Physician Payment and Policy Ontario Health Insurance Program
Resource Manual for Physicians
2.3   Schedule of Benefits Appendices

All appendices are found in the Appendices section at the end of the Schedule of Benefits. Appendix D forms part of the Schedule of Benefits for the purposes of payment of claims. While the other appendices do not, they contain information that may be helpful. Regulations, such as those excerpted within the appendices are subject to change. Physicians are cautioned to acquaint themselves with the current text of these regulations.

Appendix included as part of the Schedule of Benefits :

Appendix D – This section contains information regarding the criteria for OHIP coverage for surgical procedures that are for the purpose of altering or restoring appearance, including surface pathology and sub-surface pathology.

Appendices as attachments to the Schedule of Benefits :

Appendix A – Provides an Internet link to Section 24 of Regulation 552 of Revised Regulations of Ontario, 1990 under the Health Insurance Act.

Appendix B – Provides an Internet link to regulations relating to Conflicts of Interest in accordance with Section 15, 16 and 17 and Records in accordance with Section 18 and 19 of Ontario Regulation 241/94 made under the Medicine Act, 1991.

Appendix C – Information on Benefits Outside Ontario as well as Interprovincial Reciprocal Billing of Medical Claims.

Appendix F – Services set out here are not “insured services” within the meaning of the Health Insurance Act but are paid by the ministry, acting as a paying agent on behalf of the Ministry of Community and Social Services (MCSS), the Ministry of the Attorney General, the Ministry of the Solicitor General, and the Workplace Safety Insurance Board (WSIB). This appendix includes a list of important forms for physicians relating to the MCSS Ontario Disability Support Program and MCSS Ontario Works Program.

Appendix G – Provides an Internet link to medical record requirements as found in the Health Insurance Act.

Appendix H – Table listing the number of units payable based on the duration of time spent rendering anaesthesia or surgical assistant services.

Following the Appendices, you will find the Alphabetic Index and the Alpha Numeric Index.