1. Out of Country Care: Provincial policies
Presented by: Dr. Corinne Packer
Assisted by: Dr. Vivien Runnels and Kathleen McGovern

2. All provinces/territories provide for OOC treatment
Recognition in all provinces/territories that sometimes a patient needs medical treatment or care that cannot be provided in his or her province/territory, or indeed within Canada.
Depending on the province/territory some or all of the costs of this care will be covered under provincial/territorial health insurance plans, based on a specific process.
Out of country care symposium June
Institute of Population Health.

3. Commonalities in conditions to be met in all provinces/territories to seek OOC health services
Treatment or care must be medically required
Medical or hospital service is unavailable in the province/territory or elsewhere in Canada
The delay in the provision of medical care available in the province/territory or elsewhere in Canada is immediately life threatening or may result in medically significant irreversible tissue damage.
Treatment must fall under insured medical, oral surgeries and/or hospital services
Applicant must be a resident of the province
Out of country care symposium June
Institute of Population Health.

4. Commonalities in procedures to follow in all provinces/territories to seek OOC health services
Specialist physician must write a letter/submit an application for funding for out-of-country health services to the provincial/territorial health authority providing information on the case and explaining why out-of-country care is needed.
Provincial/territorial health authority will review the case and must approve it before treatment is sought abroad, otherwise cost will not be reimbursed.
Out of country care symposium June
Institute of Population Health.

5. Policies: Newfoundland Labrador
Province
Services Covered
Conditions
Steps Required
NFLD
Yes: Claims for insured medical services obtained outside Canada are paid at Medical Care Plan (MCP) rates. Bills exceeding this are the responsibility of the patient, unless deemed fair and reasonable in advance by MCP.
Services unavailable in Canada
Hospital services must be medically necessary
Prior approval requested by your physician
Approval by MCP (rate that will be covered will be provided)
Submission of an out-of-province claim form
No: Transportation
Source: Government of Newfoundland and Labrador
To note : Rate of reimbursement will be decided on a case to case basis.
Out of country care symposium June
Institute of Population Health.

6. Policies: Nunavut Province Services Covered Conditions Steps Required
Canada Health Act
If a healthcare professional tells you have to leave your home community (prior approval)
Medical treatment must be urgent and needed before travelling for other reasons
Must have used up all other 3rd party and employer insurance options or have no insurance plan
Prior approval
Submit claim form
This slide added by Vivien on June 8, 2011 mostly from and other associated pages
Different framing of medical travel from the North
The Department of Health and Social Services of the Government of Nunavut offers medical travel benefits to make sure you have access to medical services that are not available in your home community.
If a doctor, nurse, dentist or other health care professional tells you that you have to leave your home community for medical treatment, you may be entitled to medical travel benefits.
If a healthcare professional tells you you have to leave your home community (prior approval)
Medical treatment must be urgent and needed before travelling for other reasons
You must have used up all other 3rd party and employer insurance options or have no insurance plan
For residents of Nunavut only, Steps required for different beneficiaries e.g. for land claim beneficiaries (HSS will organize but will not pay for visitors needed emergency medevac travel to a health centre or southern hospital (Nunavummiut)
Can be paid for under 3 different government insurance plans 1. (Nunavut Health Care Plan (Canada Health Act based in Rankin Inlet) (limited coverage, deductible of $250 round trip airfare (escorts not charged) and ambulance services from health centre to airport and return ; 2. Non Insured health benefits (Land Claims Beneficiaries i.e. recognized as Inuit eligible for Airfare Ground Travel Accommodations Meals and Authorized Escorts. NIHB will pay the $250 directly to the Nunavut Health Care Plan. You do not have to pay any money or make a claim. NIHB does not cover accommodations or meals for second escorts unless there is prior approval
) ; 3. Extended health benefits To be eligible for EHB, you must be a non-beneficiary 65 years or older, a non-beneficiary with a long-term illness, or a Nunavut resident who has used up all other insurance options. You can apply for Extended Health Benefits when you:
turn 65 are diagnosed with a chronic disease condition;have used up your third party insurance plan and need help paying for medical travel
Escorts will be approved for the following reasons:
You need the legal consent of your parent or guardian
You have a mental or physical condition that makes you unable to travel alone
You do not understand the language spoken in the health facility where your appointment is booked
You are a unilingual Inuit language speaking elder 60 years or older
You need an escort to take medical instructions for home medical or nursing procedures
You are medically incapacitated )
Out of country care symposium June
Institute of Population Health.

7. Policies: Prince Edward Island
Province
Services Covered
Conditions
Steps Required
PEI
Yes: the full cost of insured services will be paid at PEI or interprovincial rates
Medical services that are unavailable
Only 1 medical practitioner in the required specialty exists in PEI
The Medical Consultant/Executive Director of Health PEI deems the services available inadequate
extenuating circumstances exist
Prior approval from the Medical Consultant/Executive Director of Medical Affairs of Health PEI
referral from a PEI physician
No: Transportation
Source: Health PEI
To Note: May go out of country if only 1 specialist exists in the province
Out of country care symposium June
Institute of Population Health.

