OTTAWA — A new edict by the federal health minister banning providers from charging for health care serves as a warning shot for virtual-care firms who charge for online appointments. 

Medically necessary treatment must be covered by provincial health-care plans, whether or not it’s provided in a doctor’s office, Mark Holland declared Friday in a long-awaited interpretation of the Canada Health Act.

The new rules don’t specifically apply to digital health-care firms, but the minister said further guidance is on the way that will directly address virtual care.

“I would say this to any provider who’s attempting to calcify or to grow their infrastructure virtually: the Canada Health Act at its core states that Canadians don’t pay for care,” Holland said Friday at a press conference in Saskatchewan. 

“It makes sense to me that … we allow all kinds of innovation within the system, but that precept that the patient doesn’t pay and that [it’s] universally accessible is absolutely essential.”

He’s given provinces and territories until April 1, 2026, to adjust to the new rules, before the federal government starts to claw back money from federal transfers for every dollar patients spend out of pocket.

Two years ago, Ottawa promised to crack down on fee-for-care services that have flourished since the COVID-19 pandemic exposed a glaring lack of available primary care physicians. Firms like Loblaw-backed Maple provide access to physicians and other health-care providers in exchange for a subscription fee while others offer paid appointments.

The new policy targets services provided by pharmacists, midwives and, in particular, nurse practitioners who now offer services that a few years ago would have typically been provided by a doctor. 

The Canadian Chamber of Commerce had urged the federal government to explicitly exempt virtual-care services from the anticipated policy—particularly when they’re provided as part of employee benefits packages.

Holland didn’t offer that exemption, but neither was there a specific reference to digital services covered by employee benefits or provided by private firms like Maple, Teladoc and Rocket Doctor.

“The directive that the minister issued, is quite vague,” said Liam MacDonald, director for policy and government relations for the chamber. 

That leaves the scale of the impact—both on patients and the health-care system—unclear. “We could see 10 million Canadians lose access to virtual care, which is going to push more people ultimately, into walk-in clinics, emergency rooms, which are already overcrowded,” MacDonald said.

Maple’s CEO and co-founder Brett Belchetz said he’s “deeply concerned” by the minister’s directive, though Maple’s operations will continue unchanged while Holland develops specific rules for virtual care.

“By moving millions of dollars of services that are currently privately funded into the public domain, this shift could overwhelm provincial budgets without a clear strategy for managing the additional costs,” Belchetz said in a statement. 

“Future policy changes of this magnitude must include careful financial planning, clear accountability, and sustainable solutions to ensure they meet the needs of Canadians without undermining our country’s stability.”

Holland said he would try to reach a consensus with his provincial and territorial counterparts on how to approach paid virtual-care appointments when they meet in Halifax at the end of January. 

A spokesperson for Ontario Health Minister Sylvia Jones said the province is reviewing the newly announced rules and plans to have conversations with Holland and her counterparts in other provinces about the new approach. 

Clarification: This story has been updated to more accurately describe the services offered by Maple