Regulation - LGIC

Proposed Amendment to Ontario Regulation 552 under the Health Insurance Act

Regulation Number(s):
Regulation 552
Bill or Act:
Health Insurance Act
Summary of Proposal:
The Ministry of Health and Long-Term Care (ministry) is proposing to amend Regulation 552 under the Health Insurance Act (HIA) to end the Ontario Health Insurance Program (OHIP) coverage for emergency services (arising while outside the country) for Ontarians travelling outside of Canada. If approved this change would take effect October 1, 2019.
Currently the Out-of-Country Travellers Program provides reimbursement at the following rates for services required to treat conditions that are acute, unexpected, arose outside Canada, and require immediate treatment.

For out-of-country inpatient services:
• a maximum of $400/day for higher level of care (e.g. Intensive Care Unit, operating room);
• a maximum of $200/day for any other level of care;

Otherwise:
• $50/day for outpatient services; and
• $210 for renal dialysis.

These reimbursement rates have not increased in over 20 years.

With this very limited coverage and the low reimbursement rates (~5% of costs on average) provided by the OOC Travellers Program, OHIP-eligible persons who do not purchase private travel health insurance can be left with catastrophically large bills to pay because of OOC emergency medical care. Ontarians are advised to obtain private travel health insurance before travelling outside of Canada.

The proposed revocation of the OOC Travellers Program is consistent with recommendations made by E and Y and by the OAGO. It also aligns with government's commitment to implement changes to restore accountability and trust in the use of taxpayer dollars and to bring greater modernization, efficiency and transparency to OHIP to benefit both providers and patients. Ontarians who decide to travel outside of Canada may continue to seek the best, most comprehensive coverage from travel insurance companies who already cover 94% of reimbursement for eligible costs related to emergency care services out of country. This proposal does not affect current publicly funded health care coverage for Ontarians travelling in other parts of Canada. In addition, this change will have no impact on 99.5% of Ontarians. OHIP data suggests, of those 40,000 Ontarians who do travel outside of Canada each year and require health services, over 90% obtain private travel health insurance.

In addition, the ministry is proposing to amend regulation 552 under the HIA to end OHIP coverage for osteopath services provided out-of-province. Regulation 280 under the Drugless Practitioners Act, which regulated the profession of osteopathy in Ontario, was revoked on October 25, 2004, and as a result osteopathy is no longer recognized as a regulated health profession in Ontario nor are there any active OHIP billing numbers. There have been no claims submitted for osteopathy services rendered in Ontario for over seven years. The ministry has however, paid annually on average, a total of $100 or less for osteopathy services rendered in other provinces to Ontario patients. This regulatory amendment will eliminate this residual inconsistency in coverage for osteopathy services provided out of province versus in province.

The proposed revocation of osteopathy services is consistent with the government's commitment to update and modernize OHIP to be more efficient, effective and responsive to Ontarians' in-province needs for health care.
Analysis of Regulatory Impact:
This proposal imposes little ongoing administrative costs to business although there will be some one-time costs associated with adapting to the elimination of the OHIP OOC Travellers program. Based on comments received during consultations with the travel insurance industry in April 2019, ending of the OOC Travellers Program would result in a small increase in premiums and some one-time transitional costs.
Further Information:
Proposal Number:
19-HLTC006
Posting Date:
April 24, 2019
Comments Due Date:
April 30, 2019
Contact Address:
Ministry of Health and Long-Term Care
Health Services Branch
49 Place D'Armes, 2nd Floor
Kingston ON K7K 1E7