Newfoundland & Labrador Health Plan

A Newfoundland MCP Health Coverage Overview

Residents of Newfoundland and Labrador can take advantage of the Newfoundland and Labrador Medical Care Plan (MCP) to stay protected.

 

Medical and Hospital Services

Health and Dental expenses covered by MCP.

  • Diagnostic, surgical and therapeutic procedures such as anesthetic supplies and services.
  • Expenses on a visit to the physicians and hospitals such as meals and accommodations. It may also cover home visits.
  • Medically essential pre-care and post-care.
  • Radiology (X-ray) interpretive services.
  • Maternity care services.
  • Medically essential dental-surgical processes, especially when carried out by a dentist or oral surgeon and in a hospital.

Ambulance services may attract a fee for each trip of the ground ambulance and $130 for each trip of the air ambulance. The Department of Human Resources, Labor and Employment may cover the ambulance fees of residents receiving income assistance.

 

MCP may not cover the following costs:

  • Vaccines and prescription drugs.
  • Times traveled by physicians.
  • Advice rendered by a doctor over the phone.
  • Medical exams required by a third party.
  • Contact lenses, glasses, and eye exams.
  • Paramedical services such as the services of chiropractors, optometrists, podiatrist, as well as acupuncture, naturopath, osteopath, and physiotherapist services.
  • Durable medical equipment and medical appliances like walkers and wheelchairs.
  • Services not medically required such as cosmetic surgery.
  • Reversing sterilization processes.
  • Unless sex changes are recommended by the Clarke Institute of Psychiatry, they will not be covered.
  • Regular dental service such as fillings, scaling, and cleanings for residents between 13 years and above. There is an exception if the resident is covered by one of the specialty programs listed below.
  • Treatment of drug and alcohol addiction outside Canada.

 

Dental Services

Dental services are not covered for all residents irrespective of their ages except surgical processes considered to be medically necessary through the Surgical Dental Program. The services are only covered if they are carried out by a dentist or an oral surgeon in a hospital.

However, an exception applies if you qualify for any of the specialty programs below.

 

Children’s Dental Program

  • This covers children under 13 years.
  • It provides examination every 6 months and cleaning every 12 months.
  • It also includes fluoride treatment every 12 months provided the child does not have access to the School Rinse Program.
  • Regular extractions and fillings, and
  • Treatments of sealant.

 

Income Support Program

  • This program is provided for teenagers between 13 and 17 (both inclusive), provided their parents are recipients of income support.
  • It includes routine extractions and fillings as well as examinations per year.
  • However, it does not provide coverage for fluoride and cleanings, sealants and removal of impacted teeth.

 

Low Income (Access) Program

  • This program is available to teams between 13 and 17 years, both inclusive, enrolled in the Newfoundland Access Plan and Labrador Prescription Drug Program (NLPDP).
  • The program offers similar benefits and ineligible services as Income Support Program.
  • It also covers regular fillings and extractions.

The program does not cover the following:

  • Sealants,
  • Extraction of impacted teeth,
  • Cleanings, and
  • Treatments of fluoride.

 

Adult Dental Program

  • This program is only available to adults who are enrolled in the Foundation Plan.
  • It covers regular services, together with standard dentures, once every 8 years.
  • It does not cover any preventive services like fluoride treatments and cleanings.
  • It covers two x-rays and examination every three years.
  • It covers standard dentures and extractions.
  • It also provides coverage for routine fillings every three years.

 

The Newfoundland Hospital Insurance Plan

The following in-patient coverage is offered in the Newfoundland hospital insurance plan.

  • Nursing services.
  • Meals and accommodations at standard rates. If a standard room is not available or if medically required, semi-private or private rooms may be covered.
  • Laboratory, x-rays, respiratory therapy, nuclear medicine, and other diagnostic services.
  • Rehabilitative services such as speech therapy, occupational therapy, audiology, and physiotherapy.
  • Drugs, surgical and medical supplies.
  • If available, radiotherapy isotopes and services are also covered.
  • Operating room, labor and delivery room.

The following out-patient services are also covered.

  • Rehabilitative services such as speech therapy, occupational therapy, audiology, and physiotherapy.
  • Surgical and medical day processes.
  • X-rays, diagnostic processes and various lab.
  • Anti-rejection drugs for transplant patients.
  • AZT for AIDS patients.

The hospital plan does not cover the following services.

  • Ambulance services are not covered unless it involves a transfer between hospitals.
  • Procreative treatments such as In vitro fertilization are also not covered.
  • Private duty nursing.
  • Unless drugs and appliances used outside of a hospital are specifically covered by the Insured Outpatient Services, they will not be covered by this plan.
  • Services not medically required such as x-rays for cosmetic processes.
  • Preferred accommodations such as private hospital rooms and semi-private hospital rooms.
  • Canadian Armed Forces members and RCMP, already covered by some federal insurance programs.

 

Prescription Drug Program (NLPDP)

Prescription drugs are only covered if they are provided in a hospital. However, the Newfoundland and Labrador Prescription Drug Plan provides financial assistance for drug coverage to residents of the province eligible for:

  • The Foundation Plan: This plan covers people who are in financial need 100%. This includes those receiving financial support from the government.
  • The 65Plus Plan: This plan is for seniors 65 years and above, who are also recipients of the OAS(Old Age Security Benefits) as well as the GIS (Guaranteed Income Supplement). Residents who qualify for this benefit are automatically qualified for the Ostomy Subsidy Program.
  • The Access Plan: This provides individuals and families with low incomes access to eligible prescription drugs.
  • The Assurance Plan: This plan is for individuals and families who require drugs with costs higher than their income. The plan provides coverage based on the following:
  • For individuals/families earning less than $40,000, it provides 5% or more of net income spent on the drug.
  • For individuals/families earning between $40,000 and $74,999, it provides 7.5% or more of net income spent on the drug.
  • For individuals/families earning less than $75,000 and $149,000, it provides 10% or more of net income spent on the drug.
  • The Select Needs Plan: This plan provides complete coverage for residents who require medications specific to their conditions or diseases and suffering from cystic fibrosis or growth hormone deficiency.

 

To know the full details visit the official Newfoundland’s Medical Care Plan (MCP) website

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