Health Claims for Auto Insurance

Health Claims for Auto Insurance
Service Provider Registry for Health Claims for Auto Insurance (HCAI)

 

What is Bill 65?

Bill 65 establishes the legislative framework for the Financial Services Commission of Ontario (FSCO) to license service providers and regulate their business practice.

What defines “Service Provider”?

A “Service Provider” is a business that provides specified goods or services (“listed expenses”) for which it submits an invoice through Health Claims for Auto Insurance (HCAI) for payment by an auto insurer. Typically, these are health and rehabilitation clinics, as well as providers of examinations and assessments.

Service providers will have to meet certain business standards of practice in order to be licensed. Insurers will be unable to make a direct payment to an unlicensed service provider for certain services (“listed expenses”) provided in connection with an auto-accident benefit claim.

The government is currently creating the corresponding regulations pertaining to Service Provider Licensing. Additional details on these regulatory developments can be found on the Ontario Regulatory Registry.

Background

From 2006 to 2010, Ontario experienced a substantial increase in automobile insurance claims costs. The significant increase in costs was primarily attributed to increases in Statutory Accident Benefits claims. 

In the 2013 Ontario Budget, following the recommendations of the Auto Insurance Anti-Fraud Task Force, the government committed to take further action to address fraud in the auto insurance sector. Among other announced measures, the government signaled its intention to:

  • Give the Financial Services Commission of Ontario (FSCO), the authority to license health clinics that invoice auto insurers through the HCAI system and regulate their business and billing practices;
  • Provide FSCO’s Superintendent of Financial Services the authority to require insurers to file for rates.

What does this mean for you?

Bill 65 establishes the legislative framework for FSCO to license and regulate service providers. Once licensed, a Service Provider will be able to continue to be paid directly by an auto insurer for certain services (“listed expenses”) invoiced through HCAI.

Businesses that wish to invoice through HCAI, and be paid directly by auto insurers for listed expenses, will need a licence from FSCO. This licence authorizes the service provider to receive direct payments from auto insurers for specific listed expenses.

Licences will be issued at the business or legal entity level (e.g. the sole proprietorship, corporation, partnership) rather than for each location. Licenses will not be issued to individual clinics or locations. This means that only one licence is needed for all facilities, branches or locations operated by a service provider.

FSCO issues licences to legal persons, not to individual clinics or locations. Many of the businesses that provide goods or services in connection with Statutory Accident Benefits are sole proprietorships, but others may be structured as partnerships, limited partnerships or corporations. 

Once a licence is issued, it will continue indefinitely, as long as the licensee complies with the law, files an Annual Information Return (AIR) every year, and pays the annual regulatory fee. The AIR will be used to collect information about business practices and internal control systems for the previous calendar year.

The licences are non-transferable.

When will licensing take effect?

Licensing is expected to become mandatory in the fall of 2014. Service providers will need to have a licence at that time in order to continue receiving direct payment from an auto insurer for listed expenses in connection with Statutory Accident Benefits.

The licence application process is planned to begin June 1, 2014.

Licence applications must be completed online. If an application is made at the appropriate time, the licence, if issued, will be effective December 1, 2014.

For additional information please follow this link to the FSCO website: http://www.fsco.gov.on.ca/en/service-providers/Pages/faqs.aspx