Frequently Asked Questions
The Canada Health Act Division responds to enquiries regarding the
Canada Health Act and health insurance issues from the public, government
departments, stakeholder organizations and the media. For information beyond
what is available here, please refer to the current Canada Health Act Annual Report, ref link: http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/index-eng.php
or contact the Canada Health Act Division:
Canada Health Act Division1906C Jeanne Mance Building
Tunney's Pasture
Ottawa, Ontario
K1A 0K9
Canada Health Act Division link: http://www.hc-sc.gc.ca/contact/hcs-sss/hpb-dgps/chad-dlsc-eng.php
Does Canada have a national health insurance plan?
Canada does not have a single
national health care plan, but rather a national health insurance program,
which is achieved by a series of thirteen interlocking provincial and
territorial health insurance plans, all of which share certain common features and
basic standards of coverage. Under the Canada
Health Act, our national health insurance program is designed to
ensure that all residents of Canada have reasonable access to medically
necessary hospital and physician services on a prepaid basis, and on uniform
terms and conditions.
Who is eligible for health care in Canada?
Our national health insurance
program is designed to ensure that all insured persons have access to medically
necessary hospital and physician services on a prepaid basis. The Canada Health Act defines insured persons as residents
of a province. The Act further defines a resident as:
"a person lawfully entitled
to be or to remain in Canada who makes his home and is ordinarily present in
the province, but does not include a tourist, a transient or a visitor to the
province."
Therefore, residence in a
province or territory is the basic requirement for provincial/territorial
health insurance coverage. Each province and territory is responsible for
determining its own minimum residence requirements with regard to an
individual's eligibility for benefits under its health insurance plan. The Canada Health Act gives
no guidance on such residence requirements beyond limiting waiting periods to
establish eligibility for and entitlement to insured health services to three
months. Most provinces and territories also require residents to be physically
present 183 days annually, and provide evidence of their intent to return to
the province.
What health care services are insured by the provinces and territories?
Provincial and territorial
health insurance plans are required to provide insured persons with coverage of
insured health services, which are: hospital services provided to in-patients
or out-patients, if the services are medically necessary for the purpose of
maintaining health, preventing disease or diagnosing or treating an injury,
illness, or disability; and medically required physician services rendered by
medical practitioners.
What other health care services do provinces and territories provide?
Provinces and territories may
also offer "additional benefits" under their respective health
insurance plans, funded and delivered on their own terms and conditions. These
benefits are often targeted to specific population groups (e.g. children, seniors,
social assistance recipients), and may be partially or fully covered. While
these services vary across different provinces and territories, examples
include prescription drugs, dental care, optometrist, chiropractic, and
ambulance services.
What health care services are not covered by provinces and territories?
A number of services provided
by hospitals and physicians are not considered medically necessary, and are not
insured by provincial and territorial health insurance plans. Uninsured
hospital services for which patients may be charged include preferred hospital
accommodation unless prescribed by a physician; private duty nursing services;
and the provision of telephones and televisions. Uninsured physician services
for which patients may be charged include prescription renewals by telephone;
the provision of medical certificates required for work, school, insurance
purposes and fitness clubs; testimony in court; and cosmetic services.
What do I do if my address changes or if I lose my health card?
The provinces and territories,
rather than the federal government, are responsible for the administration of
their health insurance plans, which includes issuing, cancelling or renewing
health cards. You should call or email your provincial/territorial Ministry of
Health- the phone numbers and websites are located inside the back cover of the
current see this link: http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/index-eng.php
What should I do if I am moving to another province or territory?
Residents moving from one
province/territory to another continue to be covered by their "home"
province/territory during any minimum waiting period, not to exceed three
months, imposed by the new province/territory of residence. After the waiting
period, the new province/territory of residence assumes your health care
coverage.
It is your responsibility to
inform your provincial/territorial plan that you are leaving and where you are
moving, and to register with the health insurance plan of your new province or
territory.
Do I need private health care coverage when traveling within Canada?
The portability criterion of
the Canada Health Act requires that the provinces and
territories extend medically necessary hospital and physician coverage to their
eligible residents during temporary absences from the province or territory.
This allows them to travel or be absent from their home province or territory
and yet retain their health insurance coverage. Within Canada, the portability
provisions are generally implemented through a series of bilateral reciprocal
billing agreements between the provinces and territories for hospital and
physician services. This generally means that your provincial/territorial
health card will be accepted, in lieu of payment, when you receive hospital or
physician services in another province or territory because the rates
prescribed within these agreements are host-province/territory rates. These
agreements ensure that Canadian residents, for the most part, will not face
point-of-service charges for medically required hospital and physician services
when they travel in Canada because the province or territory providing the
service directly bills your home province/territory.
Sometimes there is a
requirement for patients to pay "up front" and seek reimbursement
from their home provincial or territorial health insurance plan. This still
satisfies the portability criterion of the Act as long as access to a medically
necessary insured service is not denied due to the patient's inability to pay.
Private health insurance plans are prohibited from duplicating coverage for
health services provided in Canada which are insured under the Canada Health Act.
In addition, the provision of
"additional benefits" (e.g. prescription drugs, ground and air ambulance
services) that provinces and territories may include under their respective
health insurance plans are generally not portable
outside one's home province/territory. Most private health insurance plans
provide coverage for ambulance services, prescription drugs and other
additional benefits provided outside the home province/territory. Therefore,
you may wish to purchase private insurance for such services before you leave
your home province/territory, to ensure adequate coverage.
Do I need private health care coverage when traveling outside Canada?
While traveling within Canada,
the portability criterion of the Canada
Health Act requires that insured hospital and
physician services are covered at host-province/territory rates. When outside
the country, coverage is required to be at home-province/territory rates. As a
result, health care services received abroad may not be fully covered by a
provincial or territorial health insurance plan. For that reason, it is highly
recommended that you purchase private insurance before departing Canada, to
ensure adequate coverage.
Am I covered for health services that I leave the country to obtain?
Prior approval by your provincial/territorial health insurance
plan may be required before coverage is extended for elective (non-emergency)
health services obtained outside Canada. Individuals who seek elective
treatment out-of-country without obtaining approval from their provincial or
territorial health insurance plans may be required to bear the cost of the
services received.
How do I resume my health care coverage when returning to Canada following a lengthy absence?
A three-month waiting period is
usually applied before coverage is reinstated. For information on requirements
and conditions for reinstating health insurance coverage, contact the Ministry
of Health of the province or territory to which you intend to return.
Why do some provinces/territories have health care premiums?
Provinces and territories have
considerable leeway in determining how to finance health insurance plans.
Financing can be through the payment of premiums (as in British Columbia),
payroll taxes, sales taxes, other provincial or territorial revenues, or by a
combination of methods. Health insurance premiums are permitted as long as
residents are not denied coverage for medically necessary hospital and
physician services because of an inability to pay such premiums.
Provinces/territories that levy premiums also offer financial assistance based
on income so that low-income residents can have their payments reduced or be
entirely exempted from paying premiums.
How do I register a complaint against a doctor?
Since the provinces and
territories, rather than the federal government, are primarily responsible for
the administration and delivery of health care services and the management of
health human resources, you should contact your local provincial/territorial
Ministry of Health - the phone numbers and websites are located inside the back
cover of the current read more http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/index-eng.php
You can also contact your
province or territory's College of Physicians and Surgeons, which is the organization that governs physician licensing and conduct. Links to each provincial
and territorial medical regulatory authority can be found on the College of Physicians and Surgeons of
Canada website.Canada Health Act Division
August 19, 2011
0 comments:
Post a Comment