OHIP : Ambulance Services Billing

You are responsible for an ambulance service co-payment charge of $45.00 for ambulance services rendered :

• if you are a resident of Ontario, and
• you have a valid Ontario health card, and
• a physician deems your ambulance service medically necessary, and
• your ambulance trip originates in Ontario and ends in Ontario, and
• you can not claim an ambulance co-payment exemption (below).

Your ambulance transportation costs are fully covered :

• if you are a resident of Ontario, and:
• you have a valid Ontario health card, and
• a physician deems your ambulance service medically necessary, and
• your ambulance trip originates at an Ontario hospital or health care facility, and
• your destination is a hospital or health care facility outside the province but within Canada, and
• treatment is not available anywhere in Ontario.

Your ambulance transportation costs are fully covered :

• if you are a resident of Ontario, and:
• you have a valid Ontario health card, and
• a physician deems your ambulance service medically necessary, and
• your ambulance trip originates at an Ontario hospital, and
• your destination is a hospital or health care facility outside the country, and
• prior approval from OHIP for out-of-country medical treatment is obtained, and
• treatment is not available anywhere in Ontario.

You are responsible for an ambulance service co-payment charge of $240.00 for each land ambulance service rendered, and/or the actual cost for each air ambulance service rendered :

• if you are a resident of Ontario, and
• you do not have a valid Ontario health card, or
• a physician deems your ambulance service medically unnecessary, and
• your ambulance trip originates in Ontario, regardless of destination.

You are responsible for the full cost of the land and/or air ambulance services received :

• if you are a resident of Ontario, and
• your ambulance trip originates outside Ontario.

Land and air ambulance services originating out-of-province are not an insured benefit under OHIP.  Residents travelling outside the province are encouraged to purchase supplementary or travel health insurance, as some plans offer emergency medical and repatriation transportation for the ill and/or injured.

Visitors from Other Provinces

Your ambulance transportation costs are fully covered :

• if you are a visitor to Ontario from another province, and
• you are insured under your province’s health care plan, and
• a physician deems your ambulance service medically necessary, and
• you are transported between an Ontario hospital and a hospital in another province, or between two Ontario hospitals, and
• your trip is for diagnostic or therapeutic services, and
• you are returned to the hospital of origin within 24 hours.

Otherwise, you are responsible for an ambulance service co-payment charge of $240.00 for each land ambulance service rendered, and/or the actual cost for each air ambulance service rendered.

Visitors from Other Countries

You are responsible for the full cost of any land and/or air ambulance services received if you are a visitor to Ontario from another country.

Ambulance Co-Payment Exemption

All Ontario residents who travel within Ontario by ambulance for medically necessary services and who have a valid Ontario health card are required to pay a portion (co-payment) of the ambulance services rendered in the amount of $45.00, except under the following situations :

• the person receives benefits under the Ontario Works Act, the Ontario Disability Support Program Act  or the Family Benefits Act;
• the person receives provincial social assistance (general welfare assistance or family benefits);
• the person is being transferred from one hospital or health care facility to another for insured, medically necessary treatment;
• the person is enrolled in the ministry’s Home Care Program;
• the person is living in one of the following facilities licensed or approved by the Ministry of Health and Long-Term Care :
• nursing home
• home for the aged
• rest home
• home for special care
• home or residence for psychiatric patients.

Responsibility for Ambulance Costs

The Health Insurance Act , Regulation 552, specifies that any individual transported in an ambulance is responsible for any ambulance charges.

When a person accepts transport in an ambulance, that person accepts any costs associated with that service.  If a person does not wish to be transported by ambulance they can decline the service at the time of the incident by signing the “Refusal of Service” section of the Land Ambulance Call Report held by the ambulance crew.  A person refusing ambulance service by signing this section of the Land Ambulance Call Report will not receive a charge for ambulance services. 

Unable to Show Ontario Health Card

Ontario citizens who cannot provide a valid Ontario health number at the time of billing will be billed at the uninsured rate.  Upon presentation of a valid Ontario health card to the billing institution, the account will be updated and the amount to be paid will be adjusted.

Two Patients in the Same Ambulance

The Health Insurance Act regulations specify that each person transported in an ambulance is responsible for the payment of appropriate ambulance charges.  Each patient transported, regardless of the distance or number of patients in the ambulance, is responsible for payment of the costs as set out in the legislation.

Billing

Where in-province ambulance services are provided by air or by rail, including, where applicable any ambulance service required to connect with the air or rail facilities, an insured person shall pay as his or her share of the ambulance charges an amount of $45.00 a trip by way of co-payment. (refer to R.R.O. 1990, Reg. 552, s. 15(2); O. Reg. 329/92, s. 1(2))

Billing for in-province land ambulance services is normally done by hospitals.  For inpatients this is usually done the day after the arrival of the patient.  Outpatients are billed according to the hospital’s billing procedure.

Billing for land and/or air ambulance services that originate out-of-province is normally done by the provider of the ambulance service.

September 2008