This consolidation is unofficial and is for reference only. For the official version of the regulations, consult the original documents on file with the Registry of Regulations, or refer to the Royal Gazette Part II. Regulations are amended frequently. Please check the list of Regulations by Act to see if there are any recent amendments to these regulations filed with the Registry that are not yet included in this consolidation. Although every effort has been made to ensure the accuracy of this electronic version, the Registry of Regulations assumes no responsibility for any discrepancies that may have resulted from reformatting. This electronic version is copyright © 2009, Province of Nova Scotia, all rights reserved. It is for your personal use and may not be copied for the purposes of resale in this or any other form.
M.S.I. Regulations made under Section 17 of the
Health Services and Insurance Act
R.S.N.S. 1989, c. 197
O.I.C. 69-276, N.S. Reg. 41/69
as amended up to O.I.C. 2001-327 (July 5, 2001), N.S. Reg. 87/2001
1 In these regulations
(a) "Act" means the Health Services and Insurance Act;
(b) "dentist" means a person lawfully entitled to practice dentistry in the place in which such practice is carried on by him;
(c) "general practitioner" means a physician who engages in the general practice of medicine or a physician who is not a specialist within the meaning of clause (f);
(d) "hospital" means a building or place that is established and operated for the lodging and treatment of persons afflicted with or suffering from sickness, disease or injury; and includes a mental hospital, a tuberculosis hospital and a maternity hospital;
(e) "insured services" means all services rendered by physicians which are medically required or which are deemed by the Commission to be medically required but does not include
(i) services that a person is eligible for or entitled to under the Workers' Compensation Act, the Health Services and Insurance Act or any Act of the Parliament of Canada; or under any statute or law of any jurisdiction either within or without Canada,
(ii) mileage, travelling or detention time, except in circumstances specified by the Commission,
(iii) telephone advice or prescriptions unless approved by the Commission,
(iv) examinations required for the purpose of obtaining employment or insurance and similar examinations at the request of a third party,
(v) group immunizations or inoculations unless approved by the Commission,
(vi) preparation of records, reports, certificates or communications,
(vii) testimony in a court,
(viii) laboratory or diagnostic radiological services rendered in Nova Scotia,
(ix) services in connection with an electrocardiogram, electromyogram or electroencephalogram, unless the physician is a specialist in the appropriate specialty,
(x) dental services other than those referred to in Section 10;
Subclause 1(e)(x) replaced: O.I.C. 2001-327, N.S. Reg. 87/2001.
Clause 1(e) amended: O.I.C. 74-713, N.S. Reg. 60/74.
(ea) "optometrist" means a person lawfully entitled to practice optometry in the place in which such practice is carried on by him;
Clause 1(ea) added: O.I.C. 73-1227, N.S. Reg. 105/73; replaced: O.I.C. 73-1282, N.S. Reg. 43/73.
(f) "specialist" means a physician who is recognized as a specialist by the appropriate licensing body of the jurisdiction in which he practices.
Clause 1(f) replaced: O.I.C. 74-713, N.S. Reg. 60/74.
2 (1) Subject to the Health Services and Insurance Act and these regulations
(a) a resident is insured for the payment of the cost of insured services commencing on the first day of the third month immediately following the month in which he becomes a resident of Nova Scotia;
(b) a new Canadian is insured for the payment of the cost of insured services that are medically required by him, commencing on the day he becomes a resident of Nova Scotia.
(2) In clause (b) of subsection (1) "new Canadian" means a resident who moves to Nova Scotia from a place outside Canada and is legally entitled to remain in Canada.
Section 2 replaced: O.I.C. 72-783, N.S. Reg. 7/72.
3 (1) Where a person desires to complain about any act, omission, or other matter relating to the administration of the plan he shall, in the first instance, appeal in writing to the President of the Corporation.
(2) Where the Corporation does not settle the complaint to the satisfaction of the complainant, he may appeal in writing to the Chairman of the Commission.
(3) If, in the opinion of the Commission, a person's services are or were not medically required, the person shall not be insured for the payment of the cost of the services.
(4) When, in the opinion of the Commission, a doubt exists concerning the medical necessity for the services in any case, the Commission may appoint and empower a medical review board to report on the case.
4 A resident of Nova Scotia who moves from Nova Scotia to acquire residence in another part of Canada, herein called the "new province", shall be deemed to continue to be a resident of Nova Scotia during normal travelling time and any waiting period, not exceeding three months, which may be necessary in order to qualify for benefits under the medical care insurance legislation of the new province if the new province is a participating province, as defined in subsection (i) of Section 2 of the Medical Care Act (Canada) or shall be deemed to continue to be a resident of Nova Scotia for a period of three months from the date of his departure from Nova Scotia if the new province is not a participating province.
