prepaid hospital and medical services act r.s.o. 1990, chapter p.21 historical version for the period july 24, 2014 to november 13, 2017.

Prepaid Hospital and Medical Services Act
R.S.O. 1990, Chapter P.21
Historical version for the period July 24, 2014 to November 13, 2017.
Last amendment: 2014, c. 7, Sched. 27.
Legislative History: 1997, c. 28, s. 225, 226; 1998, c. 18, Sched. G,
s. 68; 1999, c. 12, Sched. I, s. 7; 2007, c. 7, Sched. 33; 2014, c. 7,
Sched. 27.
Definitions
1 In this Act,
“association” means any company or corporation incorporated for the
purpose of establishing, maintaining and operating a hospital or
medical service or providing prescription drugs on a non-profit
prepayment basis, whereby any one or more of hospital, medical,
surgical, nursing or dental services or provision of prescription
drugs or payment therefor may be provided to persons who become
subscribers with, or members of, such company or corporation, or for
these and similar purposes, but does not include an insurer licensed
under the Insurance Act or a pension fund or employees’ mutual benefit
society incorporated under Part V of the Corporations Act;
(“association”)
“group plan” means a contract for the provision of services under this
Act, under which an association provides services to insure severally
the well-being of a number of individuals under a single contract
between the association and an employer or other person; (“régime
collectif”)
“person” includes an individual, corporation, association,
partnership, organization or fraternal society; (“personne”)
“pharmacist” means a member of the Ontario College of Pharmacists;
(“pharmacien”)
“prescription drug” means a drug as defined in subsection 117 (1) of
the Drug and Pharmacies Regulation Act dispensed upon the prescription
of a legally qualified medical practitioner or dentist to a named
person, and includes such drug mixed with any other drug or substance;
(“médicament délivré sur ordonnance”)
“Superintendent” means the Superintendent of Financial Services
appointed under the Financial Services Commission of Ontario Act, 1997;
(“surintendant”)
“Tribunal” means the Financial Services Tribunal established under the
Financial Services Commission of Ontario Act, 1997. (“Tribunal”)
R.S.O. 1990, c. P.21, s. 1; 1997, c. 28, s. 225; 1998, c. 18, Sched.
G, s. 68; 1999, c. 12, Sched. I, s. 7 (1).
Section Amendments with date in force (d/m/y)
1997, c. 28, s. 225 (1-3) - 01/07/1998; 1998, c. 18, Sched. G, s. 68 -
01/02/1999; 1999, c. 12, Sched. I, s. 7 (1) - 22/12/1999
Exemption
2 Every association registered under this Act is exempt from the
Insurance Act. R.S.O. 1990, c. P.21, s. 2.
Incorporation
3 No letters patent granting a charter to an association under the
Corporations Act and no articles of incorporation of an association
under the Business Corporations Act shall be issued without the
written approval of the Superintendent. R.S.O. 1990, c. P.21, s. 3.
No association to carry on business unless registered
4 No association shall, in Ontario, contract to furnish hospital,
medical, surgical, nursing or dental service or prescription drugs, or
any combination of them, on a prepayment basis or make payment
therefor unless registered under this Act. R.S.O. 1990, c. P.21, s. 4.
Application for registration
5 (1) Every application for registration shall be made in writing to
the Superintendent and shall be accompanied,
(a) by the prescribed fee;
(b) by a certified copy of the Act or other instrument of
incorporation of the association and of its constitution, by-laws and
regulations;
(c) by a copy of every contract or proposed contract with a hospital,
physician, pharmacist and other person for the rendering of services
to subscribers or members;
(d) by a copy of every form of contract or proposed contract with
subscribers or members;
(e) by a certified list of rates charged or to be charged to
subscribers or members together with details of the benefits that the
association contracts to furnish to subscribers or members;
(f) by a copy of the balance sheet of the association and a statement
of income and expenditures as of the close of its last fiscal year,
certified by the president, or vice-president, and the managing
director or some other principal officer of the association and
reported on by its auditor;
(g) by such information or material as the Superintendent may require.
R.S.O. 1990, c. P.21, s. 5 (1).
Registration to be granted by Superintendent
(2) The Superintendent shall grant registration to an association if
he or she is satisfied,
(a) that the applicant is established as an association;
(b) that the contracts and proposed contracts with hospitals,
physicians, pharmacists or other persons for the rendering of service
to subscribers or members and the contracts or proposed contracts with
subscribers or members are fair and reasonable;
(c) that the applicant has established and has such working capital
and reserves as the Superintendent considers adequate; and
(d) Repealed: 1999, c. 12, Sched. I, s. 7 (2).
