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Hospital Insurance Plan

The Newfoundland Hospital Insurance Plan covers insured hospital services received within the province when recommended by a medical practitioner. While administration of the Plan is the responsibility of the Department of Health and Community Services, eligibility for coverage under the Plan is linked with eligibility for coverage under the Newfoundland and Labrador Medical Care Plan, which is administered by the Newfoundland and Labrador Medical Care Plan. All beneficiaries of the Medical Care Plan are automatically entitled to coverage under the Hospital Insurance Plan. The Hospital Insurance Plan pays the cost of insured in-patient and out-patient services, as follows:

Insured In-Patient Services

  • Accommodation and meals at the standard ward rate. Private and semi-private room charges are covered if provided for medical reasons or if standard accommodation is not available.
  • Nursing services
  • Laboratory, x-ray and other diagnostic procedures; e.g., EKG, Nuclear Medicine, Respiratory Therapy
  • Drugs
  • Medical and surgical supplies
  • Operating Room, Labour & Delivery
  • Use of radiotherapy facilities and radioactive isotopes where available
  • Rehabilitative Services; e.g., Physiotherapy, Occupational Therapy, Audiology, Speech Language Pathology

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Insured Out-Patient Services

  • Laboratory, x-ray and other diagnostic procedures; e.g., EKG, Nuclear Medicine, Respiratory Therapy
  • Rehabilitative Services; e.g., Physiotherapy, Occupational Therapy, Audiology, Speech Language Pathology
  • Anti-rejection drugs for transplant patients, AZT for AIDS patients
  • Surgical and Medical Day Care procedures

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Uninsured Services (Services Not Covered)

  • Additional charges for preferred accommodation (private and semi-private rooms which are not medically required)
  • Private duty nurses retained by the patient
  • Drugs and appliances issued for use outside the hospital (with the exception of drugs listed under the Insured Out-Patient Services section)
  • Bedside telephones, radios or television sets for personal, non-teaching use
  • Services for work-related conditions which are covered by the Workplace Health, Safety and Compensation Commission, or pensionable war-related disabilities which are covered by the Veterans' Affairs Canada
  • Services provided to members of the Royal Canadian Mounted Police or the Canadian Armed Forces which are covered by federal insurance programs
  • Services provided to members of the armed forces of other countries who are stationed in the province under N.A.T.O. agreements
  • Services provided without specific medical indication (e.g., x-rays required for employment or insurance purposes, cosmetic surgery, etc.)
  • Services provided in private non-approved Canadian diagnostic imaging facilities (e.g. MRI, CT, X-ray, etc.)
  • Services related to therapeutic abortions performed outside Canada or in non-accredited Canadian facilities
  • Ambulance service and other patient transportation, except when an in-patient of one hospital is conveyed to another hospital for special tests or treatment but remains an in-patient of the first hospital (Some coverage of transportation costs is available under other policies of the Department of Health and Community Services. For example, the Ground Emergency Ambulance Program, the Emergency Air Ambulance Program, or the Medical Transportation Assistance Program.)
  • In vitro fertilization and other procreative measures

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Out-of-Province Services (Within Canada)

Insured hospital services provided to beneficiaries of the Newfoundland Hospital Insurance Plan, who are temporarily absent from the province, or who are medically referred outside the province for insured treatment, are eligible for coverage under the Provincial Plan. Coverage within Canada is in accordance with the terms and conditions that apply to residents who receive insured services within Newfoundland and Labrador. All residents are required to present a valid Medical Care Plan (MCP) card when accessing insured hospital services in other jurisdictions. Uninsured services, as outlined under the Plan, are not funded outside the province. Patients and/or private insurance companies are responsible for payment of non-insured hospital services.

In-Patient Services

Insured in-patient hospital services are payable based on the standard ward rate for the facility providing the service. Provincial/Territorial Ministries of Health establish standard ward in-patient rates for insured facilities within their province/territory. Hospitals providing insured in-patient services to residents of other jurisdictions require completion of a Declaration of Hospital Insurance Coverage Form by the patient or next-of-kin.

