Health Insurance Act, R.S.O. 1990, c. H.6

• Jurisdiction: Ontario

Health Insurance Act

R.S.O. 1990, CHAPTER H.6

Consolidation Period: From September 25, 2023 to the e-Laws currency date.

Last amendment: 2023, c. 4, Sched. 2, s. 5.

CONTENTS

Definitions

1 In this Act,

“Appeal Board” means the Health Services Appeal and Review Board under the Ministry of Health and Long-Term Care Appeal and Review Boards Act, 1998; (“Commission d’appel”)

“billing number” means the unique identifying number issued by the General Manager to a physician, practitioner or health facility that has been granted a billing number by the General Manager under section 16.2; (“numéro de facturation”)

“Deputy Minister” means the Deputy Minister of Health and Long-Term Care; (“sous-ministre”)

“future cost of insured services” means the estimated total cost of the future insured services made necessary as the result of an injury that will probably be required by a patient after the date of settlement or, where there is no settlement, the first day of trial; (“coût futur des services assurés”)

“General Manager” means the General Manager appointed under section 4; (“directeur général”)

“health card” means a document in a prescribed form issued by the General Manager; (“carte Santé”)

“health facility” means an ambulance service, a medical laboratory and any other facility prescribed by the regulations as a health facility for the purposes of this Act; (“établissement de santé”)

“insured person” means a person who is entitled to insured services under this Act and the regulations; (“assuré”)

“insured services” means services that are determined under section 11.2 to be insured services; (“services assurés”)

“integrated community health services centre” means an integrated community health services centre within the meaning of the Integrated Community Health Services Centres Act, 2023; (“centre de services de santé communautaire intégré”)

“justice” has the same meaning as in the Provincial Offences Act; (“juge”)

“Minister” means the Minister of Health and Long-Term Care; (“ministre”)

“Ministry” means the Ministry of Health and Long-Term Care; (“ministère”)

“past cost of insured services” means the total cost of the insured services made necessary as the result of an injury and provided to a patient up to and including the date of settlement or, where there is no settlement, the first day of trial; (“coût antérieur des services assurés”)

“personal information” means personal information as defined in the Freedom of Information and Protection of Privacy Act and includes personal health information as defined in the Personal Health Information Protection Act, 2004; (“renseignements personnels”)

“physician” means a legally qualified medical practitioner lawfully entitled to practise medicine in the place where medical services are rendered by the physician or another prescribed person; (“médecin”)

“Plan” means the Ontario Health Insurance Plan referred to in section 10; (“Régime”)

“practitioner” means a person other than a physician who is lawfully entitled to render insured services in the place where they are rendered; (“praticien”)

“prescribed” means prescribed by the regulations; (“prescrit”)

“provincial offences officer” has the same meaning as in the Provincial Offences Act; (“agent des infractions provinciales”)

“regulations” means the regulations made under this Act; (“règlements”)

“resident” means a resident as defined in the regulations and the verb “reside” has a corresponding meaning; (“résident”)

“reviewer” means a reviewer provided for under section 41; (“examinateur”)

“schedule of benefits” means the schedule of benefits as defined by the regulations. (“liste des prestations”) R.S.O. 1990, c. H.6, s. 1; 1993, c. 2, s. 12; 1993, c. 32, s. 2 (1); 1994, c. 17, s. 68; 1996, c. 1, Sched. H, s. 1 (2) - 1/05/1996; 1998, c. 18, Sched. G, s. 54 (1); 2006, c. 19, Sched. L, s. 11 (2, 4); 2007, c. 10, Sched. G, s. 1; 2009, c. 33, Sched. 18, ss. 11 (1), 17 (2); 2019, c. 15, Sched. 15, s. 1; 2023, c. 4, Sched. 2, s. 5; 2023, c. 4, Sched. 1, s. 71 (1).

Section Amendments with date in force (d/m/y)

1993, c. 2, s. 12 - 01/07/1993; 1993, c. 32, s. 2 (1) - 14/12/1993; 1994, c. 17, s. 68 - 01/04/1994; 1996, c. 1, Sched. H, s. 1 (1) - no effect; 1996, c. 1, Sched. H, s. 1 (2) - 01/05/1996; 1998, c. 18, Sched. G, s. 54 (1) - 01/02/1999

2006, c. 19, Sched. L, s. 11 (2, 4) - 22/06/2006

2007, c. 10, Sched. G, s. 1 (1, 2) - 04/09/2007; 2007, c. 10, Sched. G, s. 1 (3) - 01/09/2009

2009, c. 26, s. 11 (1) - no effect - see Table of Public Statute Provisions Repealed Under Section 10.1 of the Legislation Act, 2006 - 31/12/2019; 2009, c. 33, Sched. 18, ss. 11 (1), 17 (2) - 15/12/2009

2017, c. 25, Sched. 9, s. 97 (1) - no effect - see 2023, c. 4, Sched. 1, s. 67; 2017, c. 25, Sched. 9, s. 97 (2, 3) - no effect - see 2009, c. 26, s. 11 (1) - 31/12/2019

2019, c. 15, Sched. 15, s. 1 (1, 2) - 10/12/2019

2023, c. 4, Sched. 1, s. 71 (1) - 25/09/2023; 2023, c. 4, Sched. 2, s. 5 - 24/07/2023

Administration

Administration of Plan by Minister

2 (1) The Minister is responsible in respect of the administration and operation of the Plan and is the public authority for Ontario for the purposes of the Canada Health Act. R.S.O. 1990, c. H.6, s. 2 (1).

