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Hospital Insurance Regulations
2001 c42 s45
Hospital Insurance Regulations
Under the authority of section 4 of the Hospital Insurance Agreement Act and the Subordinate Legislation Revision and Consolidation Act , the Lieutenant-Governor in Council makes the following regulations.
1. These regulations may be cited as the Hospital Insurance Regulations .
2. (1) In these regulations
(a) "Act" means the Hospital Insurance Agreement Act ;
(a.1) "chiropractor" means a person licensed under the Chiropractors Act ;
"federal hospital" means a hospital owned or operated by
(c) [Rep. by 47/18 s1]
(d) "in-patient" means a person admitted to and assigned a bed in a hospital upon the recommendation of a practitioner;
(e) "insured person" means a resident who is eligible for and entitled to insured services;
(f) "insured services" means the in-patient services and out-patient services set out in the Schedule, and includes x-ray services prescribed by a chiropractor, but does not include services which a person is eligible for and entitled to under an Act of the Parliament of Canada or the legislature of the province or of another competent jurisdiction as specified in the agreement;
(g) "medical officer" means a practitioner who has been appointed by the minister as medical officer of a district and includes practitioners employed in the Department of Health;
(h) "out-patient" means a person who receives out-patient services set out in the Schedule;
(i) "practitioner" means a person registered and licensed to practise medicine by the Newfoundland Medical Board; and
(j) "resident" means a person other than a tourist, transient or other visitor to the province who
is legally entitled to remain in
(ii) enters the province from a participating province if that person was eligible for insured services in that participating province and if he or she intends to reside in this province.
Other words and expressions in these regulations have the meanings assigned to them in the Hospital Insurance and Diagnostic Services Act
Entitlement free of charge
3. (1) An insured person is entitled to receive insured services in a hospital free of charge if he or she has been
(a) admitted as an in-patient to a hospital on the recommendation of a practitioner; or
(b) admitted as an out-patient to a hospital on the recommendation of a practitioner for the purpose of receiving the out-patient services set out in the Schedule.
(1.1) An insured person is entitled to receive insured services in a hospital free of charge if he or she has been admitted as an out-patient to a hospital in the recommendation of a chiropractor for the purpose of receiving x-ray services.
(2) Persons referred to in subparagraph 2(1)(j)(ii) are eligible for insured services as of the first day of the third calendar month after the month of arrival in the province.
(3) For greater certainty, the medically necessary removal and replacement of a cataractous lens by any procedure is an insured service and shall be performed in a hospital or a facility designated by the Lieutenant-Governor in Council.
4. (1) A hospital shall keep records and accounts and make reports in respect of insured persons as the minister may require.
(2) The minister shall insure in each year that adequate standards are maintained in hospitals and other facilities including the supervision, licensing and inspection of those places.
Requirements for admission
5. Subject to section 7, an insured person shall not be admitted to hospital as an in-patient or as an out-patient unless he or she has been recommended for admission in accordance with section 6.
Recommendation for admission
6. (1) Recommendation for admission to hospital as an in-patient or an out-patient shall be made by the medical officer in the district where the insured person resides, or by the usual medical practitioner attending him or her, or by his or her chiropractor.
(2) In the case of an emergency, the recommendation for admission may be made by any practitioner.
(3) Recommendation for admission shall ordinarily be made in writing on a form prescribed by the minister.
577/78 s6; 14/03 s3
7. (1) An insured person shall not be admitted to a hospital as an in-patient or as an out-patient except in accordance with the ordinary admitting routine of the hospital and with the approval of the hospital admitting officer.
(2) Except in an emergency, a practitioner shall not send a person to a hospital until the practitioner or chiropractor has been notified by the admitting officer of that hospital that the accommodation or out-patient service is available.
(3) If the form referred to in section 6 does not show that the person recommended for admission is an insured person, the admitting officer shall not admit that person as an insured person unless it is proven to his or her satisfaction that the person recommended for admission is an insured person.
(4) In the case of a person referred to in subsection (3), if it is subsequently established that he or she is an insured person, that person may be reimbursed by the minister or the minister may pay the hospital directly for the cost of insured services received by the insured person upon presentation to the minister of a detailed hospital receipt for payments that the person has made.
(5) An insured person in a hospital who requests and receives any services in addition to insured services is liable to the hospital for the difference in cost between the services received and the insured services.
