A Guide to PEI Health Plan and Health Card

Prince Edward Island's medical and hospital services plan is tailored to offer eligible residents coverage for basic medical and hospital treatment. New residents must apply for a PEI Provincial Health Card to get medical and hospital services.
    Prince Edward Island Landscape

    Free Healthcare Coverage in Prince Edward Island

    Each time you visit a medical institution or undertake medical treatment or testing at a publicly funded facility in the territory, you'll be required to produce a PEI Health Card. If you do not have a binding card, you'll be billed for physician and hospital services.

    The card is valid for 5 years from the issue date. It contains your 8-digit PHN (Personal Health Number) and personal information such as an address, gender, birth date, name, and the card's expiry date.

    A renewed provincial health care card PEI also contains your intention for tissue and organ donation and preferred language for health or medical services.

    Coverage Summary

    Drug Coverage

    A pharmacist requires a PEI Health Card to record certain prescription medications in the PDIS (PEI Drug Information System). PEI Health Card does not cover prescription drugs generally.

    Nonetheless, senior citizens that meet certain financial requirements or with certain diseases might be eligible for partial or full coverage. Here are some of the available drug programs;

    • Generic Drug Program
    • Financial Assistance Drug Program
    • Catastrophic Drug Program
    • Erythropoietin Drug Program
    • Family Health Benefit Drug Program
    • AIDS/HIV drug Program
    • Community Mental Health Drug Program

    Student Coverage

    Post-secondary international students can apply for a PEI Health Card by submitting the following documents;

    • A copy of a valid study permit that indicates you're eligible to work off-campus. You need to submit a copy for annual extensions
    • Verification of full-time, current admission from a designated institution of learning
    • A copy of valid passport

    Note: It is important to note that PEI Medicare doesn't authorise acceptance letters, student ID cards, or tuition cost forms

    International student spouses might apply for PEI Health Card by submitting these documents;

    • Marriage certificate
    • Visitor permit

    Dependent children of international students might also be eligible by providing these documents;

    Birth certificate

    Visitor permit or study permit

    Note: PEI Medicare might request proof of residency if applicable for instance enrollment letter from the school, lease/rental agreement, etc.

    Coverage When Travelling in Canada and Outside of Canada

    If you temporarily leave the territory for one reason or another, the PEI Health Card will cover you for sudden illness or emergency health care services. It is strongly recommended to have additional private insurance for purposes of health coverage when outside Canada.

    Take note of the following out-of-province situations that might apply to your case;

    • If you're travelling within Canada, you need to notify PEI Medicare if you intend to be outside for more than one month. Doing this will go miles in preventing any form of delay in processing payment for an out-of-province service. You need to provide both departure and return dates, your destination, and your reason for leaving. For instance, you can indicate a sabbatical leave or winter vacation.
    • If you're travelling outside Canada, note that the cost of medical and health services outside the country might vary considerably and you'll be needed to pay for the medical costs upfront. When you pay for the services, reimbursement will be at PEI rates in CAD. However, you'll be responsible for the difference between the amount paid by PEI Medicare and the amount charged. It is necessary to submit a detailed invoice as well as proof of payment to PEI Medicare within 6 months of the service date.
    • If you're an island student that'll be studying outside the province, you need to notify PEI Medicare of your intentions at the start of every academic school year to make sure you enjoy appropriate medical coverage. Do you have a legit PEI Health Card and you'll be studying within Canada? If yes, then you'll be insured for sudden illness care or emergency health services. Such emergency care consists of a walk-in clinic for life-threatening or sudden illness or visiting an emergency department and being admitted to the hospital for emergency treatment or procedure. Non-emergency care like elective treatments and surgeries or treatment for chronic ailments or conditions need prior approval from the Health PEI if the service is to be insured.
    • If Prince Edward Island is your primary residence and your job needs you to work and live out-of-province or out of the country for a long period, then you need to notify PEI Medicare for guaranteed appropriate medical coverage.

    Applying for A Health Card

    Applying for a PEI Health Card is a seamless process. The card is issued to all residents. You're considered a resident of Prince Edward Island if;

    • You're in Canada legally, and
    • PEI is the primary residence for not less than 6 months plus one day every year
    • You're not eligible for the card if you're a;
    • A visitor, transient, or tourist to PEI
    • An inmate of the Federal Penitentiary
    • An international student that's unable to work off-campus
    • A member of the Canadian Armed Forces
    • A citizen qualified for particular services under other government programs like the Department of Veteran Affairs, Workers Compensation, or Interim Federal Health Program for Refugees

    To apply for the PEI Health Plan, you need to be present physically in PEI.

    How to Apply in Person

    To apply offline in person, you need to download, complete and submit the PEI Health Card application. The required documentation should be sent to any of these locations;

    How To Apply Online

    Online application just like offline, is a seamless process >> Apply for PEI Health Card online. If you have all the necessary supporting documents, it is possible to complete the online application form within 15 minutes. It all depends on the number of members in your household you want to include in the form.

    Properly completed and accompanied applications are normally assessed within 2 weeks. Your application is processed immediately and it is accepted for coverage. Allow an extra three weeks for application processing.

    Forms and Documentation Required

    When making an application for the PEI Health Card, you can register a spouse and up to 7 dependent children under 18 years and residing with you. For every individual you register, you'll need to complete all the necessary identification fields and either decline or accept with their consent to be a tissue and organ donor.

