Learn More >

Ministry Status: Activation Status

Ontario Health Insurance Plan

OHIP Bulletins


INFOBulletin

Physician Services InfoBulletins

Keeping Health Care Providers informed of payment, policy or program changes

To:  Eligible Emergency Department Alternative Funding Agreement Groups (EDAFAs)

Published by:  Negotiations Branch

Date Issued:  January 12, 2017

Bulletin Number:  4689

Re:  Payment of 2016 Seasonal Premium – EDAFA

Posted Electronically Only

PDF Version Portable Document Format | 139 Kb


Issue

Seasonal Premiums were not paid for claims processed by the ministry between July 1 and September 7, 2016.

Background

Per the 2006 Emergency Department Action for Ontario, physicians practicing in specific shadow-billing EDAFA groups receive a 25% Seasonal Premium during the summer months of July and August for hospitals with an annual Emergency Room volume less than 30,000 visitors.

When claims are submitted by eligible groups, with services dates within the Seasonal Premium period, they are assessed by the ministry’s claims payment system and the premium is calculated and paid on the group's remittance advice (RA).

What You Need to Know

No action is required for claims you have previously submitted.

Claims that were eligible for the Seasonal Premium (services dates in July and August), that were originally processed by the ministry between July 1st and September 7th 2016, have been reprocessed. The Seasonal Premium payment for these claims will be paid on the February 2017 RA. RA reporting of the Seasonal Premium is located in the Premium Payments Report.

Any outstanding claims for services should be submitted in adherence with the ministry's stale date policy. Services processed by the ministry after September 7, 2016 for eligible services in the July and August Seasonal Premium period have been assessed and paid correctly.

For any inquiries please contact the Service Support Contact Centre at 1-800-262-6524.


To view Portable Document Format PDF files, you will need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe website.

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free)
In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation : Monday to Friday, 8:30am - 5:00pm