Duties of Minister

(2) The Minister may,

(a) enter into arrangements for the payment of remuneration to physicians, practitioners and health facilities rendering insured services to insured persons on a basis other than fee for service;

(b) enter into agreements with persons, organizations and government agencies outside Ontario for the provision of insured services to insured persons.

(c), (d), (e) Repealed: 2009, c. 33, Sched. 18, s. 11 (2).

R.S.O. 1990, c. H.6, s. 2 (2); 2009, c. 33, Sched. 18, s. 11 (2); 2017, c. 11, Sched. 3, s. 11.

Collection of personal information

(3) The Minister may collect, directly or indirectly,

(a) personal information that relates to the eligibility of a person to become or to continue to be an insured person; or

(b) the prescribed personal information, which may include a photograph and signature, that relates to the form or content of the health card. 1994, c. 17, s. 69.

Agreements concerning personal information

(4) The Minister may enter into agreements to collect, use or disclose the personal information referred to in clause (3) (a) and to collect and use the personal information referred to in clause (3) (b). 1994, c. 17, s. 69.

Agreements concerning payment information

(4.1) The Minister may enter into agreements to collect, use and disclose,

(a) personal information concerning insured services provided by physicians, practitioners or health facilities; and

(b) such other personal information as may be prescribed. 1996, c. 1, Sched. H, s. 2 (1).

Limitation

(5) An agreement shall provide that personal information collected or disclosed under the agreement will be used only,

(a) to verify the accuracy of information held or exchanged by a party to the agreement;

(b) to administer or enforce a law administered by a party to the agreement; or

(c) for such other purposes as may be prescribed. 1994, c. 17, s. 69; 1996, c. 1, Sched. H, s. 2 (2).

Confidentiality

(6) An agreement shall provide that personal information collected, used or disclosed under it is confidential and shall establish mechanisms for maintaining the confidentiality of the information. 1996, c. 1, Sched. H, s. 2 (3).

Deemed terms

(7) The Lieutenant Governor in Council may make regulations providing for provisions that shall be deemed to be included in arrangements made under clause (2) (a) that require reporting of physician payments to individual physicians from remuneration provided under such arrangements, and which shall be deemed to be included in arrangements entered into before the regulations were made and before this subsection came into force. 2019, c. 15, Sched. 15, s. 2.

(8) Repealed: 2015, c. 20, Sched. 15, s. 1.

Section Amendments with date in force (d/m/y)

1994, c. 17, s. 69 - 23/06/1994; 1996, c. 1, Sched. H, s. 2 (1-3) - 01/05/1996

2007, c. 10, Sched. C, s. 1 - 04/06/2007

2009, c. 33, Sched. 18, s. 11 (2) - 15/12/2009

2015, c. 20, Sched. 15, s. 1 - 29/10/2015

2016, c. 30, s. 38 - no effect - see 2019, c. 5, Sched. 3, s. 28 - 18/04/2019

2017, c. 11, Sched. 3, s. 11 - 30/05/2017

2019, c. 15, Sched. 15, s. 2 - 10/12/2019

Ontario-Canada agreement

3 (1) The Government of Ontario, represented by the Minister of Finance, may enter into and amend from time to time an agreement with the Government of Canada under which Canada will contribute to the cost of that part of the Plan related to the provision of any insured services in or by hospitals and health facilities in accordance with such terms and conditions as the agreement provides. R.S.O. 1990, c. H.6, s. 3 (1); 2006, c. 19, Sched. L, s. 11 (5).

Idem

(2) The Government of Ontario, represented by the Minister, may enter into and amend from time to time an agreement with the Government of Canada under which Canada will contribute to the cost of that part of the Plan related to insured services other than insured services provided in or by a hospital or health facility, in accordance with such terms and conditions as the agreement provides. R.S.O. 1990, c. H.6, s. 3 (2).

Section Amendments with date in force (d/m/y)

2006, c. 19, Sched. L, s. 11 (5) - 22/06/2006

General Manager

4 (1) A General Manager for the Plan shall be appointed by the Lieutenant Governor in Council. R.S.O. 1990, c. H.6, s. 4 (1).

Duties

(2) Subject to this Act and the regulations, it is the function of the General Manager and he or she has the power,

(a) to administer the Plan as the chief executive officer of the Plan;

(b) to carry out registrations in the Plan, including the determination of eligibility and the verification of eligibility;

(c) to make payments by the Plan for insured services, including the determination of eligibility and amounts;

...