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A-29, r. 5 - Regulation respecting the application of the Health Insurance Act

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Updated to 1 January 2016

This document has official status.

chapter A-29, r. 5

Regulation respecting the application of the Health Insurance Act

HEALTH INSURANCE ACT

Health Insurance Act

(chapter A-29, s. 69).

A-29

09September 011 2012

DIVISION I

INTRODUCTION

1. In this Regulation,

(a) “Act” means the Health Insurance Act (chapter A-29);

(b) “Board” means the Régie de l’assurance maladie du Québec established by the Act respecting the Régie de l’assurance maladie du Québec (chapter R-5);

(d) “professional in the field of health” or “professional” means any physician, dental surgeon, optometrist or pharmacist legally authorized to provide insured services;

(e) (paragraph revoked);

(e.1) “spouse” means

(1) the man or woman with whom a person is married and cohabits;

(2) the man or woman of the opposite or the same sex with whom a person cohabits in a conjugal relationship, if they have been so cohabiting for at least 1 year or if

i. a child has been born of their union;

ii. they have adopted a child together; or

iiii. one of them has adopted the other’s child;

(f) “agreement” means any agreement concluded between the Minister of Health and Social Services and a body representing any class of health professionals for the purposes of carrying out the Act;

(g) (paragraph revoked);

(h) (paragraph revoked);

(i) (paragraph revoked);

(j) (paragraph revoked);

(k) (paragraph revoked);

(l) (paragraph revoked);

(l.1) “educational institution” means a legal person or body providing education at the elementary, secondary, college or university levels;

(m) “laboratory” means a laboratory as defined in the Act respecting medical laboratories, organ and tissue conservation and the disposal of human bodies (chapter L-0.2);

(n) (paragraph replaced);

(o) (paragraph replaced);

(p) (paragraph replaced);

(q) (paragraph replaced);

(r) “insured services” means the services referred to in subparagraph a of the first paragraph of section 1 of the Act;

(s) “insured person” means the insured person referred to in subparagraph g.1 of the first paragraph of section 1 of the Act;

(t) “professional in the field of health subject to the application of an agreement” means the professional referred to in subparagraph c of the first paragraph of section 1 of the Act;

(u) “hospital centre” means a hospital centre within the meaning of the Act respecting health services and social services (chapter S-4.2) or the Act respecting health services and social services for Cree Native persons (chapter S-5);

(v) “List of medications” means the List of medications drawn up under section 60 of the Act respecting prescription drug insurance (chapter A-29.01).

R.R.Q., 1981, c. A-29, r. 1, s. 1; O.C. 937-84, s. 1; O.C. 1769-84, s. 1; O.C. 1469-92, s. 1; O.C. 869-93, s. 44; O.C. 1179-95, s. 1; O.C. 1403-96, s. 48; O.C. 554-2001, s. 1.

DIVISION II

(Replaced)

R.R.Q., 1981, c. A-29, r. 1, Div. II; O.C. 1470-92, s. 37.

2. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 2; O.C. 1470-92, s. 37.

3. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 3; O.C. 1470-92, s. 37.

4. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 4; O.C. 2277-85, ss. 1 and 9; O.C. 1470-92, s. 37.

5. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 5; O.C. 1470-92, s. 37.

6. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 6; O.C. 2277-85, ss. 2 and 9; O.C. 1470-92, s. 37.

7. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 7; O.C. 1470-92, s. 37.

DIVISION III

(Replaced)

R.R.Q., 1981, c. A-29, r. 1, Div. III; O.C. 1470-92, s. 37.

8. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 8; O.C. 1470-92, s. 37.

9. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 9; O.C. 1470-92, s. 37.

10. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 10; O.C. 1470-92, s. 37.

11. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 11; O.C. 1470-92, s. 37.

12. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 12; O.C. 1470-92, s. 37.

13. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 13; O.C. 1470-92, s. 37.

14. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 14; O.C. 1470-92, s. 37.

DIVISION IV

(Replaced)

R.R.Q., 1981, c. A-29, r. 1, Div. IV; O.C. 1470-92, s. 37.

15. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 15; O.C. 858-90, s. 1; O.C. 1470-92, s. 37.

16. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 16; O.C. 858-90, s. 2; O.C. 1470-92, s. 37.

17. (Revoked).

R.R.Q., 1981, c. A-29, r. 1, s. 17; O.C. 858-90, s. 3.

18. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 18; O.C. 1470-92, s. 37.

19. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 19; O.C. 1470-92, s. 37.

20. (Replaced).

R.R.Q., 1981, c. A-29, r. 1, s. 20; O.C. 1470-92, s. 37.

21. (Revoked).

R.R.Q., 1981, c. A-29, r. 1, s. 21; O.C. 858-90, s. 4.

DIVISION V

SERVICES NOT CONSIDERED INSURED

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a) every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i. issue or renewal of an insurance policy;

ii. employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii. passports, visas or other similar purposes;

(b) psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

i. rhytidectomy;

ii. any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii. any excision or dermabrasion of a nontraumatic tattoo;

iv. any capillary graft to correct hereditary alopecia;

v. any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi. any correction of a nonsymptomatic congenital deformation;

vii. any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii. any mammoplasty, unless such a service is provided for:

(A) correction of mammary applasia;

(B) correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

ix. any excision of nonsymptomatic excess adipose tissue;

(c.1) any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i. astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii. anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d) any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e) any service rendered by a professional to his consort or his children;

(f) any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i. proof of death;

ii. a medico-legal examination of a sexual assault victim;

iii. an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv. an examination required under the Public Curator Act (chapter C-81);

v. an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi. an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii. an examination required under the Youth Protection Act (chapter P-34.1);

(g) any visit made for the sole purpose of obtaining the renewal of a prescription;

(h) any examination, vaccination, immunization or injection given:

i. to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii. for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i) any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j) among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i. complete eyesight examination;

ii. extensive study of colour vision;

(j.1) (paragraph revoked);

(k) any adjustment of spectacles or contact lenses;

(k.1) among the services referred to in the second paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during a 12-month period by a dentist:

i. examination, except an emergency examination or, where the insured person is followed for oncological purposes by a dentist practising in an institution which operates a hospital centre listed in Schedule E, a second examination;

ii. teaching and demonstration of oral hygiene procedures;

iii. cleaning of teeth;

iv. scaling;

v. topical fluoride application;

(l) any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i. to an insured person less than 10 years of age;

ii. to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii. by antrostomy;

(m) all procedures of acupuncture;

(n) the injection of sclerotial substances into:

i. telangiactases;

ii. arteriovenous vessels;

iii. varicosities of the lower limbs; or

iv. varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o) i. thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii. mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p) the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q) ultrasonography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre or is rendered for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

(q.1) computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2) magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3) optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration;

(r) any radiological service provided by a physician:

i. if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii. if it is required by a person other than a physician or dentist; or

iii. if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services (chapter S-4.2);

(s) any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t) any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u) any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v) any assisted procreation service, except the artificial insemination services, including services required for ovarian stimulation, referred to in subparagraph e of the first paragraph of section 3 of the Act.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19.

DIVISION VI

SERVICES OUTSIDE QUÉBEC

R.R.Q., 1981, c. A-29, r. 1, Div. VI; O.C. 499-92, s. 1.

23. For the purposes of subparagraph b of the first paragraph of section 3 of the Act a hospital outside Québec is:

(a) any hospital possessed or operated by the Government of Canada or of another province, or by the government of a country other than Canada;

(b) a hospital legally authorized by the competent authority of another province, of Canada or of a country other than Canada.

R.R.Q., 1981, c. A-29, r. 1, s. 23.

23.1. The Board shall assume or reimburse the payment of an amount for insured medical services given to an insured person in a facility maintained by the institution which operates the hospital centre and situated outside Québec but in Canada where those services are received when a hospital service is provided and where they were authorized beforehand by the Board upon written request signed by 2 physicians specialized in the field related to the illness of the person for whom the authorization is requested.

