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Ministry Programs

Ontario Health Insurance Plan

Protecting Access to Public Health Care

The Commitment to the Future of Medicare Act, 2004 (CFMA) confirms the Ontario Government’s commitment to the fundamental principles of insured accessible health care services as set out in the Canada Health Act.

Patients with a valid OHIP card are entitled to access insured health care services at no charge.

Under the authority of Ontario’s CFMA, the Ministry of Health and Long-Term Care investigates cases of extra-billing and queue jumping. The ministry is working to ensure all patients have equitable access to insured health care services. This is important in helping to sustain our publicly funded health care system.

Under the Commitment to the Future of Medicare Act, 2004 (CFMA):

• Extra-billing is prohibited – Physicians and designated practitioners cannot charge more than the amount payable under the Ontario Health Insurance Plan (OHIP) for providing an insured service to an insured person.
• Charging patients for an insured service is prohibited – No one can charge insured patients or their private insurers for a service that is insured under OHIP.
• Queue jumping is prohibited – The CFMA prohibits anyone from accepting payment for giving patients preferred access to insured services. It also prohibits patients from paying an amount or some other benefit in order to receive preferred access to insured services.
• Prescribed health care providers must report queue jumping – It is mandatory for a prescribed health care provider who believes that a person has paid to queue jump or accepted a payment to allow queue jumping to inform OHIP. Failure to report can result in a fine as set out in the Act.
• Investigations are conducted and penalties may apply – The ministry will investigate possible violations of the CFMA with respect to charges for insured services and preferential access. Any individual or corporation convicted of contravening the provisions of the CFMA is subject to fines as set out in the Act.
• Block or annual fees may not be used to circumvent the universality of medicare – The CFMA does not prohibit charging fees for uninsured services like preparation of sick notes or cosmetic surgery. However, the Act clearly prohibits a physician, hospital or clinic from refusing to provide access to insured services if a patient chooses not to pay a block or annual fee.

Examples of Insured and Uninsured Services

Insured Services - Examples

Uninsured Services - Examples

Medically necessary physician services Hospital Services Routine eye exams for specified patients in specified age groups Medically necessary eye care services for patients of all ages Dental services that require hospitalization Limited physiotherapy services provided by designated clinics Limited podiatry services Insured services provided in other provinces of Canada Services provided outside of Canada with prior ministry approval and limited emergency services

Uninsured services are listed in Section 24 of Regulation 552 under the HIA. People pay directly for uninsured services, or they may be covered by private insurance. Services that are not medically necessary or are experimental Prescription drugs and those provided in non-hospital settings Eyeglasses, contact lenses, refractive surgery Routine dentistry Cosmetic surgery that is not medically necessary

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Patient Fact Sheet – Are You Paying For Insured Health Services? Know the Law

Patient Fact Sheet - Cataract and Lens Exchange Surgeries

Commitment to the Future of Medicare Act, 2004

If you have any questions or concerns about charges for insured services or charges for access to insured services, please contact the Ministry of Health and Long-Term Care:

CFMA toll free call-line : 1 888-662-6613

CFMA e-mail: CFMA.Program@ontario.ca or Protectpublichealthcare@ontario.ca