The Out-of-Country Prior Approval Program is introducing an electronic application form

To: All Physicians
Category: Physician Services
Written by: Health Insurance Branch, Health Programs and Delivery Division
Date issued: April 22, 2024
Bulletin Number: 240404

Overview

Effective April 15, 2024, the Out-of-Country Prior Approval Program implemented a new, electronic version of the Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health Services application form (on00314).

Practicing Ontario physicians complete and submit this form when requesting consideration of funding for out-of-country health services on behalf of patients.

This new, electronic application form includes an easy to use submit function and will be available on the Central Forms Repository, in both PDF and HTML. Physicians are asked to complete and submit the form online.

Out-of-Country Prior Approval Program

The Out-of-Country Prior Approval Program acts as a safety valve for the Ontario health care system by funding health services outside of the country when services are either not available in Ontario or are not available without medically significant delay. Regulation 552, under Ontario’s Health Insurance Act (HIA), sets out specific requirements that must be met before an Ontario resident can qualify for full funding of medical services to be delivered outside of the country and paid for under the Ontario Health Insurance Plan.

Details regarding the ministry’s Out-of-Country Prior Approval Program can be found online at: OHIP coverage while outside Canada and Out-of-country OHIP covered services for physicians.

Implementation and support

Any providers with questions or concerns on this application form, the intent of the Out-of-Country Prior Approval Program or questions while filling out the form can contact the Out-of-Country Prior Approval Program directly either by phone at 1-888-359-8807 or by email at OOCPAApplicationRequests.MOH@ontario.ca.

Keywords/Tags

Out-of-country; Prior approval; electronic form

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.