An Overview of PEI Health Plan Coverage and Benefits
Residents of the Prince Edward Island can take advantage of the Health PEI provincial healthcare plan which provides coverage for basic medical and hospital treatments.
Here is an overview of the Health PEI coverage.
Health PEI insures 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 as 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 eye glasses 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 homecare 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 the 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.
To know the full details visit the official PEI Health website
Read more informative Prince Edward Island’s articles here
Learn some critical information about PEI