The request shall be accompanied by a summary of the case history of that person and shall contain the following items:

(1) a description of the specialized services required;

(2) a certificate attesting that the specialized services required are not available in Québec;

(3) the name of the physician whose services are required and the address of the facility maintained by the institution which operates the hospital centre in which he practises.

O.C. 499-92, s. 2; O.C. 1179-95, s. 3.

23.2. The Board shall assume or reimburse the payment of an amount for the insured medical services given to an insured person in a facility maintained by the institution which operates the hospital centre and situated outside Canada where all the conditions provided for in section 23.1 have been fulfilled and where it is certified that the services required are not available in Canada.

O.C. 499-92, s. 2; O.C. 1179-95, s. 4.

DIVISION VII

RULES GOVERNING A NOTICE BY A PROFESSIONAL WHO HAS WITHDRAWN, BY A NON-PARTICIPATING PROFESSIONAL OR BY A PHYSICIAN IN A PERIOD OF TRAINING

R.R.Q., 1981, c. A-29, r. 1, Div. VII; O.C. 13-83, s. 1.

24. The Board must publish, each month, in the Gazette officielle du Québec, a list, compiled on a regional basis, of the names and business addresses of professionals who intend practising their profession outside the scope of the plan as professionals withdrawn or as non-participating professionals or who have ceased to practise in this capacity, as well as the date on which their withdrawal or non-participation becomes effective or ceases to become effective.

R.R.Q., 1981, c. A-29, r. 1, s. 24.

25. Any professional who has withdrawn shall, except in the cases of emergency determined by the Act and the regulations, inform an insured person in writing that if the insured person avails himself of the professional’s services, he must claim the cost of the services directly from the Board.

This notice must be signed by the professional, bear the date of issuance, be drawn up in the manner prescribed hereafter and be delivered by hand in advance by the professional to any insured person who avails himself of the professional’s services:

NOTICE OF WITHDRAWAL

To insured persons under health insurance plan

This is to notify you that I am a professional who has withdrawn from the health insurance plan.

If you avail yourself of my professional services, you must send the statement of fees that I must complete and return to you to the Board. When the Board has paid you after you have submitted the statement of fees and the information prescribed in the Act, you must pay the cost of insured services I have furnished directly to me.

The cost that I will claim for these insured services will be in accordance with the tariff payable by the Régie de l’assurance maladie du Québec.

You have been given this Notice in accordance with the Health Insurance Act (chapter A-29) and its regulations.

__________(date)__________

__________(signature of professional who has withdrawn)__________

R.R.Q., 1981, c. A-29, r. 1, s. 25; O.C. 1469-92, s. 3.

26. Any professional who practises his profession outside the scope of the plan as a non-participating professional shall, except in cases of emergency determined by the Act and the regulations, inform an insured person in writing that the insured person must assume the full cost of the professional services he is intending to request.

NOTICE OF NON-PARTICIPATION

To insured persons under health insurance plan

I notify you that I am a professional non-participating in the Health Insurance Plan. As such, I may not claim payment of my fees from the Régie de l’assurance maladie du Québec.

If you have recourse to my professional services, you must therefore pay me directly the cost of insured services I will dispense to you.

You may neither demand or obtain from the Régie de l’assurance maladie du Québec the reimbursement of the cost of insured services which you will have paid to me.

This notice is given to you in accordance with the Health Insurance Act (chapter A-29) and the regulations.

__________(date)__________

__________(name of non-participating professional)__________

R.R.Q., 1981, c. A-29, r. 1, s. 26; O.C. 1469-92, s. 4.

26.1. Any physician in a period of training to obtain his first specialist’s certificate shall, except where the services are furnished in a centre operated by an institution other than the institution with which he is in a period of training or for the Corporation d’urgences-santé, inform an insured person in writing that the services the insured person intends to request are not insured and that the insured person must assume the full cost of the services.

