PEI Health: A Resident's Guide to Health Insurance Coverage in PEI

Posted on November 16, 2018

Prince Edward Island may be Canada's smallest province, but it spends big on health care. In fact, the 2018 budget included a $32.5 million boost to the province's health spending.

If you're an Islander or thinking about moving, you might wonder what's in PEI health coverage. After all, you want to know what you're getting for that multi-million dollar price tag.

In this guide, we'll go over what you can expect from your health insurance in PEI. You'll learn both what's covered and what's not covered. We'll also discuss how to make sure you have the right coverage for you and your loved ones.

What Does PEI Health Coverage Include?

The first question most people ask when they think about health insurance in PEI is what's covered. Like other provinces in Canada, health care in PEI is funded by the PEI Department of Health and Wellness. Public funds pay for health services, and most Islanders are eligible for services.

So which services are actually covered under the public system? PEI's health care coverage includes both hospital and basic medical services.

Hospital Services in PEI

Public health in PEI covers most basic hospital services. These services include:

  • Hospital rooms
  • Meals
  • Prescription medications administered in hospital settings
  • Laboratory tests and other diagnostic procedures
  • Necessary nursing services
  • In-hospital physiotherapy
  • Some out-patient services

The PEI health care system doesn't cover all hospital services. These can include medications administered outside the hospital, dental services, and ambulance fees.

Basic Medical Services

The department of health in PEI also offers coverage for many basic medical services. These can include:

  • Visits to the doctor and most services
  • Medically necessary surgery
  • Treatment of broken bones and dislocated joints
  • Some necessary oral surgeries performed in a hospital setting
  • Obstetrical services

The system also covers some specialists' visits and services, but not all.

What Isn't Covered?

PEI health care doesn't cover everything. The system covers most basic medical services, which the majority of Islanders will need at some point in their lives.

Long time and new residents of PEI ask the same question. What isn't covered under the provincial health care insurance plan? Knowing this is often as important as knowing what is covered.

Services provided by some specialists, including dietitians, osteopaths, physiotherapists, and psychologists, are not covered. Dental procedures are also not covered unless it's a hospital-based procedure.

Eyeglasses, hearing aids, and other devices aren't covered by the province either. Medically unnecessary procedures, such as cosmetic surgery, are also ineligible for coverage.

Pharmacare in PEI

PEI offers a pharmacare program to help Islanders pay for medications. Coverage under this program is not comprehensive, so not all medications are eligible.

To be eligible, you'll need a valid PEI health card and you'll need to qualify for one of the province's Drug Programs. Your medication must also be listed on the PEI Pharmacare Formulary. If it isn't, you can't receive coverage for the cost.

Out-of-Province Procedures

Since PEI is such a small province, it's sometimes necessary to seek services elsewhere in Canada. Generally speaking, you can receive emergency medical services anywhere in Canada. PEI health insurance will cover the costs.

You may also receive coverage for procedures performed outside of the province. You may be approved if there is only one practitioner in the field in PEI or the service is not available at all.

The health department's Medical Director might allow out-of-province procedures in some situations.

Travel Coverage with PEI Health Insurance

The provincial health insurance plan provides some coverage for PEI residents who travel. This is different than the coverage provided for out-of-province procedures.

If you're traveling in Canada, you can receive services for sudden illness or emergency medical procedures. The same is true if you travel outside of Canada. Keep in mind that you may need to pay upfront for medical services in other countries.

Are You Eligible for Health Coverage in PEI?

If you move to PEI from another province or you're a newcomer to Canada, you might ask if you qualify for PEI health care.

Most residents of PEI are eligible for services. If you've moved from another province, you'll need to wait three months before you apply. Then you can receive your PEI health card from the PEI Department of Health and Wellness.

Newcomers must live legally in Canada. This means you'll need a permanent residency card or a certain type of immigration visa. You must live in PEI for six months and one day each year and have a permanent home in the province.

Foreign students without work visas and tourists aren't eligible for PEI health insurance. Some people, such as members of the Canadian Armed Forces, might qualify for different programs. They cannot apply for a PEI health card.

Getting Your Health Card

If you meet the eligibility criteria, getting a health card is easy. You can fill out a form and submit it, either in person or online. You'll need to renew the card once every five years.

It's important to keep your health card up to date. Be sure to update your address if you move, even within PEI.

Do You Need Supplemental Coverage in PEI?

When considering their health, PEI residents should review provincial coverage carefully. Once you have, you might want to invest in some supplemental coverage.

Good private benefits can help you cover medical costs like prescription medications. With the right private insurance, you may be able to afford hearing aids or other medical devices. Access to these medical items and services can help you live your best life.

Make Sure You Have the Coverage You Need

PEI health coverage is designed to assist Islanders in getting basic medical care. This goes a long way to improving health and wellness in Canada's smallest province.

You may not have all the coverage you need. If you think you might need more health coverage, get a quote today. When it comes to your health, adding more protections is never a mistake.

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