Expanded health coverage for uninsured people in Ontario

Expanding on the statement that Ontario "will cover the cost of COVID-19 services for uninsured people who do not meet the criteria for OHIP coverage" (archived), further details can be found at this March 25, 2020, OHIP Bulletin, "Re: COVID-19 Expanding access to OHIP Coverage and Funding Physican and Hospital Services for Uninsured Patients" (archived). It includes (highlighting added):

1. Removal of the Three Month Waiting Period

Effective March 19, 2020, the three-month waiting period for OHIP coverage has been removed from Regulation 552 in response to the COVID-19 situation. This is a temporary measure. The three-month waiting period will be reinstated at a future date.

Individuals who are currently in their three-month waiting period will be eligible for OHIP coverage as of March 19, 2020. All individuals enrolled for OHIP after March 19, 2020 will have immediate coverage.

2. Funding for Physician and Hospital Services for Patients without OHIP or Other Provincial/Federal Health Coverage

Physicians who perform services for uninsured patients in a hospital setting will be remunerated by the hospital at existing rates listed in the Schedule of Benefits for Physician Services (the Schedule). Claims for these services cannot be submitted to OHIP.

Please Note: Physicians should continue to use existing billing methods for patients who have Canadian provincial health insurance coverage (e.g. BC, QC etc), and for those who have federal coverage (e.g. Interim Federal Health).

The ministry will be providing a tracking spreadsheet to all hospitals with the information required for reimbursement of hospital services and physician services performed in hospital. Physicians are expected to report this information to the hospital where the service was provided. Hospitals will be responsible for submitting reports to the ministry for reconciliation and payment, from which hospitals will distribute payment to physicians.

For services performed outside the hospital setting, the ministry is introducing the following temporary fee codes for the provision of medically necessary physician services provided to uninsured patients in the community.

These codes come into effect March 21, 2020.

Please Note: While payment for the provision of services associated with these temporary codes is effective March 21, 2020, system changes will be implemented over the coming weeks to process payment. As a result, the ministry requests that physicians wait to submit claims for these codes until futher notice. Further information regarding each of these changes will be forthcoming.

Fee Codes and Payment

Temporary Codes

K087:
Minor assessment of an uninsured patient provided in-person or by telephone or video or advice or information provided in-person or by telephone or video to an uninsured patient's representative regarding health maintenance, diagnosis, treatment and/or prognosis - $23.75

K088:
a. intermediate assessment of an uninsured patient provided in-person or by telephone or video, or advice or information provided in-person or by telephone or video to an uninsured patient's representative regarding health maintenance, diagnosis, treatment and/or prognosis, if the service lasts a minimum of 10 minutes; or
b. psychotherapy, psychiatric or primary mental health care, counselling or interview conducted in-person or by telephone or video, if the service lasts a minimum of 10 minutes - $36.85

K089:
Psychotherapy, psychiatric or primary mental health care, counselling or interview conducted in-person or by telephone or video per unit (unit means half hour or major part thereof) per unit - $67.75

Payment Requirements

The services must be documented on the patient's medical record (including the start and stop times).

If K087, K088, or K089 are claimed, no charge can be billed to, or payment received from, the patient or the patient's representative. [...]

3. Extending Expiry Dates of Recently Expired and Expiring Health Cards

Most recently expired and expiring health cards will remain valid and can continue to be used for accessing insured health services until further notice.

Health care providers are encouraged to continue using existing health card validation services to validate all health cards at point of service.

If an individual does not have a valid Ontario health card, please do not turn the patient away. Instead, please use billing codes identified above for individuals without OHIP or another provincial health plan.

4. Suspension of the Elimination of Red and White Health Cards

Ontario residents with a valid red and white health card can continue to use their card.

The ministry's planned elimination of red and white health cards on July 1, 2020 has been suspended at this time. [...]

A new deadline has not been determined. When a new date has been set, the ministry will make an announcement. [...]

Presenting and Validating the Health Card

[...] Please note that if an individual does not have a valid health card please do not turn them away. Instead, please use billing codes identified above for individuals without OHIP or another provincial health plan.