    During the application process, you'll be required to upload copies of supporting forms and documentation for every individual listed on the application. Some of the forms and documentation needed include;

    • If you're a Canadian citizen, you need to attach a copy of a health card from your former province, back and front if appropriate, or a birth certificate.
    • If you're a Canadian citizen that's returning from another country, you need to attach a copy of your Canadian passport.
    • If you're a permanent resident, you need to attach a Confirmation of Permanent Residence document copy or both sides of your Permanent Resident Card.
    • If you're an international student, you should attach a Study Permit and proof of registration from a designated learning institution copies
    • If you have a working visa, you need to attach a copy of your immigration record.

    Note: 18 years is the age of majority in PEI.

    Renewing or Replacing Your PEI Health Card

    Renewing Your Health Card

    The PEI Health Card is operational or valid for 5 years. Roughly two or so months before the card expires, you'll receive a notice of renewal that contains all the necessary validation information. The information will be mailed to the address you provided to PEI Medicare.

    Note: Always ensure that PEI Medicare has your current contact and address information. In case of any changes in your contact or address, call 1-800-321-5492.

    To renew your PEI Health Card, you need to complete and return a paper form included in your renewal letter if there's a major change of information on one or more cards that are registered to your household. For instance,

    • The information contained on the card is incorrect
    • There's been a change in household composition since the last renewal; perhaps one or two residents has moved out or into the household

    You can renew your PEI Health Card if you're reporting a minor change or no change of information such as;

    • Language preference for getting health services (optional)
    • Change of household phone number and/or address
    • Intention for tissue or organ donation (optional). Read Organ and Tissue Donation.

    To renew your PEI Health Card, you'll need the following;

    • Household renewal letter containing essential access information
    • For purposes of online security, you need to enter validation information that includes;
    • Household number (This number is contained in your renewal letter);
    • Personal Health Number coupled with a date of birth for any adult cardholder for the household number
    • If there's no change in the cardholder information, all you need to do is click 'submit' and every card registered under your household will renew automatically
    • If making changes to organ donor consent or language preference, you might need information from the card you intend to update.

    If you're an international student and intend to renew your health card, you need to provide a copy of your present health card, a copy of existing proof of enrollment, and a copy of your new study permit, that is, if applicable. Be sure to note any changes in your phone number or address.

    If you're a Work Permit holder and desire to renew your PEI Health Card, you need to submit a copy of the new Work Permit and current health card copy. Be sure to note any changes in your phone number or address.

    If you don't want to do your renewal online, you can send all the necessary documents via mail:

    • PEI Medicare
    • PO Box 3000
    • 126 Douses Road
    • Montague, PE C0A 1R0

    Or drop off at Health PEI at 16 Garfield Street in Charlottetown. Alternatively, you can drop to any Access PEI location.

    Replacing Your Health Card

    Is your PEI Health Card stolen or lost? If yes, replacement, which is a breeze, is necessary. You have to part with a replacement fee of $10 per card. The household maximum is $50.

    If you have changed your name or you received a card with incorrect information, you'll not be charged for the replacement card.

    For card replacement, you need to download and print a Request for a Replacement Health Card. Once you've done that, send the completed form with a money order or cheque payable to Health PEI to the PEI Medicare.

    Alternatively, you can request a replacement card and issue payment at any Access PEI Centre location.

    Changing Your Address On Your Health Card

    Do you need to update your telephone number or address; you can do so by notifying PEI Medicare at 1-800-321-5492.

    PEI Health Plan Coverage Details

    The PEI Health Card covers or caters to the cost of many medically necessary services. Some of the medical and hospital services that the card covers include;

    • Addiction services, drug programs, and mental health services
    • Long-term care, and palliative care
    • Home care services such as
    • Adult protection
    • Adult day programs
    • Dietician services
    • Occupational therapy to transform the home special gadgets that assist in daily living
    • Physiotherapy to assist residents to recover their independence and overall mobility and function
    • Home support with day-to-day living activities such as dressing and bathing
    • Most in-hospital and physician services such as;
    • Meals and accommodation provided at standard ward rate
    • Medically necessary nursing services
    • Therapies like physiotherapy and radiotherapy
    • Diagnostic processes like laboratory and x-ray procedures
    • Anaesthetic facilities, regular surgical supplies, and operating room
    • Doctor-prescribed drugs and administered in the hospital
    • Primary care services (public health nursing, chronic disease management, and prevention, as well as dental public health services for kids)
    • Urgent medical conditions such as;
    • Tightness or discomfort in the chest
    • Abdominal pain
    • Unusual shortness of breath
    • Prolonged vomiting or diarrhoea particularly in children
    • Prolonged and persistent dizziness or headaches
    • Injuries that need stitches or might involve a broken bone

    If you aren't feeling well and can't wait for an appointment with a doctor or nurse practitioner, you can step into a walk-in clinic that provides non-urgent care after hours.

    What Is and Isn't Covered under PEI Health Plan

    Generally, some examples of medical and hospital services not covered by the PEI Health Card include;

    • Most prescription drugs
    • Dental services (Regular dental services like examinations, cleanings, extractions, and fillings unless considered medically necessary and undertaken in a hospital)
    • Appliances such as crutches, artificial limbs, or hearing aids
    • Eye exams as well as eyewear such as contacts or glasses
    • Examinations by a 3rd party
    • The time you spend with a doctor when you're travelling
    • Cosmetic surgeries are not categorised as medical necessities
    • Services of professionals like naturopaths, physiotherapists, podiatrists, osteopaths, dentists, optometrists, dieticians, homoeopaths, acupressurists, audiologists, chiropractors, chiropodists, and acupuncturists
    • Medical appliances like hearing aids and artificial limbs

    In general, ambulance services aren't covered. Nonetheless, they're subsidised for PEI residents in certain situations.

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