Cord Blood Testing / Changes to Ontario Regulations 552 and 682 and to the Schedule of Benefits for Laboratory Services

The Ontario Health Insurance Plan is administered in accordance with the provisions of the Health Insurance Act (HIA) and Ontario Regulation 552. The Ontario Health Insurance Plan (OHIP) insures those medically necessary physician services and laboratory services that are specifically listed in the “Schedule of Benefits” for physician services or in the “Schedule of Laboratory Benefits”. Physician services are subject to the exclusions specified in Section 24 of Ontario Regulation 552. Further, a service is also not insured if provided by a laboratory, physician or hospital in support of certain services deemed under Ontario Regulation 552 not to be insured. Generally, in those circumstances where a physician or a laboratory service is not medically necessary or is not specifically listed in one of the Schedules, coverage may not be provided.

Physician and laboratory services provided for the purpose of umbilical cord blood testing and for umbilical cord blood banking are not insured services as cord blood testing and cord blood banking are not medically necessary for the patient. Accordingly, any service provided in relation to cord blood testing or cord blood banking, such as procurement, processing, storage and any other operational or administrative procedure, is also not an insured service.

As a laboratory service specifically requested for umbilical cord blood testing and umbilical cord blood banking purposes is not an insured service, PHLs of the ministry will no longer support any laboratory testing for the purpose of umbilical cord blood banking effective October 15, 2004. The ministry has advised the companies involved in umbilical cord blood banking in Ontario of this change.

The ministry recognizes that there are circumstances in which the same laboratory services required for the provision of insured prenatal and neonatal services, such as those for screening of infectious diseases, may also be of assistance to cord blood banking facilities. The results of these medically necessary insured tests may be shared with cord blood bank operators by the health care provider should appropriate consent be obtained from the parties involved.