Health and Community Services

Eligibility

The Medical Care Insurance Beneficiaries and Inquiries Regulations opens new window (10 KB) and the supporting policies of the Medical Care Plan (MCP) identify those residents who are eligible for coverage under the Medical Care Plan, the Dental Health Plan, and the Hospital Insurance Plan. As the administrator of the regulations, the Medical Care Plan has established rules to ensure that the regulations are applied consistently and fairly in the processing of applications. As eligibility is based on the individual’s circumstances additional documentation to that listed below may be required.

Residency in Newfoundland and Labrador

All MCP beneficiaries must be residents of the province. The Newfoundland and Labrador Medical Care and Hospital Insurance Act defines a resident as a person... "who is lawfully entitled to be or to remain in Canada, makes his or her home in the province, and is ordinarily present in the province but does not include a tourist, transient or visitor to the province"

Persons who are not resident in the province are not eligible for MCP coverage and should seek healthcare coverage from their province of residence.

Eligible applicants can be classed into four basic groups: Canadian Citizens, Permanent Residents, International Workers and International Post-Secondary Students. MCP requires documentation which must be provided by the applicant to prove eligibility under the Plans.

Canadian Citizens must present documentation which confirms their citizenship status. This may include:

A valid Canadian passport
A Canadian Birth Certificate
A Social Insurance Card or Federal document containing the applicant’s Social Insurance Number (SIN)
An official Federal Government Identity Card or Federal Government document containing the applicant’s SIN and name.

Permanent Residents must present their Permanent Resident record or card and/or Record of Landing Documents from Immigration Canada. If landed status was granted in Newfoundland and Labrador, proof of intention to remain in Newfoundland and Labrador may be required.

If applicable, Canadian Citizens and Permanent Residents may also have to provide the following:

  • a previous province or territory's health care number or card
  • proof that Canadian citizenship/permanent residency status has not been forfeited if returning to Canada after a lengthy stay abroad
  • proof of discharge from the Canadian Armed Forces
  • proof of release from federal prison.

Applications for newborn coverage require the Birth Certificate of the child and a parent’s valid Medical Care Plan (MCP) number, if applicable.

Applications for coverage for an adopted child require a copy of the official adoption documents or a Notice of Adoption Placement from the Department of Health and Community Services, and the birth certificate of the child. Applications for coverage for children adopted outside Canada also require Permanent Resident documents for the child.

International Workers coming to Newfoundland and Labrador must present an Employment Authorization (Work Visa) and letter from their employer.

The Employment Authorization must be:

  • issued before coming to Canada; and
  • for a named Newfoundland and Labrador employer; and
  • for a specific full time job within the province; and
  • valid for at least 12 months (except international health care workers).

The letter from the employer must indicate that:

  • the employment contract is for at least 12 months; and
  • the work site is in Newfoundland and Labrador.

International Post-secondary Students coming to Newfoundland and Labrador must present a Student Authorization (Study Permit) and a letter from the post-secondary institution.

The Study Permit must be:

  • for studies within Newfoundland and Labrador; and
  • issued before coming to Canada; and
  • for a recognized named Newfoundland and Labrador post-secondary educational institution; and
  • valid for at least 12 months.

The letter from the post-secondary institution must indicate that:

  • the student is enrolled full time;
  • the program or course of study exceeds 12 months; and
  • the studies will occur on a campus in Newfoundland and Labrador.

MCP coverage is not available for students who study by distance from outside the province.

All international applicants should be prepared to present a valid foreign passport for identification purposes.

Excluded Categories

The following categories are not eligible for coverage under the Plans, even if living in Newfoundland and Labrador:

  • Dependents of residents of another province or territory
  • Refugee claimants
  • International workers with Employment Authorizations that do not meet the established criteria
  • International students with Student Authorizations that do not meet the established criteria
  • Tourists, transients and visitors
  • Dependents of any of the above excluded categories
  • Canadian Armed Forces
  • Inmates of federal prisons
  • Armed Forces personnel of other countries stationed in the province.

Claim Submission Requirements

If you have been treated by a physician in Canada who is not participating in the inter-provincial arrangement, or have obtained services which are excluded from the agreement, it will be necessary for you to submit an Out-of-Province Claim Form. This claim may be submitted on your behalf by the physician, in which case you will be asked to sign the form.

If the physician elects not to submit a claim on your behalf or you obtain medical services outside Canada, you should obtain letterhead billing which contains an itemized statement of the charges and services. This information is required so that we may substantiate and assess your claim. You will then be required to submit an Out-of-Province Claim Form, accompanied by the letterhead billing.

Beneficiary Audit

Beneficiaries, while having a right to receive insured services from providers, may not make unnecessary use of medical services.

When MCP suspects that a beneficiary is making unnecessary use of services, a Utilization Audit may be conducted into the beneficiary's use to determine the nature and the cost of any abuse. Each suspected case of abuse is decided on its own merits, in consideration of the individual circumstances and the beneficiary's medical history. A chronically ill beneficiary requiring numerous services for treatment is not generally audited.

The Newfoundland and Labrador Medical Care Insurance Act allows MCP to assess a beneficiary for abuse of services, and to recover the cost of those services through court action. MCP may also require a beneficiary to enter into a contract to restrict a beneficiary to receiving services from only one physician.

If MCP determines that a physician is encouraging a beneficiary to over utilize the Medical Care Plan, an audit into that physician's practice may be conducted.

All MCP cards remain the property of the Department of Health and Community Services. MCP reserves the right to retain a copy of all required documentation. Personal health information is collected, used, disclosed, and safeguarded in accordance with the Personal Health Information Act (PHIA). If you have any questions about the collection or use of this information please contact our office. The Department of Health and Community Services privacy statement can be found at
www.health.gov.nl.ca/health/PHIA

The information presented on this site has been compiled as a guide to programs and services under the Medical Care Plan and does not represent the complete Program rules. For more information, please contact MCP.

This information is subject to change without notice.

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