Specialized In-patient and Out-Patient Services

Specialized in-patient services, such as transplantations, are payable based on National High Cost Rates established by a National Committee, the Coordinating Committee on Reciprocal Billings (CCRB). Out-patient services are payable based on National Out-patient Rates also established by the CCRB.

Claim Payment

The Provincial/Territorial Ministry of Health, on behalf of the hospital where services are received, invoices and recovers insured hospital costs from the Newfoundland Hospital Insurance Plan, Department of Health and Community Services.

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Out-of-Province Services (Outside Canada)

Under the Newfoundland Hospital Insurance Plan, residents who are temporarily absent from the country for vacation, temporary employment and/or educational leave are eligible for insured hospital services in accordance with rates established by the provincial plan. Hospital services will be considered under the Plan when the insured services are provided by a recognized facility (licensed or approved by the appropriate authority within the state or country in which the facility is located) outside Canada. Patients seeking coverage under the Newfoundland Hospital Insurance Plan are required to complete an Application for Out-of-Country Benefits which must be supported by a detailed itemized statement of account from the out-of-country hospital where services were obtained. Some foreign hospitals may agree to submit claims directly to the Newfoundland Hospital Insurance Plan, while some facilities may require patients pay the account when the services are rendered.

It is recommended that residents traveling outside this country ensure that they have adequate private health insurance to supplement their provincial health plan.

Insured Hospital Rates

The Newfoundland Hospital Insurance Plan pay the following:

Inpatient

a maximum of $350 per day in a community or regional hospital
a maximum of $465 per day in a tertiary or specialized hospital

Outpatient a maximum of $62 per day
Haemodialysis a maximum of $220 per day

All payments are made in Canadian Currency and are subject to change. After payment by the provincial health plan, any remaining account balance is the responsibility of the patient and/or private insurance.

Prior Approval

If you are planning to have insured medical/hospital treatment which you think may not be available in Canada, and are seeking funding under the Newfoundland Hospital Insurance Plan and/or Medical Care Plan, you must ask your physician to request prior approval from Medical Care Plan (MCP) before obtaining such treatment in another country. By doing so you will be made aware in advance of the rate at which your hospital bills will be reimbursed. Prior approval is mandatory to receive payment at rates higher than those identified in the table above. If a patient opts to travel outside the country for medical service/treatment and prior approval has not been granted, payment will be in accordance with those established rates and any balance remaining is the responsibility of the patient.

If prior approval is granted based on the unavailability of the services in Canada, the Newfoundland Hospital Insurance Plan will provide coverage for medically necessary hospital services. Payment will be in the currency of the country where the services are received, provided the rates are deemed to be fair and reasonable as determined by the Department of Health and Community Service.

If prior approval is not granted based on the availability of the services in Newfoundland and Labrador, the Newfoundland Hospital Insurance Plan will make payments in accordance with the established rates cited in the table above. Any balance remaining will be the responsibility of the patient.

If prior approval is not granted because the services are available within Canada, but not in Newfoundland and Labrador, the Newfoundland Hospital Insurance Plan will pay for hospital services at the Reciprocal Billing rates as if the services had been provided in another Canadian province. Any balance remaining will be the responsibility of the patient.

Claim Payment

Upon receipt of all the required documentation to support a claim for insured hospital services, the Newfoundland Hospital Insurance Plan will make the eligible payments to the appropriate party. If the patient has paid the claim and provides proof of payment, reimbursement will be payable to the claimant. If private insurance has paid the hospital directly, reimbursement will be payable to the Insurance Company. If the account has not been paid, payment will be made directly to the hospital.

Manager, Insurance Programs
Department of Health and Community Services
P.O. Box 8700
West Block
Confederation Building
St. John's, NL A1B 4J6
Tel: (709) 729-3108
Tel: (709) 729-5222
Fax: (709) 729-1918

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