Act
Proposed Service Provider Regulations
Regulation Number(s):
Instrument Type:
Act
Bill or Act:
Insurance Act
Summary of Decision:
Ontario Regulation 348/13 (Service Providers - Licensing), Ontario Regulation 349/13 (Service Providers - Principal Representatives) and Ontario Regulation 350/13 (Service Providers - Public Registry) have been approved.
Further Information:
Insurance Act
Prosperous and Fair Ontario Act (Budget Measures), 2013
Ontario Regulation 348/13 (Service Providers – Licensing)
Ontario Regulation 349/13 (Service Providers – Principal Representatives)
Ontario Regulation 350/13 (Service Providers – Public Registry)
Proposal Number:
13-MOF019
Posting Date:
October 10, 2013
Summary of Proposal:
The 2013 Ontario Budget included a commitment to introduce legislative amendments that would, if passed, "Give the Financial Services Commission of Ontario (FSCO) authority to license and oversee business practices of health clinics and practitioners who invoice auto insurers". This authority was included in The Prosperous and Fair Ontario Act (Budget Measures), 2013, which received Royal Assent on June 13, 2013.
This legislation provides that insurers are not permitted to make payments for listed expenses directly to a person or entity who does not hold a service provider's licence, subject to exceptions as may be prescribed by regulation. Insurers continue to be permitted to reimburse insured persons for listed expenses.
This legislation also provides that holders of a service provider's licence are required to comply with such standards as may be prescribed by regulation with respect to their business systems and practices in connection with statutory accident benefits, and to comply with such standards as may be prescribed with respect to matters of integrity in the management of the licensee's operations. Licensees are also required to submit invoices to the applicable insurer (or to such other person or entity as the insurer directs) for payment of listed expenses.
The proposed regulations would prescribe:
- Licensing eligibility including grounds for unsuitability
- Designated principal representative eligibility requirements and duties
- Public registry information
Future proposed regulations would be expected to prescribe:
- Business/billing standards of practice
- Listed expenses (e.g. expenses covered by licensing)
- Expenses not covered by licensing
- Licence applicability
- Revocation/Suspension criteria and expedited process
- Licence surrender criteria
- Unfair or deceptive acts or practices
- Administrative monetary penalties
- Consequential amendments to the Statutory Accident Benefits Schedule (SABS)
This legislation provides that insurers are not permitted to make payments for listed expenses directly to a person or entity who does not hold a service provider's licence, subject to exceptions as may be prescribed by regulation. Insurers continue to be permitted to reimburse insured persons for listed expenses.
This legislation also provides that holders of a service provider's licence are required to comply with such standards as may be prescribed by regulation with respect to their business systems and practices in connection with statutory accident benefits, and to comply with such standards as may be prescribed with respect to matters of integrity in the management of the licensee's operations. Licensees are also required to submit invoices to the applicable insurer (or to such other person or entity as the insurer directs) for payment of listed expenses.
The proposed regulations would prescribe:
- Licensing eligibility including grounds for unsuitability
- Designated principal representative eligibility requirements and duties
- Public registry information
Future proposed regulations would be expected to prescribe:
- Business/billing standards of practice
- Listed expenses (e.g. expenses covered by licensing)
- Expenses not covered by licensing
- Licence applicability
- Revocation/Suspension criteria and expedited process
- Licence surrender criteria
- Unfair or deceptive acts or practices
- Administrative monetary penalties
- Consequential amendments to the Statutory Accident Benefits Schedule (SABS)
Contact Address:
Maria Cece
Senior Manager
Insurance Policy Unit
Industrial and Financial Policy Branch
Ministry of Finance
95 Grosvenor Street
Frost Building North, 4th Floor
Toronto, ON
M7A 1Z1
Senior Manager
Insurance Policy Unit
Industrial and Financial Policy Branch
Ministry of Finance
95 Grosvenor Street
Frost Building North, 4th Floor
Toronto, ON
M7A 1Z1
Royal Assent Date:
May 1, 2014
Decision:
Approved