of the premises, equipment, supplies and personnel for the common elements
of the service are included in the fee payable for the service. Any charge
to the patient is extra-billing and subject to action under the Health
Insurance Act and the Health
Care Accessibility Act. For additional information regarding the
common elements of insured services, refer to the Schedule General
Preamble, Section B.1. Refer to the note below regarding administration of
privately obtained vaccine.
Public Health Branch will be evaluating the effectiveness of the influenza
vaccine. Therefore, physicians are directed to enter diagnostic code 487
in the diagnostic code field on the item record of the claim for all
claims related to the diagnosis and treatment of influenza and its
Publicly Funded Vaccine
Ontarians are eligible to receive publicly funded influenza vaccine.
However, the Public Health Branch of the Ministry of Health and Long-Term
Care can release the publicly-funded vaccine in stages and/or direct
physicians to administer the available supply to different population
groups at different times in order to give priority to people with the
highest risk of contracting influenza.
may choose to purchase a private supply of the influenza vaccine to
accommodate patient convenience. In this situation, administration of the
vaccine remains insured. The physician can charge the patient for the
vaccine in accordance with the Health Insurance Act, Regulation 552, section 24(4). However,
physicians should advise patients of the availability of publicly funded
vaccine which they are eligible to receive at no cost. Physicians should
also be familiar with provisions under the Medicine
Act applicable to the dispensing and sale of drugs.
from physicians regarding fee-for-service claims submissions should be
directed to the physician's local OHIP claims processing office.
from public agencies and facilities should be directed to the local Public
· Related Public Health Branch Bulletins are available on the web at : http://www.health.gov.on.ca/english/providers/program/pubhealth/flu/professionals/flu_bul/flubul_mn.html
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