Canada does not have a single national health care plan, but rather a national health insurance program, which is achieved through a series of thirteen interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage, with slight differences. Under the Canada Health Act, our national health care 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 residents of Canada have access to medically necessary hospital and physician care on a prepaid basis. Residence in a province or territory is the basic requirement for insured health care coverage. The Canada Health Act defines a resident of a province or territory 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."
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 minimum residence requirements beyond an initial three-month waiting period to establish eligibility for and entitlement to insured health services. Provinces may require minimum residence annually in the province, and evidence of intention of returning to the province for that minimum residence period each year.
The federal government is responsible for:
setting and administering national principles or standards for the health care system through the Canada Health Act;
assisting in the financing of provincial health care services through fiscal transfers;
delivering direct health services to specific groups including veterans, native Canadians living on reserves, military personnel, inmates of federal penitentiaries and the Royal Canadian Mounted Police; and
fulfilling other health-related functions such as health protection, disease prevention and health promotion.- The provincial and territorial governments are responsible for:
managing and delivering health care services;
planning, financing, and evaluating the provision of hospital care;
physician and allied health care services; and
managing some aspects of prescription care and public health.
What health care services are insured by the provinces and territories?
Under the Canada Health Act, provincial and territorial health insurance plans are required to provide coverage to their residents for all medically necessary hospital and physician services on a prepaid basis.
What other health care services do provinces and territories provide?
Provinces and territories may also offer "additional benefits" under their respective health insurance plans, at their discretion, and on their own terms and conditions. While these services vary from province to province, some examples include prescription drug benefits, dental care, optometric services, chiropractic services, hearing aids, transportation services and home care programs.
What health care services are not covered by provinces and territories?
Services not covered are generally those considered not to be medically necessary. Some examples include: cosmetic surgery, health examinations for employment purposes and tattoo removal. However, there can be exceptions; for example, the removal of concentration camp tattoos or reconstructive cosmetic surgery following a trauma.
Are alternative forms of health care (i.e. chiropractic, acupuncture, herbal medicines) covered under my medicare plan?
Although Canada's current health care system is based on the practice of traditional western medicine, this does not mean that there is no room for alternative forms of health care. Some alternative health care is covered, at least partially, by the provincial and territorial health insurance plans. Under the federal health insurance legislation, the Canada Health Act, the provinces and territories are required to provide medically necessary hospital and physician services to all their eligible residents on a prepaid basis. In addition to the provision of medically necessary hospital and physician services, provincial and territorial governments may also offer "additional benefits" at their own discretion. Chiropractic, acupuncture and naturopathy services are examples of the additional benefits provided by the provinces and territories on their own terms and conditions.
How do I replace a lost provincial health card?
The provinces and territories, rather than the federal government, are primarily responsible for the administration and delivery of health care services. You should contact your local provincial Ministry of Health office - the number can be found in the blue pages of your phone directory. That office will assist you with your enquiry. Alternatively, you could visit your provincial Ministry of Health web site to locate the information there.
Who do I contact for a change of address for my provincial health care?
The provinces and territories, rather than the federal government, are primarily responsible for the administration and delivery of health care services. You should contact your local provincial Ministry of Health office - the number can be found in the blue pages of your phone directory.
Do I need private health care coverage when travelling within Canada?
The portability criterion of the federal health insurance legislation, 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 individuals to travel or be absent from their home province or territory and yet retain their health insurance coverage. Individuals should seek prior approval for out-of-province health care services from their home province insurance plan for non-emergency health care services. 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. These agreements are interprovincial, not federal, and signing them is not a requirement of the Canada Health Act. The rates prescribed within these agreements are host-province rates, and the agreements are meant to 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.
Reciprocal billing is a convenient administrative arrangement, and it is but one method of satisfying the portability criterion of the Act. A requirement for patients to pay "up front" and seek reimbursement from their home province or territory also 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.
The provision of prescription drug benefits outside hospitals falls within the range of "additional benefits" that provinces and territories may include under their respective health insurance plans, on their own terms and conditions and are generally not portable outside one's home province/territory.
Do I need private health care coverage when travelling outside Canada?
In relation to out-of-country health insurance coverage, the federal health insurance legislation, the Canada Health Act, requires provincial and territorial health insurance plans to provide portability of coverage for insured medically necessary hospital and physician services when temporarily outside one's home province or territory. The portability criterion of the Act does not entitle one to seek services in another country, but is more intended to entitle one to receive necessary services in relation to an emergency when the absence is temporary, such as on business or vacation. However, because of the high costs associated with health care in some foreign countries, reimbursement for emergency health care by a province or territory may not be made at the full amount. Therefore, it is recommended that when travelling outside Canada, individuals are encouraged to purchase private insurance to ensure adequate coverage. Individuals who seek treatment out-of-country without prior approval from their provincial or territorial health insurance plans may be required to bear the cost of the services received.
