Regulation - LGIC
Proposed Service Provider Licensing Regulations
Regulation Number(s):
Instrument Type:
Regulation - LGIC
Bill or Act:
Insurance Act
Summary of Decision:
Ontario Regulation 88/14 (Service Providers - Licensing), Ontario Regulation 89/14 (Service Providers - Listed Expenses) and Ontario Regulation 90/14 (Service Providers - Standards for Business Systems and Practices) have been approved.
Further Information:
2013 Ontario Budget
Prosperous and Fair Ontario Act (Budget Measures), 2013
Insurance Act
Regulations approved in December 2013
New Regulations for Service Provider Licensing and Proclamation Order
Ontario Regulation 88/14 (Service Providers - Licensing)
Ontario Regulation 89/14 (Service Providers – Listed Expenses)
Ontario Regulation 90/14 (Service Providers – Standards for Business Systems and Practices)
Proposal Number:
14-MOF004
Posting Date:
February 18, 2014
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 (provisions to come in force on proclamation).
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.
Regulations approved in December 2013 prescribed:
- Licensing eligibility including grounds for unsuitability
- Designated principal representative eligibility requirements and duties
- Public registry information
The proposed regulations would 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
Future proposed regulations would be expected to prescribe:
- 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.
Regulations approved in December 2013 prescribed:
- Licensing eligibility including grounds for unsuitability
- Designated principal representative eligibility requirements and duties
- Public registry information
The proposed regulations would 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
Future proposed regulations would be expected to prescribe:
- 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
Effective Date:
May 1, 2014
Decision:
Approved