Text Size

Out of Province Coverage

Medical Care Plan (MCP) will provide coverage under the Medical Care Plan (MCP) to beneficiaries who temporarily leave Newfoundland and Labrador. Coverage under the Hospital Insurance Plan will also be provided, however, the Department of Health and Community Services can provide more information on the services insured outside Newfoundland and Labrador. Coverage under the Dental Health Plan is not available outside Newfoundland and Labrador.

To ensure that coverage remains intact while outside Newfoundland and Labrador, an Out-of-Province Coverage Certificate should be obtained from Medical Care Plan (MCP). This provides a maximum of twelve months' out-of-province coverage to eligible beneficiaries, with the following qualifications:

  • Beneficiaries leaving for vacation purposes may receive an initial Out-of-Province Coverage Certificate for up to twelve months' coverage. The normal four month residency requirement must be met immediately following their return to Newfoundland and Labrador. Further Out-of-Province Coverage Certificate's will only be issued to provide up to eight months' coverage.
  • Beneficiaries leaving for work purposes (temporarily absent workers) may receive an Out-of-Province Coverage Certificate for up to twelve months' coverage. Beneficiaries who are working outside of the country may renew their Out-of-Province Coverage Certificate each year to provide up to three years' out-of-province coverage. A letter from the employer, on letterhead, stating the dates of employment is required.
  • Beneficiaries leaving for study purposes may receive an Out-of-Province Coverage Certificate for up to twelve months' coverage. This is renewable each year if a newly completed form and updated proof of enrolment in an educational institution is received. Approval is conditional upon the beneficiary's intention to return to Newfoundland and Labrador upon completion of the program of study.

Rates Payable-Services Obtained in Canada

Insured medical services obtained in other provinces and territories are payable at the rates established by the medical care plan in those jurisdictions. This means that, with some exceptions which are outlined below, you will not have to pay for any portion of the physician's charges for insured medical services.

There are several situations where you may receive a bill for services. These are as follows:

  • Services provided in the province of Quebec
  • Services excluded from those covered by the inter-provincial agreement mentioned below.
  • Certain physicians in some provinces have decided not to participate in the agreement adopted by the provinces. When a physician has intentions of billing you outside of the medical care plan, he/she should make you aware of this. In your own best interests, if you obtain medical care services in another province, you should determine how the physician will bill for the service.

With the exception of Quebec, all provinces and territories have an agreement whereby physicians in each province or territory submit claims to their local medical care plan for services provided to residents of the other Canadian jurisdictions. The fees for the services are paid to the physician and the costs are then charged to the resident's home plan.

Rates Payable-Services Obtained Outside Canada

With certain exceptions, claims for insured medical services obtained outside Canada are paid at Medical Care Plan (MCP) rates, which are the rates paid to Newfoundland and Labrador physicians. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility. It should be noted that the costs of medical care in certain countries, particularly the United States, are significantly higher than the rates paid by Medical Care Plan (MCP). It is strongly recommended that additional travel insurance be obtained whenever traveling outside Canada. For more information on travel insurance, please contact one of the insurance companies listed in the yellow pages of our local Telephone Directory under Insurance - Life and Health.

A) Rates Payable-Services Available in Newfoundland and Labrador

Claims for insured medical services obtained outside Canada, that are available in Newfoundland and Labrador, are paid at Medical Care Plan (MCP) rates, which are the rates paid to Newfoundland and Labrador physicians. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.

B) Rates Payable-Services Available in Canada but not in Newfoundland and Labrador

Insured medical services obtained outside of Canada which are not available in Newfoundland and Labrador but are available in another province are payable at the rates established by the medical care plan in that province. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.

C) Rates Payable-Services Not Available in Canada

If you are planning to have insured medical treatment which you think may not be available in Canada, and if you wish to claim reimbursement of related medical costs through Medical Care Plan (MCP), 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 medical bills will be reimbursed.

If you are granted prior approval based on the unavailability of the services in Canada, the Medical Care Plan will provide coverage for medically necessary physician 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 Services. Prior approval is mandatory to receive payment at rates higher than those published in the Medical Care Plan (MCP) or other provincial physician fee schedules. 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 the established rates outlined in A) or B) above, and any balance remaining is the responsibility of the patient.

Claim Submission Requirements

If you have been treated by a physician in Canada who is not participating in the interprovincial arrangement, or have obtained services which are excluded firm 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.

 
Last Updated:
This page and all contents are copyright, Government of Newfoundland and Labrador, all rights reserved.