577/78 s7; 14/03 s4
8. Every insured person shall be discharged from a hospital in accordance with the ordinary discharge routine of the hospital.
Liability for costs on termination of entitlement
9. (1) If, after consideration of the hospital administrator's report, the minister is of the opinion that an insured person no longer requires insured services, that person's entitlement to insured services with respect to that hospital stay ceases.
(2) Entitlement to services terminates on the day following which the minister notifies the hospital administrator to that effect.
(3) The minister is not liable to the hospital or the insured person for any further insured services with respect to that hospital stay as of the time indicated in subsection (2).
Authority to enter agreements
10. The minister may enter into an agreement with any hospital listed in the Schedule for the provision of insured services to insured persons and under that agreement may make payment
(a) to or in respect of hospitals listed in Part I of Schedule A to the agreement
(i) for insured services based on their approved operating costs, and
(ii) for approved items of furniture and equipment, other than ambulances, based on the approved purchase price, and the cost of installation, where identifiable; and
(b) to hospitals listed in Part II of the Schedule to the agreement, for insured services at agreed rates.
Services within federal hospitals
11. (1) An insured person shall be entitled to receive insured services in a federal hospital within the province according to the ordinary admission procedures of the hospital and upon the recommendation of a practitioner.
(2) The minister may make arrangements to pay for the cost of insured services referred to in subsection (1) at an agreed daily rate based on the cost of operation of similar non-federal hospitals in the province.
12. (1) An insured person who receives insured services outside the province shall be entitled to be reimbursed or have payment for those services made on his or her behalf if the hospital which supplied the insured services is one which is licensed or approved as a hospital by the licensing authority in whose jurisdiction the hospital is located.
(2) Subject to these regulations, the minister may reimburse the insured person for the cost of insured services received on presentation of a detailed receipt from the hospital which supplied the insured services showing the amount paid together with the additional information that the minister may require or pay the hospital in respect of the cost of those services.
(3) Where insured services are provided
(a) in a participating province in a hospital which is listed in an agreement with the Government of Canada the amount payable under subsection (2) shall be at the rate established for that hospital by the participating province; or
(b) in a hospital outside the province but not in a participating province the minister may authorize payment under subsection (2) at a rate which in his or her opinion is fair having regard to the nature of the services provided and the hospital which provided the services.
Insured persons outside the province
13. (1) An insured person who leaves the province to reside in a participating province is considered to be a resident of this province during the normally required travel time from this province to the province of destination, and during any additional period not exceeding 3 months during which residence in the participating province is necessary to secure benefits under that province's hospital insurance legislation.
(2) A person described in subsection (1) is entitled to be reimbursed by the minister or have payment made on his or her behalf in respect of the cost of insured services received by that person in a hospital listed in an agreement between the participating province and the Government of Canada at a rate established by the participating province for that hospital.
(3) An insured person who leaves the province to reside elsewhere in Canada, other than a participating province, is considered to be a resident of this province during the normal time required to travel from Newfoundland and Labrador to that other part of Canada, and for a period of 3 months from the date of arrival in that other place.
(4) Subject to paragraph 12(1)(b), an insured person referred to in subsection (2) is entitled to be reimbursed by the minister or to have payment made on his or her behalf in respect of the cost of insured services received by him or her at rates which, in the opinion of the minister, are fair, having regard to the nature of the services provided and the hospital which provided the services.
577/78 s13; 2001 c42 s45
14. (1) Where insured services are provided to an insured person in respect of an injury or disability caused or contributed to by or resulting from default, negligence or other wrongful act of another person, notwithstanding that the service was provided free of charge under the Act and these regulations an action may be brought by or on behalf of the insured person to recover the cost of that service from the other person and the insured person shall on recovery from that other person of the cost of the service provided pay to the minister the cost so recovered and the minister may, if the insured person fails to pay to him or her within a reasonable time the cost so recovered, recover them from the insured person as a debt due the Crown.
(2) The minister is subrogated to all rights of recovery of or on behalf of the insured person referred to in subsection (1), and may bring an action in his or her own name or in the name of the insured person to enforce those rights against that other person in respect of the cost of service provided where
(a) service was provided free of charge under this Act and these regulations;
(b) an agreement has been entered into covering payment by the minister on behalf of the government of the province to any person or hospital; or
(c) the insured service is provided in a hospital controlled by or by a person employed by the Department of Health.