8. Policies: Nova Scotia To Note: Insured Procedures will be paid 100%.
Province
Services Covered
Conditions
Steps Required
Nova Scotia
Yes: All insured procedures are covered 100%
Must be in an accredited public hospital
Prior written approval from the department of health
No: Transportation
To Note: Insured Procedures will be paid 100%.
Source: Nova Scotia Medical Service Insurance
Out of country care symposium June
Institute of Population Health.

9. Policies: New Brunswick
Province
Services Covered
Conditions
Steps Required NB
Yes: Doctor bills
No: Travel and Accommodation Fees are not covered
Prior approval is mandatory
Medically necessary and scientifically acceptable service
Unavailable in New Brunswick or elsewhere in Canada.
Written request submitted to New Brunswick Medicare by specialist who identifies a specific, medically necessary and scientifically acceptable service unavailable in New Brunswick or elsewhere in Canada.
Source: New Brunswick Medicare
Out of country care symposium June
Institute of Population Health.

10. Policies: Quebec Province Services Covered Conditions Steps Required
Full cost of hospital services (services related to a hospital stay, such as nursing care and accommodation);
professional services rendered in a hospital setting (such as the services of a doctor).
Diagnostic or therapeutic services not available in Quebec
Exceptional cases, last resort
Advance authorization from Régie; a written request signed by two Québec medical specialists having recognized expertise concerning the disease from which the insured person suffers and attesting that the services required are not available in Québec
Source: Regie de l’assurace maladie Quebec
Out of country care symposium June
Institute of Population Health.

11. Policies: Ontario Province Services Covered Conditions Steps Required
Yes: Only medical treatment approved in advance
performed at a hospital or licensed health facility
not experimental or for research, generally excepted in Canada
not performed in Ontario by an identical or equivalent procedure
delay in Ontario may cause death or irreversible tissue damage
application form is submitted by your Ontario physician prior to services
No: Any supplemental treatment will not be covered
To Note: Any treatment supplemental to that of the pre-approved treatment will not be covered
Source: Ontario Ministry of Health and Long term care
Out of country care symposium June
Institute of Population Health.

12. Policies: Manitoba Province Services Covered Conditions Steps Required
Yes: Doctor bills (same rate as Manitoba)
Hospital bills (up to 75%),
Reasonable transportation costs
Required escorts
an appropriate physician recommends that you need a necessary, specific medical service
that treatment is not available in Manitoba.
written letter from a Manitoba Specialist
Manitoba Health will review letter from specialist, and seek opinion from medical consultant if necessary;
proof of seeing other Canadian specialists
To Note: Will cover costs of reasonable transportation and required escorts
Source: Manitoba Health
Out of country care symposium June
Institute of Population Health.

13. Policies: Saskatchewan
Province
Services Covered
Conditions
Steps Required SK
If approved, full cost of treatment at a rate considered fair and reasonable
Travel, meals and accommodation not covered
Exceptional circumstances
Treatment normally covered in Saskatchewan
A specialist physician must refer to outside of Canada for treatment
Prior approval from the Medical Services Plan of Saskatchewan Health or from the Saskatchewan Cancer Agency
Source: Saskatchewan Ministry of Health
Out of country care symposium June
Institute of Population Health.

14. Policies: Alberta Province Services Covered Conditions Steps Required
Yes: Insured Medical Care
Travel costs covered
Medically necessary
Not experimental or a clinical trial
Unavailable in Canada
Funding approved before medical services performed
Request submitted in writing,
Letter of referral or support from a physician or dentist
Recent health history including options that have been pursued
Documentation confirming all Alberta/Canadian resources have been utilized or it is unavailable
Explanation why it is not being used in Canada if available
To Note: Travel costs are covered; documentation proving all other options have been explored is required
Source: Government of Alberta Health and Wellness and
Out of country care symposium June
Institute of Population Health.

15. Policies: British Columbia
Province
Services Covered
Conditions
Steps Required
British Columbia
Yes: Services insured in BC
Medically necessary
Provided by a licensed physician or oral surgeon
Appropriate, acceptable treatment is not available
A delay would have medical consequences for the patient
Accepted non-controversial treatment
Worthwhile for the patient
Provided in an accredited acute care general hospital
Prior authorization from MSP
An attending medical specialist has submitted written request or application
Options available in BC or Canada must have been investigated
No: A substantial portion of costs may remain the responsibility of the patient where the fees are much higher than in Canada
Transportation not covered
To Note: A substantial portion of costs may remain the responsibility of the patient
Source: British Colombia Ministry of Health and
Out of country care symposium June
Institute of Population Health.

16. Worthy to note … Importance of the specialist
The application itself to have treatment covered abroad is out of the hands of the patient – completely up to the specialist to apply.
Specialist will also decide (and must indicate) where patient should go for this treatment.
Should have a good idea of what will be accepted or rejected prior to applying.
Conclusion: need a pro-active and informed specialist
Out of country care symposium June
Institute of Population Health.

17. Worthy to note …
Difficult to use OOC provisions to by-pass long waiting lists
… but not impossible! If delay in treatment is not proven to be life threatening or risk causing irreversible damage, jumping queues by requesting treatment abroad is not possible.
Appeal processes available
If treatment abroad is denied, most provinces have an appeal system (either an appointed Review Board or an Ombudsman).
Out of country care symposium June
Institute of Population Health.