Physician Payment and Policy Ontario Health Insurance Program
Resource Manual for Physicians
 
2.2   General Preamble

NOTE :

This is intended to be a brief overview of the critical elements within the General Preamble, and not a substitute for the actual document.

The first section of the Schedule is the “General Preamble”. The General Preamble provides details about billing requirements for all physicians.  The Definitions section of the General Preamble lists general definitions of key terms and phrases used in the Schedule.  Information regarding a number of topics is provided under General Information.  This is followed by the Constituent and Common Elements of Insured Services and the Specific Elements of Assessments.  The next sections provide information on Consultations and Assessments followed by the section regarding services provided only in Hospitals and Other Institutions.  The next section focuses on psychotherapy, counseling, and related services, followed by a similar review of services that involve interviews.  The remaining sections include special visits, surgical assistants’ services, anaesthesiologists’ services, and others as listed.

In addition to the information provided in the General Preamble, it is necessary to review service specific information provided elsewhere in the Schedule to have a complete understanding of the requirements for a particular service.

The following is an overview of the issues and information within the General Preamble that may guide you in a more detailed examination of the General Preamble.

NOTE :

In the event of a conflict between this overview and the full text of the General Preamble, the General Preamble prevails. You are expected to be familiar with all the relevant provisions of the General Preamble and applicable legislation and regulations. All claims for payment will be determined in accordance with the General Preamble and not with this overview. For specific details and definitions, refer to the General Preamble of the Schedule of Benefits.

Common and Constituent Elements

All insured services include the skill, time and responsibility involved in performing the constituent elements of the service. As a provider, you should be aware of the following list of elements that are common to all insured services :

  • Being available to provide follow-up insured services to the patient or making arrangements for coverage when you are not available
  • Making any arrangements for appointment(s) involving the insured service

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