(e) that the applicant has complied with the provisions of subsection
(1). R.S.O. 1990, c. P.21, s. 5 (2); 1999, c. 12, Sched. I, s. 7 (2).
Section Amendments with date in force (d/m/y)
1999, c. 12, Sched. I, s. 7 (2) - 22/12/1999
Application for renewal of registration
6 (1) Every application for renewal of registration shall be made in
writing to the Superintendent on or before the 21st day of March in
each year and shall be accompanied by the prescribed fee and such
information and material as the Superintendent may require. R.S.O.
1990, c. P.21, s. 6 (1).
Renewal of registration
(2) The Superintendent shall grant renewal of registration to an
association if he or she is satisfied,
(a) that the contracts and proposed contracts with hospitals,
physicians, pharmacists or other persons for the rendering of service
to subscribers or members and the contracts or proposed contracts with
subscribers and members are fair and reasonable;
(b) that the applicant has such working capital and reserves as the
Superintendent considers adequate; and
(c) Repealed: 1999, c. 12, Sched. I, s. 7 (3).
(d) that the applicant has complied with subsection (1). R.S.O. 1990,
c. P.21, s. 6 (2); 1999, c. 12, Sched. I, s. 7 (3).
Section Amendments with date in force (d/m/y)
1999, c. 12, Sched. I, s. 7 (3) - 22/12/1999
Filing of proposed rate change
7 (1) An association shall file with the Superintendent any proposed
change in rates at least thirty days prior to the effective date of
the change, together with particulars as to how any such rate is made
up, and shall furnish such other further information with respect
thereto that the Superintendent may require.
Order of prohibition
(2) The Superintendent may, within thirty days of the filing with him
or her of any notice of a proposed change in rates, by order prohibit
the proposed change in rates if, in his or her opinion, such proposed
change in rates would be excessive, inadequate, unfairly
discriminatory between risks or otherwise unreasonable. R.S.O. 1990,
c. P.21, s. 7.
Not applicable to group plans
(3) Subsections (1) and (2) do not apply to group plans. 1999, c. 12,
Sched. I, s. 7 (4).
Section Amendments with date in force (d/m/y)
1999, c. 12, Sched. I, s. 7 (4) - 22/12/1999
Termination and renewal of registration
8 Every registration and renewal of registration lapses on the 31st
day of March in each year. R.S.O. 1990, c. P.21, s. 8.
Suspension and cancellation
9 (1) The Superintendent may suspend or cancel any registration upon
any grounds that would justify refusal to grant registration or
renewal of registration or where the association fails to comply with
any provision of this Act.
Conditional or limited registration
(2) Any registration, or renewal of registration, may be granted by
the Superintendent subject to such limitations and conditions relating
to the operations of the association that the Superintendent considers
necessary to give effect to this Act or for the protection of persons,
subscribers or members of any association in Ontario.
Application of s. 7, ss. 12-17
(3) Where the registration of a registered association lapses or is
suspended or cancelled and where the Superintendent considers it
necessary for the protection of persons, subscribers or members, the
Superintendent may designate the association as one to which this Act
continues to apply and, until the designation is revoked, section 7
and sections 12 to 17 apply to such designated association in the same
manner as to a registered association.
Winding up
(4) The Superintendent may apply to the court under section 244 of the
Corporations Act or section 210 of the Business Corporations Act as
appropriate for an order winding up an association that has ceased
issuing contracts to its members or subscribers and sections 243 to
271 of the Corporations Act or sections 208 to 238 of the Business
Corporations Act, as the case may be, apply thereto. R.S.O. 1990, c.
P.21, s. 9.
Cancellation by request of association
10 The Superintendent may at the request of an association, evidenced
as he or she directs, cancel its registration. R.S.O. 1990, c. P.21,
s. 10.
Further application for registration
11 Despite any decision of the Superintendent, a further application
for registration or renewal of registration may be made upon new or
other material or where it is clear that any material circumstance has
changed. R.S.O. 1990, c. P.21, s. 11.
Appeal
12 An association that considers itself aggrieved by a decision of the
Superintendent may appeal the decision to the Tribunal in accordance
with the procedures set out in the Insurance Act. R.S.O. 1990, c.
P.21, s. 12; 1997, c. 28, s. 226.
Section Amendments with date in force (d/m/y)
1997, c. 28, s. 226 - 01/07/1998
Filing of by-laws
13 (1) Every registered association shall deliver to the
Superintendent within one month of the passing thereof a certified
copy of any by-law passed by the board of directors.
