Excluded Services Regulation

Excluded Services Regulation, M.R. 46/93 The Health Services Insurance Act , C.C.S.M. c. H35 Regulation 46/93 Registered March 19, 1993 bilingual version (HTML) Definition 1 In this regulation, "Act" means The Health Services Insurance Act . Exclusions 2 The following services are not insured services: 1. Services for any illness, injury or condition arising out of or in the course of employment and for which indemnity is received under workers' compensation law, occupational disease law or similar legislation. 2. Services that an insured person is entitled to receive by virtue of a statute of another province or under the following statutes of the Government of Canada: (a) Aeronautics Act ; (b) Civilian War Pensions and Allowances Act ; (c) Government Employees Compensation Act ; (d) Merchant Seamen's Compensation Act ; (e) National Defence Act ; (f) Pension Act ; (g) R.C.M.P. Act ; (h) Veterans Rehabilitation Act ; or under legislation of any other jurisdiction. 3. Services received outside Canada that are not provided in an emergency or in another circumstance in which medical care is required without delay, unless the insured person has obtained the approval of the minister before obtaining the services. 4. Services, including examinations and reports, for reason of employment, insurance, attendance at university or camp, or performed at the request of a third party, but not including a pre-school medical examination required by a school board before initial registration in a school operated by the school board. 5. Services provided by a medical practitioner, dentist, chiropractor or optometrist pursuant to an arrangement for rendering services to the employees of an employer. 6. Services provided by a medical practitioner, dentist, chiropractor or an optometrist on a group basis, in a school, hall, auditorium or other place of assembly or for the purpose of diagnostic screening, immunization, inoculation or refraction, unless the minister has been notified before the services are provided and an agreement has been entered into between the minister and the medical practitioner, dentist, chiropractor or optometrist. 7. Immunization and examination for the purpose of travel, employment and emigration. 8. Preparation of records, reports, certificates, communications or testimony in a court. 9. Mileage or travelling time. 10. Ambulance services. 11. Transportation costs except as provided in the Out of Province Transportation Subsidies Regulation made under the Act. 12. Drugs, medications, vaccines, sera or biological products, materials and surgical supplies, except as provided for in regulations made under the Act. 13. Fitting and supply of eyeglasses, except as provided for in regulations made under the Act. 14. Advice by telephone. 15. Unless the minister is of the opinion that such surgery is medically required, all services related to elective plastic surgery other than the following: (a) treatment of congenital and acquired deformities in children under the age of 16 years: (i) cleft lip, (ii) excision of nevi, (iii) otoplasty (correction of protruding ears), (iv) the revision of scars sustained traumatically, and (v) correction of syndactyly and reduction mammoplasty in adolescent girls for either excessive virginal hypertrophy, unilateral hypertrophy of one breast, or amastia of a single breast. (b) people over age 16: (i) correction of defects secondary to trauma (A) revision of scars sustained traumatically, and (B) correction of nasal deformities where septal deviation is a feature and which have resulted from accidents, (ii) dermabrasion for treatment of acne, (iii) mammary hypertrophy and amastia, and (iv) correction of defect secondary to surgery. The services listed above are insured services only if the minister receives a statement acceptable to the minister showing the reason for provision of the service. 16. Laboratory and x-ray procedures performed in facilities not approved by the minister. 17. Diagnostic examination or treatment by means of non-radiation emitting medical imaging devices, including ultrasound, unless provided in a hospital as an in-patient or out-patient service, or in a facility approved by the minister. This exclusion does not apply to the ultrasonography of the eye for which a fee is set out in the Payments for Insured Medical Services Regulation under the Act. 18. Services that are determined by the minister, after reviewing the available evidence, to be (a) experimental or provided as part of a clinical trial or an applied research study; (b) an emerging treatment or diagnostic procedure for an illness, injury or condition for which the efficacy of the service has not been established; or (c) any other services that are provided in conjunction with or in relation to services referred to in clause (a) or (b). 19. Services provided by a medical practitioner, dentist, chiropractor or optometrist to himself or herself or any of his or her dependants. 