Amendments to the Health Insurance Act and Regulation 552 - Expanding Access to Insured Sex-reassignment Surgery

Regulation Number(s):

552



Bill or Act:

Health Insurance Act

Summary of Decision:

Regulation 552 and the Schedule have been amended to remove the requirement to attend the GIC Program at CAMH and receive a recommendation from CAMH for the surgery. Instead, recommendations for surgery can be made by qualified providers anywhere in Ontario, who are trained in accordance with the World Professional Association for Transgender Health (WPATH) standards. A referral for the surgery must be made by an Ontario physician or nurse practitioner.

Further Information:

Proposal Number:

15-HLTC025

Posting Date:

November 6, 2015

Summary of Proposal:

The Ontario Health Insurance Plan (OHIP) covers payments for medically necessary physician services, prescribed hospital and health facility services, certain dental services that are required to be performed in a hospital, and certain practitioner services that are therapeutically necessary. The Schedule lists the physician services that are insured under Ontario's HIA.



Currently, SRS is an insured service for patients who attend the Gender Identity Clinic (GIC) at the Centre for Mental Health and Addictions (CAMH) in Toronto and for whom the clinic makes a recommendation for surgery. These requirements are set out in the Schedule.



The proposed amendments will remove the requirement to attend CAMH, and will instead allow for recommendations for surgery from qualified providers across the province. The proposed changes align the Ontario requirements for access to insured SRS with the World Professional Association for Transgender Health (WPATH) Standards.



Contact Address:

Health Services Branch

1055 Princess Street

PO Box 168 Stn Main

Kingston ON K7L 5V1

Effective Date:

March 1, 2016

Decision:

Approved