001

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

(General)

1.Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by adding the following section:

38.0.1(1)The following circumstances are prescribed for the purposes of paragraph 7 of subsection 18 (2) of the Act:

1.If the General Manager is of the opinion that the account for the service has not been submitted in accordance with the regulations.

2.For a service provided by a practitioner or a physician, if after consulting with another practitioner qualified to provide the same service or with another physician, the General Manager is of the opinion that medical or therapeutic procedures required to perform the service and included in the account for the service have also been included in an account for another service rendered to the same insured person.

(2)The following circumstances are prescribed for the purposes of paragraph 5 of subsection 39.1 (6) of the Act:

1.If the applicable committee is of the opinion that the account for the service has not been submitted in accordance with the regulations.

2.For a service provided by a physician or a practitioner, the applicable committee is of the opinion that medical or therapeutic procedures required to perform the service and included in the account for the service have also been included in an account for another service rendered to the same insured person.

2.The Regulation is amended by adding the following section:

38.6(1)For the purposes of subsection 27.2 (3) of the Act, the General Manager may require a physician or practitioner to submit accounts directly to the Plan if the physician or practitioner owes money to the Plan, has received the notice referred to in subsection (2) and has not paid the amount specified in the notice within 30 days after the day the notice is given.

(2)The General Manager shall give a physician or practitioner 30 days written notice of,

(a)the amount owing to the Plan;

(b)the matter in respect of which the amount is owing; and

(c)the intention of the General Manager to require the physician or practitioner to submit accounts directly to the Plan.

3.(1)Section 1 shall be deemed to have come into force on April 1, 1998.

(2)Section 2 comes into force on April 1, 2001.