Bulletin 201107 — Expired and Expiring Health Cards During COVID‑19
Most expired and expiring health cards remain valid until further notice
To: All Providers
Category: Physician Services
Written by: Claims Services Branch, Ontario Health Insurance Plan Division
Date issued: November 25, 2020
Further to INFOBulletin 4749, in response to COVID-19, most expired and expiring health cards (including red and white health cards) remain valid at this time and can continue to be used for accessing insured health services until further notice. In the case of expired health cards, only the most current version code will be accepted, and no provision has been made for incorrect version codes.
Red and white cards can continue to be used for insured health services as long as they remain valid.
Physician funding for services provided to uninsured patients is intended to facilitate payments for the following services:
- medically necessary services provided in the hospital to patients who are not insured under OHIP or another provincial plan or private insurance; and,
- limited medically necessary services provided by physicians in the community as outlined in INFOBulletin 4749.
In all cases providers should follow existing health card validation services to determine health card validity. If a health care provider cannot reasonably obtain the health card information from the patient or from existing records, the ministry offers an escalation process to provide health numbers and version codes directly to providers. The 24x7 ServiceOntario Help Desk (
- Services provided in the hospital may be claimed to the ministry on the spreadsheet provided to hospitals for services provided to uninsured patients.
- Services provided in the community may not be claimed to the ministry and providers should use existing processes for expired or invalid health cards in these scenarios, as outlined in this INFOBulletin.
OHIP claim submissions are not accepted for invalid cards, whether or not they are expired. Invalid card categories include Lost, Stolen, Damaged or Voided. Individuals with an invalid health card should contact the ServiceOntario INFOline at
Health Card Validation
As usual, providers should ask for an individual’s most recent health card and validate it each time the patient visits. Validation will help to reduce the number of claims that are rejected for any reason, including patient ineligibility.
If an expired health card passes validation, the card should be accepted and standard OHIP billing procedures should be followed. A card that passes validation would receive a response code between 50-55 from the ministry’s Health Card Validation systems.
If a health card does not pass validation, health care providers should take the following steps:
- Check for keying errors
- Confirm the health number and version code
- Ask if the cardholder has another health card
- Ask the cardholder to contact ServiceOntario to update their health card registration
If a claim was previously rejected due to an invalid version code or health card eligibility issue, the provider can resubmit the claim once the patient presents with a new valid health card and version code.
Further information regarding Health Card Validation can be found in the Health Card Validation Reference Manual.
Valid Health Card Validation Response Codes
The chart below from the Health Card Validation Reference Manual details response codes indicating if a health card is valid and can be used to submit claims for OHIP-insured services to the ministry. For example, a response code of 53 indicates that the card is expired, but valid to access insured services.
| Response Code | Descriptive Text | Recommended Action |
|---|---|---|
| 50/51 | Health card passed validation | You will receive payment for billable services rendered on this day subject to adjudication by the ministry. |
| 52 | Health card passed validation; Cardholder did not respond to notice to register | You will receive payment for billable services rendered on this day subject to adjudication by the ministry. |
| 53 | Health card passed validation; card is expired | You will receive payment for billable services rendered on this day subject to adjudication by the ministry. |
| 54 | Health card passed validation; card is future dated | You will receive payment for billable services rendered on this day subject to adjudication by the ministry. |
| 55 | Health card passed validation; cardholder required to update address with ministry | You will receive payment for billable services rendered on this day subject to adjudication by the ministry. |
Invalid Health Card Validation Response Codes
The chart below details common response codes indicating a health card is not valid and cannot be used for OHIP claim submissions.
| Response Code | Descriptive Text | Recommended Action |
|---|---|---|
| 05 | The Health Number submitted is not 10 numeric digits. | No payment for services, bill the cardholder directly. |
| 10 | The Health Number submitted does not exist on the ministry’s system | No payment for services, bill the cardholder directly. |
| 20 | Eligibility does not exist for this Health Number | No payment for services, bill the cardholder directly. |
| 25 | Unknown health card | No payment for services, bill the cardholder directly. |
| 65 | Invalid version code | No payment for services on this Health Number and Version Code combination. Ask the cardholder to contact the local ServiceOntario office. |
| 70 | Health card reported stolen | No payment for services on this Health Number and Version Code combination. Ask the cardholder to contact the local ServiceOntario office. |
| 75 | Health card cancelled or voided | No payment for services on this Health Number and Version Code combination. Ask the cardholder to contact the local ServiceOntario office. |
| 80 | Health card reported damaged | No payment for services on this Health Number and Version Code combination. Ask the cardholder to contact the local ServiceOntario office. |
| 83 | Health card reported lost | No payment for services on this Health Number and Version Code combination. Ask the cardholder to contact the local ServiceOntario office. |
For a complete list of response codes, please see the Health Card Validation Reference Manual.
Keywords/tags
COVID-19; health card; OHIP card; health card validation; HCV; eligibility
Contact information
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