Filing of balance sheet, etc.
(2) Not later than four months after the expiration of its fiscal
year, every registered association shall file with the Superintendent
a balance sheet and a statement of income and expenditures for such
fiscal year, certified by the president, or vice-president, and the
managing director or some other principal officer of the association
and reported on by its auditor, and such other financial statements as
the Superintendent may require.
Time for filing may be extended
(3) On sufficient cause shown, the Superintendent may by writing
extend the time for filing the statements required under subsection
(2). R.S.O. 1990, c. P.21, s. 13.
General statement of affairs
14 (1) Not later than four months after the expiration of its last
fiscal year, every registered association shall prepare a general
statement of its affairs in a form approved by the Superintendent.
Time may be extended for preparation
(2) On sufficient cause shown, the Superintendent may by writing
extend the time for the preparation of a general statement of affairs
under subsection (1).
Statement to be attested
(3) Every such statement shall be attested by the signature of the
president, or vice-president, and the managing director or some other
principal officer of the association and shall be accompanied by the
auditor’s report.
Copies to subscribers on request
(4) A copy of such statement shall be mailed or delivered without
charge to any subscriber or member who requests a copy. R.S.O. 1990,
c. P.21, s. 14.
Investigatory power
14.1 The Superintendent has the same powers in respect of registered
associations that the Superintendent of Financial Services has in
respect of an insurer under sections 442.1, 442.2, 442.3, 443 and 444
of the Insurance Act. 1999, c. 12, Sched. I, s. 7 (5); 2014, c. 7,
Sched. 27, s. 1.
Section Amendments with date in force (d/m/y)
1999, c. 12, Sched. I, s. 7 (5) - 22/12/1999
2014, c. 7, Sched. 27, s. 1 - 24/07/2014
Inspection of books, etc.
15 (1) The Superintendent or his or her duly authorized representative
may at any time make or cause to be made an inspection of the books,
documents and records of any registered association.
Access to books, etc.
(2) Upon any such inspection, the Superintendent or his or her duly
authorized representative is entitled to free access to all books of
account, cash, securities, documents, bank accounts, vouchers,
correspondence and records of every description of the association,
and no person shall withhold, destroy, conceal or refuse to furnish
any information or thing reasonably required by the Superintendent or
his or her representative under this section. R.S.O. 1990, c. P.21, s.
15.
Investments
16 A registered association may invest its funds in the same manner
and subject to the same limitations that apply to a joint stock
insurance company, other than a company licensed to transact the
business of life insurance, under the provisions of the Acts and the
regulations that are the old investment rules for the purposes of
section 431.1 of the Insurance Act, and not otherwise. 2007, c. 7,
Sched. 33, s. 1.
Section Amendments with date in force (d/m/y)
2007, c. 7, Sched. 33, s. 1 - 05/05/2008
Power to hold real property
17 (1) A registered association may hold real property which, having
been mortgaged or hypothecated to it, has been acquired by it for the
protection of its investment, and real property conveyed to it in
satisfaction of debts previously contracted in the course of its
business, and may from time to time sell, mortgage, lease, exchange or
otherwise dispose of such real property, but the association shall
sell any such real property within seven years after it has been so
acquired.
Idem
(2) A registered association may hold to its own use and benefit such
real property as is necessary for the transaction of its business, or
is acquired or held in good faith for building upon or improving for
that purpose, and may sell, mortgage or dispose of such real property.
Power to acquire and construct building
(3) A registered association, when authorized by its letters patent or
by the Lieutenant Governor in Council, may construct on any lands held
under subsection (2), or may acquire, a building larger than is
required for the transaction of its business and may lease any part of
the building not so required. R.S.O. 1990, c. P.21, s. 17.
Fees for registration and renewal
18 The fee for registration or renewal of registration for an
association is, where the income from subscribers or members in the
previous fiscal year,
did not exceed $15,000
$10
exceeded $15,000 but did not exceed $50,000
$15
exceeded $50,000 but did not exceed $100,000
$25
exceeded $100,000 but did not exceed $250,000
$50
exceeded $250,000 but did not exceed $1,000,000
$100
exceeded $1,000,000
$200
R.S.O. 1990, c. P.21, s. 18.
Offence
19 Every person not registered under this Act who contracts to furnish
hospital or medical service on a prepayment basis or makes payment
therefor is guilty of an offence and on conviction is liable to a fine
of not more than $100,000 in the case of an individual and not more
than $200,000 in the case of a corporation. R.S.O. 1990, c. P.21, s.
19.
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