While most people in Canady rely on the inter-provincial agreement between providers, moving to Newfoundland is a wakeup call for some Canadians. Health insurance in Newfoundland is different than anywhere else in Canada mainly because of how strict it is compared to other places. The Medical Care Plan has limitations you won't find elsewhere in the country.
Here is everything you need to know about setting up an MCP in Newfoundland.
Check Your Residency
To qualify as an MCP beneficiary in Newfoundland or Labrador, you need to reside in the province. The province's Medical Care and Hospital Insurance Act has a strict definition of who qualifies as a resident.
According to their rules, a resident is any person who is lawfully in the province and makes their home there as long as they're not considered tourist or visitors.
If you're not a resident of the province or you're transient, you won't be considered eligible for MCP coverage. In this case, you'll need to seek coverage from the province that you reside in permanently.
Eligibility is defined by a few basic groups. Canadian citizens and permanent residents are considered to be part of the group that's fully eligible for coverage through the MCP. International workers and international post-secondary students are other groups who are considered eligible if they have the appropriate documents.
Canadian citizens need to provide some kind of documentation to prove their citizenship. This could be a passport, birth certificate, or a social insurance card showing the applicants' Social Insurance Number. Permanent residents should have a record or a card that proves their residency status.
Check the Exclusions
There are lots of people in the province who are covered by the law. There are also plenty of others who fall into categories that leave them more vulnerable or in a state that's less secure than permanent residents. Even if they're living in the province, they still don't get the coverage from the MCP.
If you're a dependent of someone who resides in another province, you need to apply in that province instead. If you're currently in a refugee program, you might not be eligible. Thankfully, there are other programs to help ensure you get coverage.
If you're an international student without the required authorizations, you might not meet the criteria needed. This means you won't be covered. The same goes for international workers without the right employment authorization.
If you're a member of the Canadian Armed Forces, you need to apply for coverage with the Armed Forces rather than through MCP. Armed Forces from abroad might be in search for coverage. However, they need to get their coverage from their home country, even when stationed in the province.
If you're an inmate at a federal prison, you won't be covered by the MCP either.
Submitting a Claim Has Requirements
When you're looking at submitting a claim, it's necessary to follow strict guidelines for having it covered. There are a lot of doctors who don't participate in the inter-provincial arrangement. They sometimes provide services that are outside of that agreement as well.
If this is the case and you've received that treatment, you need to submit an "out of province" claim form for review. This claim can be submitted by your healthcare provider as long as you've signed the form in advance. Your doctor will notify you of the results of the claim.
When a healthcare provider doesn't provide this service, you need letterhead billing that has an itemized statement of services. If you get medical services outside of Canada, you can sometimes get coverage if you submit your claim via this letterhead.
When this information is sent in, the MCP departments review your claim. They'll assess its validity and substantiate it. Next, they'll ask you as the claimant to provide them with an out of province claim form along with the letterhead billing.
Learn about Beneficiary Audits
While you have the right to get services from the providers who offer them, you're prohibited from any unnecessary medical services. If the MCP finds that you're making unnecessary use of their services, you'll be audited. A Utilization Audit is run to assess the cost of the abuse or the damages that you'll need to pay the department.
Each case is assessed on its own and considered carefully by each person on the board. There are lots of individual circumstances to factor in and personal hardships to take into account.
The Medical Insurance Act allows MCP to look for abuse of services and recover any unnecessary costs. They can even ask a beneficiary to get into a contract to restrict them from receiving services from more than one provider. If they find that that provider is encouraging the beneficiary to overuse their plan, he'll be held responsible.
They consider standard visits to an office or hospital to fall well under the umbrella of what's allowed. They also consider any pre-operative or post-operative care, which includes house calls, to be covered.
Even some dental procedures are allowed under the act.
Health Insurance in Newfoundland Is Different
Everything from the terminology to the way that claims are submitted is different in Newfoundland. If you're moving there for the first time, do your research before trying to get health insurance in Newfoundland.
To learn more about individual coverage across the country, check out our latest guide. We provide everything you need to make an informed decision.