Effective June 3, 2008, Regulation 552 of the Health Insurance Act (HIA) has been amended to add sex reassignment surgery (SRS) as an insured service under the Ontario Health Insurance Plan (OHIP).
Sex-reassignment surgical procedures, including reconstruction of genitalia and mastectomy, are an insured benefit effective June 3, 2008 only if they are performed on patients who have completed the Gender Identity Clinic program operated by the Centre for Addiction and Mental Health and for whom the Clinic has recommended that surgery take place.
Within the foregoing guidelines, reconstruction of genitalia and mastectomy are insured benefits. However, since the hormonal treatments associated with sex-reassignment themselves give rise to breast enlargement, augmentation mammoplasty or breast reconstruction in a male to female conversion is not an insured benefit. Prior approval from the MOHLTC is required.
As the Province moves forward in the delivery of SRS services, we want to ensure that we are adopting the most up to date and efficacious techniques to serve the transgender community. To that end, we have sought the advice of the Centre for Addiction and Mental Health as well as the Sherbourne Health Centre about using the World Professional Association for Transgendered Health (WPATH) standards of care to inform our implementation strategy.
For services proposed to be received at a hospital or health facility outside Canada, prior approval of the General Manager of OHIP is required. See
http://www.health. gov.on.ca/ english/public/ program/ohip/ outcountry_ services. html
for the application process and requirements.
Bulletins and the updated version of the Schedule of Benefits are available on the Ministry of Health and Long-Term Care website http://www.health. gov.on.ca/ .
This Bulletin is a general summary provided for information purposes only. Physicians, hospitals and other health care providers are directed to review the Health Insurance Act, Regulation 552 and the Schedules under that regulation, for the complete text of the provisions. You can access this information on-line at:
www.e-laws.gov. on.ca/. In the event of a conflict or inconsistency between this bulletin and the applicable legislation and/or regulation, the legislation and/or regulation prevail.
Hamilton 119 King Street West, 10th Floor P.O. Box 2280, Stn A L8P 4Y7
Kingston 1055 Princess Street, Suite 401 P.O. Box 9000 K7L 5A9
London 217 York Street, 5th Floor Station A N6A 5P9
Mississauga 201 City Centre Drive Suite 300 L5B 2T4
Oshawa Executive Tower, Oshawa Centre 419 King Street West P.O. Box 635 L1J 7J2
Ottawa Fuller Building 75 Albert Street K1P 5Y9
Sudbury 199 Larch Street Suite 801 P3E 5R1
Toronto 47 Sheppard Avenue East Suite 505 M2N 7E7
Subject: Relisting of Sex Reassignment Surgery under OHIP
Effective June 3, 2008, Regulation 552 of the Health Insurance Act (HIA) has been amended to add sex reassignment surgery (SRS) as an insured service under the Ontario Health Insurance Plan (OHIP).
Sex-reassignment surgical procedures, including reconstruction of genitalia and mastectomy, are an insured benefit effective June 3, 2008 only if they are performed on patients who have completed the Gender Identity Clinic program operated by the Centre for Addiction and Mental Health and for whom the Clinic has recommended that surgery take place.
Within the foregoing guidelines, reconstruction of genitalia and mastectomy are insured benefits. However, since the hormonal treatments associated with sex-reassignment themselves give rise to breast enlargement, augmentation mammoplasty or breast reconstruction in a male to female conversion is not an insured benefit. Prior approval from the MOHLTC is required.
As the Province moves forward in the delivery of SRS services, we want to ensure that we are adopting the most up to date and efficacious techniques to serve the transgender community. To that end, we have sought the advice of the Centre for Addiction and Mental Health as well as the Sherbourne Health Centre about using the World Professional Association for Transgendered Health (WPATH) standards of care to inform our implementation strategy.
For services proposed to be received at a hospital or health facility outside Canada, prior approval of the General Manager of OHIP is required. See
http://www.health. gov.on.ca/ english/public/ program/ohip/ outcountry_ services. html
for the application process and requirements.
Bulletins and the updated version of the Schedule of Benefits are available on the Ministry of Health and Long-Term Care website http://www.health. gov.on.ca/ .
This Bulletin is a general summary provided for information purposes only. Physicians, hospitals and other health care providers are directed to review the Health Insurance Act, Regulation 552 and the Schedules under that regulation, for the complete text of the provisions. You can access this information on-line at:
www.e-laws.gov. on.ca/. In the event of a conflict or inconsistency between this bulletin and the applicable legislation and/or regulation, the legislation and/or regulation prevail.
Hamilton 119 King Street West, 10th Floor P.O. Box 2280, Stn A L8P 4Y7
Kingston 1055 Princess Street, Suite 401 P.O. Box 9000 K7L 5A9
London 217 York Street, 5th Floor Station A N6A 5P9
Mississauga 201 City Centre Drive Suite 300 L5B 2T4
Oshawa Executive Tower, Oshawa Centre 419 King Street West P.O. Box 635 L1J 7J2
Ottawa Fuller Building 75 Albert Street K1P 5Y9
Sudbury 199 Larch Street Suite 801 P3E 5R1
Toronto 47 Sheppard Avenue East Suite 505 M2N 7E7
| Attachment | Size |
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| MOH June03.08 Bulletin.pdf | 36.94 KB |