The notice must be signed by the physician, bear the date of issue, be drawn up in the manner prescribed below and be delivered by hand in advance by the physician to any insured person who avails himself of the professional’s services:

NOTICE OF UNINSURED SERVICES

To insured persons under health insurance plan

I inform you that I am a physician in a period of training to obtain my first specialist’s certificate. As such, I may not claim, payment of my fees from the Régie de l’assurance maladie du Québec for services which I render on a private basis, which services are not insured.

If you have recourse to my professional services, you must therefore pay me directly the cost of services which I will dispense to you on a private basis.

You may neither request or obtain from the Régie de l’assurance maladie du Québec the reimbursement of the cost of the services which you will have paid to me.

This notice is given to you in accordance with the Health Insurance Act (chapter A-29) and regulations thereunder.

__________(date)__________

__________(signature of physician in a period of training)__________

O.C. 13-83, s. 2; O.C. 1469-92, s. 5; O.C. 1179-95, s. 5.

DIVISION VIII

STANDARDS RESPECTING EMERGENCIES

27. An emergency case within the meaning of this Act and the regulations is any pathological condition which, in the opinion of a professional in the field of health, should require the immediate provision of insured services.

R.R.Q., 1981, c. A-29, r. 1, s. 27.

DIVISION IX

NOTICE OF WITHDRAWAL, OF RE-ENGAGEMENT OR OF NON-PARTICIPATION

28. Failing provisions in an agreement, every professional subject to the application of an agreement who wishes to become a professional withdrawn or a non-participating professional, every professional withdrawn who wishes to become a professional subject to the application of an agreement or a non-participating professional and every non-participating professional who wishes to become a professional subject to the application of an agreement or a professional withdrawn must transmit to the Board, by registered mail, a notice of withdrawal, of re-engagement or of non-participation according to the form and tenor of Form 1.

R.R.Q., 1981, c. A-29, r. 1, s. 28; I.N. 2016-01-01 (NCCP).

29. The re-engagement becomes effective on the 8th day following the date on which the notice is mailed. The withdrawal and the non-participation become effective on the 30th day following the date on which the notice is mailed.

R.R.Q., 1981, c. A-29, r. 1, s. 29.

30. The Board sends without delay copy of every notice to the Minister, as well as to the representative body that concluded an agreement and of which the professional who gives notice is a member.

R.R.Q., 1981, c. A-29, r. 1, s. 30; S.Q. 2006, c. 43, s. 51.

DIVISION X

ORAL SURGERY SERVICES CONSIDERED AS INSURED SERVICES

R.R.Q., 1981, c. A-29, r. 1, Div. X; O.C. 1712-82, s. 1.

31. For the purposes of subparagraph b of the first paragraph of section 3 of the Act, the oral surgery services listed below are considered insured services:

(A) Diagnosis:

Examination

Consultation

(B) Radiography:

Intraoral radiographs

Extraoral radiographs

Injection of contrast substance

Local and regional

(D) Surgery:

Package for complex surgery (cases of trauma, reconstruction or oncology where the duration of the anaesthesia is 6 hours or more)

Removal of foreign body from oral cavity or maxilla

Removal of teeth, dental fragments or foreign body by anthrostomy

Surgical exposure, for orthodontic purposes, of tooth whose crown is covered with bony tissue

Incision and drainage of abscess

Osteitis treatment

— alveolitis

— osteomyelitis

Excision and curettage of intraosteal cyst or granuloma

Marsupialization of intraosseous cyst

Evacuation of cervicofacial hematoma / seroma

Biopsy

Excision of tumor

Mandibulectomy

Maxillectomy

Complete lowering of the floor of the mouth

Extension of mucous folds

Excision of genial apophyses

Excision of mylohyoid ridge

Reinsertion of mylohyoid muscle

Alveolectomy

Tuberoplasty

Alveoplasty

Excision of hyperplastic tissue

Excision of excess mucous membrane

Excision of torus

Treatment of salivary glands

Closure of buccosinusal opening

Frenectomy

Gingivectomy in the case of hyperplastic gingivitis resulting from absorption of medicinal substance

