PEI Health Plan

Health PEI ensures the following medical services.

• • The insured services in Health PEI are required to be medically necessary.
• • It covers most services rendered by a physician at home, in a hospital, and in a doctor’s office.
• • Medically necessary surgical services are covered.
• • Sterilization of both male and female but a reversal of the process is not covered.
• • Pre-natal and post-natal services or generally obstetrical services.
• • Some oral surgeries when performed by an oral surgeon in a hospital and considered a medical necessity.
• • Some services of an insured specialist especially when referred by an attending physician.
• • Treatment of fractures and dislocations.

The following medical services are not insured by Health PEI.

• • Examinations by a third party.
• • Time spent by a doctor on travel.
• • Cosmetic surgeries not considered medical necessities.
• • Regular dental services such as fillings, extractions, cleanings, and examinations unless they are considered a medical necessity and carried out in a hospital.
• • The service of professionals such as acupuncturists, chiropodists, chiropractors, audiologists, acupressurists, homeopaths, dieticians, optometrists, dentists, osteopaths, podiatrists, physiotherapists, and naturopaths.
• • Medical appliances such as artificial limbs and hearing aids as well as eyeglasses and lenses.
• • Unless an ambulance is needed urgently and the resident involved in a senior above 65, ambulance services will attract a fee.

Health PEI covers the following home care services.

• • Palliative care
• • Nursing care such as wound care, injections, IV therapy and so forth.
• • Home support with daily living activities like bathing and dressing.
• • Services of a dietician.
• • Adult protection.
• • Physiotherapy to help the resident recover his/her independence and also assist with overall function and mobility.
• • Occupational therapy to modify the home with special devices that help in daily living.
• • Adult day programs.
• • Long term care.

The hospital services below are insured. Some of the services are provided on an out-patient basis.

• • Accommodations and meals are provided at the rate of standard wards. This includes coverage for semi-private and private rooms.
• • Medically essential nursing services.
• • Diagnostic processes such as x-rays and laboratory procedures.
• • Therapies such as radiotherapy and physiotherapy.
• • Anesthetic facilities, operating room, and regular surgical supplies.
• • Drugs prescribed by a doctor and administered in a hospital.

The services below are not covered:

• • Semi-private and private rooms.
• • Ambulance user fee in PEI and all ambulance fees outside PEI.
• • Private and semi-private hospital rooms.
• • Crutches and some prosthetic devices.
• • Unless there is a prior approval or the patient is medically required to be in a hospital, dental extractions are not covered.

Health PEI does not cover prescription drugs on a general note. But if you are a senior citizen, meet some financial requirements and/or have certain diseases, you may be eligible for full or partial coverage. Some of the available drug programs include:

• • AIDS/HIV Drug Program
• • Catastrophic Drug Program
• • Children in Care Drug Program
• • Community Mental Health Drug Program
• • Cystic Fibrosis Drug Program
• • Diabetes Drug Program
• • Erythropoietin Drug Program
• • Family Health Benefit Drug Program
• • Financial Assistance Drug Program
• • Generic Drug Program
• • Growth Hormone Drug Program, and many others.

To avoid delays in the payment of out-of-province services, it is necessary to inform Health PEI ahead of time if you are traveling out of your province for more than a month. Further, Health PEI may not take full responsibility for the costs you incur in the case of out-of-country medical costs. Thus, it is advised you supplement your plan with a private travel insurance plan when you are traveling outside your province.

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Additional PEI’s  Resources:

• • Check it out also here the Best Private Insurance company providers in Canada and North America.
• • To know the full details visit the official PEI Health website

LEARN MORE ABOUT PEI

Read more articles about Prince Edward Island province, the coverage, extended benefits, FAQ, etc.