(3) Ministerial rights conferred in subsection (2) shall not restrict those other rights of recovery of the insured person in respect of the injury or disability in question, or for loss or damage not the subject of insured services.
(4) Where the insured person commences an action in respect of the loss or damage referred to in subsection (1), he or she shall include a claim on behalf of the minister for the cost of the insured service provided to him or her.
15. (1) Notwithstanding that an insured service was provided free of charge under the Act and these regulations, where those services are provided to insured persons in respect of injury or disability caused or contributed to by or resulting from default, negligence or other wrongful act of another person an action may be brought by or on behalf of the insured person to recover the cost of that service from the other person.
(2) The insured person shall, on recovery of the cost of the provided service from the other person, pay to the minister that cost that has been recovered.
(3) The minister may recover costs of insured services as a debt due to the Crown if the insured person fails to pay him or her costs recovered in subsection (1) within a reasonable time.
(4) A settlement which includes the cost of insured services shall not be effective unless the consent of the minister has been obtained or provision satisfactory to the minister has been made.
(5) The costs of an action by an insured person in which a claim has been joined on behalf of the minister under subsection (3) shall be borne by the minister in the same proportion as the minister's claim for the cost of the insured services bears to the total claimed by and through the insured person in the action.
(6) If no action has been commenced by an insured person for the recovery of damages arising out of injury, illness or disability within 2 months after the last act or omission which caused or contributed to the injury, illness or disability, the minister
(a) may, upon the service of notice on the insured person, commence an action in the name of the insured person for the recovery of the cost of insured services and before trial of the action, the insured person may join in the action other claims arising out of the same occurrence upon those conditions as to costs or otherwise as to the court may seem just; and
(b) may in that case effect settlement of the claim.
(7) A liability insurer shall pay to the minister any amount referrable to a claim for recovery of the cost of insured services that would otherwise be payable to an insured person and payment of that amount shall discharge the liability of the insurer to pay that amount to the insured person or to a person claiming under or on behalf of the insured person.
(8) For the purpose of this regulation, "liability insurer" means a person regularly engaged in the business of underwriting risks in respect of negligence.
(9) For the purpose of this regulation the cost of the insured services provided is
(a) in the province the cost as established by the minister;
(b) in a participating province the cost as established by the provincial authority which administers the hospital insurance program in that participating province; and
(c) elsewhere than in the province or a participating province the cost computed at a rate which in the opinion of the minister is fair, having regard to the services provided and the hospital which provided the services.
16. (1) A person who defrauds or attempts to defraud the minister or hospital by impersonating an insured person or in obtaining payments which are not legally payable under these regulations is guilty of an offence and liable on summary conviction to a penalty of not less than $200 and not more than $10,000.
(2) A person who contravenes a provision of these regulations for which no penalty is specifically provided is guilty of an offence and liable on summary conviction to a penalty of not less than $25 and not more than $500.
(1) Accommodation and meals at the standard or public ward level.
(2) Necessary nursing services.
(3) Laboratory, radiological and other diagnostic procedures including radioactive isotopes together with the necessary interpretations for the purpose of maintaining health, preventing disease and assisting in the diagnosis and treating of any illness, injury or disability.
(4) Drugs, biological and related preparations as provided in the agreement when administered in a hospital.
(5) Use of operating room, case room and anaesthetic facilities, including necessary equipment and supplies.
(6) Routine surgical supplies.
(7) Use of radio therapy facilities and radioactive isotopes where available.
(8) Use of physiotherapy facilities where available.
(9) Services rendered by persons who received remuneration from a hospital or from a province in respect of a hospital for those services including therapeutic radiologists and psychiatrists but not including clinical, medical or surgical services by physicians or surgeons except as are directly required in providing the services specified in subsection (3).
(1) Laboratory and radiological procedures including radioactive isotopes, electroencephalograms, cardiograms and basal metabolism estimations, together with the necessary interpretations.
(2) Use of radiotherapy facilities, including radioactive isotopes where available.
(3) Use of physiotherapy facilities where available.
(4) Services rendered by persons who received remuneration from a hospital or from a province in respect of a hospital for those services including therapeutic radiologists and psychiatrists but not including clinical, medical or surgical services by physicians or surgeons except as are directly required in providing the services specified in subsection (1).