Regulation - LGIC

Fertility Services: Changes to the Schedule of Benefits for Physician Services and Regulation 552 of the Health Insurance Act.

Regulation Number(s):
Instrument Type:
Regulation - LGIC
Bill or Act:
Health Insurance Act
Summary of Decision:
Made: December 9, 2015
Filed: December 18, 2015
Published on e-Laws: December 18, 2015
Printed in The Ontario Gazette: January 2, 2016
Analysis of Regulatory Impact:
No new administrative cost for business.
Further Information:
Proposal Number:
Posting Date:
September 14, 2015
Summary of Proposal:
Under the Health Insurance Act (HIA), the Ontario Health Insurance Plan (OHIP) provides payments for prescribed hospital services, medically necessary physician services, certain dental services that are required to be performed in a hospital, and prescribed therapeutically necessary services provided by practitioners and health facilities. Regulation 552 and the Schedule of Benefits for Physician Services (Schedule) list the physician services that are insured under Ontario's HIA.

Two medical procedures used to assist patients with infertility to achieve a pregnancy are Intra-Uterine Insemination (IUI) and In Vitro Fertilization (IVF).

Currently under Regulation 552 and the Schedule, OHIP insures physician, hospital, and laboratory services related to IUI. In addition, OHIP insures physician, hospital, and laboratory services related to the first three treatment cycles of IVF that are intended to address infertility due to complete bilateral anatomical fallopian tube blockage that did not result from sterilization.

The Ministry of Health and Long-Term Care is proposing amendments to Regulation 552 and the Schedule that will remove both IUI and IVF as insured services under OHIP.

The proposed amendments will support the government's plan to expand access to fertility services by removing IVF and IUI as insured services under OHIP and instead establishing a new program to publicly fund these assisted reproduction services for more patients outside OHIP.
Contact Address:
Health Services Branch
1055 Princess Street, 3rd Floor
PO Box 168 Stn Main
Kingston, ON K7L 5V1
Effective Date:
December 21, 2015