Operculectomy

Haemorrhage control

Repair of laceration of soft tissue

Complete avulsion of inferior dental nerve

Avulsion of a branch of trigeminal nerve

Neural transposition and decompression

Alcoholization of a branch of trigeminal nerve

Infiltration of a branch of trigeminal nerve for diagnostic purposes

Anastomosis of a peripheral nerve under a microscope

Vascular anastomosis under a microscope

Implantation of alloplastic craniomaxillofacial prosthesis to correct congenital, developmental or post-traumatic defects

Craniomaxillofacial distractor

Stitching of a cut nerve (neurorraphy)

Tracheotomy

Submandibular percutaneous intubation

Cleft palate

— closing of soft palate

— closing of hard palate

— additional lengthening of palate with intravelar myoplasty

— pharyngeal flap to cure velopharyngeal insufficiency

— cure of residual palatal fistula

— reconstruction of alveolar ridge

— primary rhinoplasty in the presence of cleft lip

— secondary rhinoplasty by open or endonasal approach

Cheiloplasty (reconstruction of lip)

Glossectomy

Bone graft

Taking of graft

Reduction of fractures

— bicoronal flap

— reduction of frontal bone

— occlusion of frontal sinus

— zygomatic arch

— zygomatic arch or malar bone, or both

— orbit

— nose

— maxilla

— mandible

— condyle

— alveolar bone

— opened reduction of bucket handle mandibular fracture

Immobilization of tooth loosened by trauma

Reimplantation of completely exfoliated tooth

Mandibular reconstruction plate and bone fixation

— placement of reconstruction plate

— removal of bone fixation (pins, plate or screws) by surgical approach

Intermaxillary fixation and preprosthetic splint

Treatment of temporomandibular articulation

— luxation

— meniscectomy

— condylectomy

— high condylectomy (condyloplasty)

— temporomandibular arthroplasty

— coronoidectomy

— arthrocentesis

— arthroscopy

— injection of botulinum toxin for functional purposes

— implantation of glenoid fossa prosthesis

— implantation of condylar prosthesis

— cure of ankylosis

— infiltration of temporomandibular articulation (intra-articular medication including substance)

Osteotomy

— mandible

- vertical or horizontal branch by intra or extraoral approach

- segmental

— maxilla

- le Fort I

- total turbinectomy

- le Fort II

- le Fort III

- segmental

- zygomatic arch

- nasal pyramid

— interdental

Corticotomy

Repositioning or lessening of symphysis menti

Emergency opening of pulp chamber (emergency endodontia)

Oncology and reconstruction

— neck dissection

— lip repair with Abbé flap or cross lip flap

— correction of post-traumatic or surgical scars

— post-traumatic / cleft lip dermabrasion

— graft by transfer of local pedicled myocutaneous flap

— graft by transfer of regional pedicled flap

— free cutaneous graft, head and neck region

— graft by free microanastomosed flap

— intralesional injection of pharmaceutical agent for non-cosmetic purposes.

R.R.Q., 1981, c. A-29, r. 1, s. 31; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 1 and 2; O.C. 1980-88, s. 1; O.C. 1134-91, s. 1; O.C. 1179-95, s. 6; O.C. 1100-99, s. 1; O.C. 840-2004, s. 1; O.C. 21-2015, s. 1.

DIVISION XI

DETERRENT FEES — MEDICATIONS

32. Subject to section 33, a pharmacist may require deterrent fees from a person for whom the cost of medications is assumed by the Board, where:

(a) the cost of the medication prescribed by a physician or dentist exceeds the median price; and where

(b) the person refuses to have the prescribed medication substituted by a medication with the same generic name, form and content, the cost of which is equal to or less than the median price.

The person must pay the deterrent fees to the pharmacist on the pharmacist’s request.

The amount of deterrent fees to be paid must not exceed the difference between the cost indicated in the List of medications for the medication furnished and the median price assumed by the Board in accordance with the List.

The median price on the List of medications is the price of the product situated at the median of a distribution of products within the same generic name, form and content.

R.R.Q., 1981, c. A-29, r. 1, s. 32.