20. Services provided by naturopaths, podiatrists or chiropodists. 21. Services provided by any other practitioner in the healing arts except as provided for in regulations made under the Act. 22. Dental care except as provided for in regulations made under the Act. 23. Nursing services except as provided for in regulations made under the Act. 24. Physiotherapy, occupational therapy and speech therapy services except as provided for in regulations made under the Act. 25. Services provided by a chiropractor except as provided for in regulations made under the Act. 25.1 Services provided by a chiropractor for an injury sustained in an automobile accident for which an insured person is entitled to compensation under The Manitoba Public Insurance Corporation Act . 26. Optometric services except as provided for in regulations made under the Act. 27. A complete eye examination, whether provided to the insured person by an optometrist or a medical practitioner, if (a) the examination is not required for a medical reason approved by the minister; and (b) a previous complete eye examination, also not required for a medical reason approved by the minister, was provided as a benefit to the insured person within the same benefit period. In this section, "benefit period" means the period of 24 months that begins on January 1, 1993 and includes each subsequent 24 month period. 27.1 A complete eye examination, whether provided by an optometrist or a medical practitioner, that (a) is provided to a person who is 19 years of age or older but under the age of 65; and (b) is not required for a medical reason approved by the minister. 28. Therapeutic abortion, unless performed by a medical practitioner (a) in a hospital in Manitoba other than a private hospital licenced under The Private Hospitals Act ; (b) in a hospital outside Manitoba that meets the criteria set out in the Hospital Services Insurance and Administration Regulation made under the Act; or (c) in a facility approved by the minister. 29. Unless the minister is of the opinion that such services are medically required and receives a statement acceptable to the minister showing the reason for the provision of the service, the following services, and all related services, are not insured: (a) cosmetic removal of benign or asymptomatic nevi, warts, and skin lesions, except for persons 15 years of age and under; (b) treatment of asymptomatic varicose veins; (c) surgery for reversal of previous elective sterilization; (d) tattoo removal, except for concentration camp victims, prisoners of war and persons in similar circumstances. 30. Contact lens fitting, except as provided for under the Prosthetic, Orthotic and other Medical Devices Regulation made under the Act and except for any of the following conditions: (a) aphakia-monocular and binocular; (b) high myopia (greater than nine diopters); (c) irregular astigmatism resulting from post corneal grafting or corneal scarring from disease states; (d) keratoconus. 31. Psychoanalysis. 32. Anaesthetic services provided in connection with or in relation to the services of a dentist (a) in a hospital, if the dentist's services do not qualify as insured services under the Hospital Services Insurance and Administration Regulation ; or (b) outside of a hospital. However, these services are not excluded when they are provided to a child under the age of six or to a child under the age of 16 who has a serious pre-existing medical condition. 33. [Repealed] M.R. 21/2000 34. Services, including laboratory services and other diagnostic procedures, together with any necessary interpretation, provided in the course of, in conjunction with or as a prerequisite to (a) a diet or weight loss program; or (b) any other similar program; that requires the insured person to pay a fee or make any other payment to any person, other than for a prescribed drug. 35. A service in relation to an injury, illness or condition is an excluded service if the minister determines, after reviewing the available evidence, that (a) another service is available that is as effective in treating or diagnosing the illness, injury or condition; and (b) the other service is more cost-effective. 36. Treatment for cancer with a chemotherapeutic agent not approved for use in Manitoba — other than as may be approved for use under clause (a) or (b) — and any other services provided in conjunction with or in relation to that treatment. However, these services are not excluded if (a) the chemotherapeutic agent is approved for use in a specific case; or (b) the chemotherapeutic agent is approved for use in a clinical trial or an applied research study, in which case item 18 does not apply. The phrase " approved for use " means approved for use in cancer treatment by the chief executive officer of CancerCare Manitoba, or his or her delegate. M.R. 144/95; 74/96; 155/96; 21/2000 ; 170/2005 ; 255/2006 ; 114/2008 Coming into force 3 This regulation comes into force on March 31, 1993.