Acts and Regulations

84-20 - General

Section 13
Disposition versions

Full text
13(1)Where a participating medical practitioner or participating oral and maxillofacial surgeon provides an entitled service to a person who is a beneficiary or dependent and wishes to charge the person for the service and not submit an account for service to Medicare, the medical practitioner or oral and maxillofacial surgeon shall inform the person that he or she may charge the person for the service directly and shall provide the person with such information as is prescribed in subsections 11(2.1) and (3) on a form provided by the Medicare Branch so as to enable the person to make a claim for reimbursement.
13(1.1)Before providing a service under paragraph (n.1) of Schedule 2 to a person who is a beneficiary or a dependent, a participating medical practitioner or a participating oral and maxillofacial surgeon shall
(a) inform or cause to be informed the person in such manner as is required by the Director that he or she will be charging the person directly for the service and that the person is not entitled to be reimbursed by the Medicare Branch for the service, and
(b) complete a waiver on a form provided by the Medicare Branch and send it to the Medicare Branch before charging the person for the service.
13(2)Where an entitled service is provided in accordance with subsection (1), the amount that is payable for the service by the Medicare Branch shall be paid
(a) directly to the person where that person is a beneficiary,
(b) to the beneficiary where the person receiving the service was a dependent, or
(c) to the dependent when, in the opinion of the Director, special circumstances warrant payment in this manner.
13(3)Notwithstanding any other section of this Regulation, the Director may, make payments directly to persons acting on behalf of patients, and such payments to be made in accordance with this Regulation and are not to exceed the amounts provided hereunder.
13(4)Where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from the beneficiary a claim for reimbursement notwithstanding that all the information set out in subsection 11(2.1) has not been provided.
13(5)Notwithstanding the provisions of this section, where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from that medical practitioner or oral and maxillofacial surgeon an account for service rendered to the beneficiary or dependent and make payment in the amounts permitted by this Regulation directly to the medical practitioner or oral and maxillofacial surgeon notwithstanding that all the information set out in subsection 11(2.1) has not been provided.
13(6)Any payment made pursuant to subsection (5) shall be in lieu of making payment to the beneficiary.
86-150; 87-22; 90-83; 94-13; 94-118; 97-23; 2003-51; 2019, c.12, s.21
13(1)Where a participating medical practitioner or participating oral and maxillofacial surgeon provides an entitled service to a person who is a beneficiary or dependent and wishes to charge the person for the service and not submit an account for service to Medicare, the medical practitioner or oral and maxillofacial surgeon shall inform the person that he or she may charge the person for the service directly and shall provide the person with such information as is prescribed in subsections 11(2.1) and (3) on a form provided by the Medicare Branch so as to enable the person to make a claim for reimbursement.
13(1.1)Before providing a service under paragraph (n.1) of Schedule 2 to a person who is a beneficiary or a dependent, a participating medical practitioner or a participating oral and maxillofacial surgeon shall
(a) inform or cause to be informed the person in such manner as is required by the Director that he or she will be charging the person directly for the service and that the person is not entitled to be reimbursed by the Medicare Branch for the service, and
(b) complete a waiver on a form provided by the Medicare Branch and send it to the Medicare Branch before charging the person for the service.
13(2)Where an entitled service is provided in accordance with subsection (1), the amount that is payable for the service by the Medicare Branch shall be paid
(a) directly to the person where that person is a beneficiary,
(b) to the beneficiary where the person receiving the service was a dependent, or
(c) to the dependent when, in the opinion of the Director, special circumstances warrant payment in this manner.
13(3)Notwithstanding any other section of this Regulation, the Director may, make payments directly to persons acting on behalf of patients, and such payments to be made in accordance with this Regulation and are not to exceed the amounts provided hereunder.
13(4)Where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from the beneficiary a claim for reimbursement notwithstanding that all the information set out in subsection 11(2.1) has not been provided.
13(5)Notwithstanding the provisions of this section, where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from that medical practitioner or oral and maxillofacial surgeon an account for service rendered to the beneficiary or dependent and make payment in the amounts permitted by this Regulation directly to the medical practitioner or oral and maxillofacial surgeon notwithstanding that all the information set out in subsection 11(2.1) has not been provided.
13(6)Any payment made pursuant to subsection (5) shall be in lieu of making payment to the beneficiary.
86-150; 87-22; 90-83; 94-13; 94-118; 97-23; 2003-51
13(1)Where a participating medical practitioner or participating oral and maxillofacial surgeon provides an entitled service to a person who is a beneficiary or dependent and wishes to charge the person for the service and not submit an account for service to Medicare, the medical practitioner or oral and maxillofacial surgeon shall inform the person that he or she may charge the person for the service directly and shall provide the person with such information as is prescribed in subsections 11(2.1) and (3) on a form provided by the Medicare Branch so as to enable the person to make a claim for reimbursement.
13(1.1)Before providing a service under paragraph (n.1) of Schedule 2 to a person who is a beneficiary or a dependent, a participating medical practitioner or a participating oral and maxillofacial surgeon shall
(a) inform or cause to be informed the person in such manner as is required by the Director that he or she will be charging the person directly for the service and that the person is not entitled to be reimbursed by the Medicare Branch for the service, and
(b) complete a waiver on a form provided by the Medicare Branch and send it to the Medicare Branch before charging the person for the service.
13(2)Where an entitled service is provided in accordance with subsection (1), the amount that is payable for the service by the Medicare Branch shall be paid
(a) directly to the person where that person is a beneficiary,
(b) to the beneficiary where the person receiving the service was a dependent, or
(c) to the dependent when, in the opinion of the Director, special circumstances warrant payment in this manner.
13(3)Notwithstanding any other section of this Regulation, the Director may, make payments directly to persons acting on behalf of patients, and such payments to be made in accordance with this Regulation and are not to exceed the amounts provided hereunder.
13(4)Where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from the beneficiary a claim for reimbursement notwithstanding that all the information set out in subsection 11(2.1) has not been provided.
13(5)Notwithstanding the provisions of this section, where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from that medical practitioner or oral and maxillofacial surgeon an account for service rendered to the beneficiary or dependent and make payment in the amounts permitted by this Regulation directly to the medical practitioner or oral and maxillofacial surgeon notwithstanding that all the information set out in subsection 11(2.1) has not been provided.
13(6)Any payment made pursuant to subsection (5) shall be in lieu of making payment to the beneficiary.
86-150; 87-22; 90-83; 94-13; 94-118; 97-23; 2003-51