33. No deterrent fees may be paid by a person for whom the cost of medications is assumed by the Board or may be claimed by a pharmacist, where:

(a) the physician or dentist who wrote the prescription has indicated on the prescription in handwriting that another medication may not be substituted for the medication prescribed;

(b) the List of medications does not indicate the median price for medications with the same generic name, form and content as the medication prescribed;

(c) the medication prescribed appears as an appendix to the List of medications as medication for which the median price method does not apply for therapeutic reasons; or

(d) the pharmacist furnishes the person with medication from a Québec supplier on the following conditions:

i. the cost of the medication exceeds the median price assumed in accordance with the List by no more than 10% for all medication with the same generic name, form and content as the medication prescribed;

ii. the number of pharmaceutical products from Québec suppliers for the medication is less than half of the medication the cost of which is equal to or less than the median price assumed in accordance with the List for the medication.

A special entry is made on the List for medication that meets the conditions prescribed in the first paragraph.

R.R.Q., 1981, c. A-29, r. 1, s. 33.

DIVISION XII

OPTOMETRIC SERVICES

34. The optometric services listed hereafter are to be considered insured services for the purposes of subparagraph c of the first paragraph of section 3 of the Act for insured persons under 18 years of age or 65 years of age or over and for insured persons 18 years of age or over and less than 65 years of age who have held, for at least 12 consecutive months, a valid claim booklet issued in accordance with section 71 or 71.1 of the Act:

(a) complete eye test;

(b) (paragraph revoked);

(d) extended study of colour vision;

(e) examination of the central visual field;

(f) examination of the peripheral visual field;

(g) ocular motility study;

(h) adaptometry;

(i) specific examination of subnormal vision;

(j) specific examination of aniseiconia;

(k) specific examination of contact lenses in the case of:

— deformity of the cornea

— coloboma

— albino

— aniridia

— polycoria

— aphacia (where there was no insertion of intraocular lenses)

— antimetropia or anisometropia of at least 2 diopters difference between the 2 eyes

— myopia of at least 5 diopters

— hypermetropia of at least 5 diopters

— ordinary astigmatism of at least 3 diopters difference between the major meridians

— amblyopia where correction in the better eye does not exceed 20/40

— therapeutic lenses in the case of ocular pathology necessitating the wearing of contact lenses following a doctor’s orders;

(l) specific control examination for subnormal vision, aniseiconia, or for contact lenses.

In addition, a partial vision examination and an emergency examination, as defined in the agreement entered into in accordance with section 19 of the Act between the Minister of Health and Social Services and the Association des optométristes du Québec are considered insured services for all insured persons.

R.R.Q., 1981, c. A-29, r. 1, s. 34; O.C. 1192-92, s. 2; O.C. 124-93, s. 1; O.C. 729-93, s. 2; O.C. 896-94, s. 2; O.C. 1287-96, s. 2; O.C. 894-2009, s. 2.

34.1. The optometric services mentioned hereafter shall be deemed insured services for the purposes of subparagraph c of the first paragraph of section 3 of the Act on behalf of any insured person who is 16 years of age or less:

(a) specific orthoptic examination;

(b) orthoptic check-up.

O.C. 321-85, s. 1; O.C. 1469-92, s. 6.

34.1.1. The posterior segment examination with pupil dilation is to be considered an insured service, for the purposes of subparagraph c of the first paragraph of section 3 of the Act, for insured persons with a known diagnosis of diabetes and treated by medication, and for insured persons with myopia of 5 diopters or more.

O.C. 894-2009, s. 3.

DIVISION XII.1

FAMILY PLANNING SERVICES

O.C. 1258-87, s. 1.

34.2. The family planning services mentioned hereafter shall be deemed insured services for the purposes of subparagraph d of the first paragraph of section 3 of the Act:

(a) services required for the purposes of mechanical, hormonal or chemical contraception;

(b) services required for the purposes of surgical sterilization, namely a tubal ligation or vasectomy;

O.C. 1258-87, s. 1.

DIVISION XII.2

FERTILITY PRESERVATION SERVICES