5 Where during the course of a single illness a person receives medical services with respect to that illness from more than one physician he shall not, except for the services of the first attending physician, be entitled to receive those services as insured services unless
(a) he was referred by one physician to another; or
(b) the first attending physician was not available to render the subsequent service; or
(c) the Commission approves of the receipt of the services.
6 Where a claim in respect of insured services is not received by the Corporation within a period of six months from the date when the service was rendered, it shall not be payable under the plan unless the Commission is of the opinion that the delay was justified in the circumstances.
Section 6 amended: O.I.C. 72-196, N.S. Reg. 18/72.
7 Where an insured service is rendered by a specialist to a resident who was not referred to the specialist by another physician, the amount payable for the service shall be equal to the amount that would have been paid, had the service been rendered by a general practitioner.
8 Where a physician
(a) serves in a hospital for purposes of receiving clinical training and receives a salary from the hospital; and
(b) renders an insured service in the hospital,
he shall not be entitled to remuneration for the service from the recipient or under the plan.
9 A claim in respect of insured services shall not be payable under the plan unless it contains the following information and is made on a form prescribed by the Commission for that purpose:
(a) the patient's name in full and address, the year of his birth, his sex and plan registration number;
(b) the diagnosis or chief complaint;
(c) where the service is provided in Nova Scotia, the fee code number and amount corresponding to the procedure or treatment performed;
(d) where the service is provided outside Nova Scotia, a description of the service or treatment performed;
(e) the date of each service; and for hospital visits, the name of the hospital;
(f) amounts, if any, charged pursuant to Section 21 of the Act, [S.N.S. 1973, c. 8] and the written consent to the charge by the patient or some other person acting on his behalf;
Clause 9(f) replaced: N.S. Reg. 43/69.
(g) additional remarks if the nature of the service was unusual;
(h) the name and signature or approved facsimile of the person providing the service and the identification number issued to him by the Corporation;
(i) the name of the referring physician or referred physician as the case may be;
(j) the names of other physicians attending the patient and their relationship to the services rendered;
(k) whether the services were performed due to an automobile accident or other third party liability; and
(l) such other information as the Commission may require.
10 (1) For the purposes of the plan, a dentist shall be deemed to be a physician if the dentist renders insured dental services as outlined in the Insured Dental Services Tariff Regulations.
(2) Services rendered under this Section shall only be insured when rendered by a person registered with the Provincial Dental Board.
Section 10 replaced: O.I.C. 2001-327, N.S. Reg. 87/2001.
Section 10A repealed: O.I.C. 2001-327, N.S. Reg. 87/2001.
Section 10B repealed: O.I.C. 2001-327, N.S. Reg. 87/2001.
11 (1) For the purposes of the plan, an optometrist shall be deemed to be a physician when he performs a vision analysis which shall include the determination of the refractive status of the eye, the presence of any observed abnormality in the visual system and all necessary tests and prescriptions connected with such determinations.
Subsection 11(2) repealed: O.I.C. 73-1282, N.S. Reg. 43/73.
Section 11 added: O.I.C. 73-1227, N.S. Reg. 105/73.
12 For the purposes of the plan, the following prosthetic services shall be insured services subject to such conditions as the Commission may from time to time prescribe with the approval of the Minister of Health and Wellness:
(a) assistance in the acquisition, replacement and repair of arm and leg prostheses;
Subsection 12(1) redesignated clause (a): O.I.C. 2001-327, N.S. Reg. 87/2001.
(b) artificial eyes;
Subsection 12(2) redesignated clause (b): O.I.C. 2001-327, N.S. Reg. 87/2001.
(c) intro-oral or extra-oral prostheses including ears for persons who have undergone maxillofacial surgery; and
Subsection 12(3) redesignated clause (c): O.I.C. 2001-327, N.S. Reg. 87/2001.
(d) mastectomy prostheses.
Clause 12(d) added: O.I.C. 2001-327, N.S. Reg. 87/2001.
Section 12 added: O.I.C. 84-900, N.S. Reg. 156/84.
[Note: The reference to the Minister of Health has been updated in accordance with Order in Council 2011-15 under the Public Service Act, R.S.N.S. 1989, c. 376, effective January 11, 2011.]
Schedule "A" repealed: O.I.C. 2001-327, N.S. Reg. 87/2001.