The Canada Health Act Division responds to enquiries regarding the Canada Health Act and health insurance issues from the public, government departments, stakeholder organizations and the media. For information beyond what is available here, please refer to the current Canada Health Act Annual Report, or contact the Canada Health Act Division.
Canada does not have a single national health care plan, but rather a national health insurance program, which is achieved by a series of thirteen interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage. Under the Canada Health Act, our national health insurance program is designed to ensure that all residents of Canada have reasonable access to medically necessary hospital and physician services on a prepaid basis, and on uniform terms and conditions.
Our national health insurance program is designed to ensure that all insured persons have access to medically necessary hospital and physician services on a prepaid basis. The Canada Health Act defines insured persons as residents of a province. The Act further defines a resident as:
"a person lawfully entitled to be or to remain in Canada who makes his home and is ordinarily present in the province, but does not include a tourist, a transient or a visitor to the province."
Therefore, residence in a province or territory is the basic requirement for provincial/territorial health insurance coverage. Each province and territory is responsible for determining its own minimum residence requirements with regard to an individual's eligibility for benefits under its health insurance plan. The Canada Health Act gives no guidance on such residence requirements beyond limiting waiting periods to establish eligibility for and entitlement to insured health services to three months. Most provinces and territories also require residents to be physically present 183 days annually, and provide evidence of their intent to return to the province.
Provincial and territorial health insurance plans are required to provide insured persons with coverage of insured health services, which are: hospital services provided to in-patients or out-patients, if the services are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness, or disability; and medically required physician services rendered by medical practitioners.
Provinces and territories may also offer "additional benefits" under their respective health insurance plans, funded and delivered on their own terms and conditions. These benefits are often targeted to specific population groups (e.g. children, seniors, social assistance recipients), and may be partially or fully covered. While these services vary across different provinces and territories, examples include prescription drugs, dental care, optometric, chiropractic, and ambulance services.
A number of services provided by hospitals and physicians are not considered medically necessary, and are not insured by provincial and territorial health insurance plans. Uninsured hospital services for which patients may be charged include preferred hospital accommodation unless prescribed by a physician; private duty nursing services; and the provision of telephones and televisions. Uninsured physician services for which patients may be charged include prescription renewals by telephone; the provision of medical certificates required for work, school, insurance purposes and fitness clubs; testimony in court; and cosmetic services.
The provinces and territories, rather than the federal government, are responsible for the administration of their health insurance plans, which includes issuing, cancelling or renewing health cards. You should call or email your provincial/territorial Ministry of Health- the phone numbers and websites are located inside the back cover of the current Canada Health Act Annual Report.
Residents moving from one province/territory to another continue to be covered by their "home" province/territory during any minimum waiting period, not to exceed three months, imposed by the new province/territory of residence. After the waiting period, the new province/territory of residence assumes your health care coverage.
It is your responsibility to inform your provincial/territorial plan that you are leaving and where you are moving, and to register with the health insurance plan of your new province or territory.
The portability criterion of the Canada Health Act requires that the provinces and territories extend medically necessary hospital and physician coverage to their eligible residents during temporary absences from the province or territory. This allows them to travel or be absent from their home province or territory and yet retain their health insurance coverage. Within Canada, the portability provisions are generally implemented through a series of bilateral reciprocal billing agreements between the provinces and territories for hospital and physician services. This generally means that your provincial/territorial health card will be accepted, in lieu of payment, when you receive hospital or physician services in another province or territory because the rates prescribed within these agreements are host-province/territory rates. These agreements ensure that Canadian residents, for the most part, will not face point-of-service charges for medically required hospital and physician services when they travel in Canada because the province or territory providing the service directly bills your home province/territory.
Sometimes there is a requirement for patients to pay "up front" and seek reimbursement from their home provincial or territorial health insurance plan. This still satisfies the portability criterion of the Act as long as access to a medically necessary insured service is not denied due to the patient's inability to pay. Private health insurance plans are prohibited from duplicating coverage for health services provided in Canada which are insured under the Canada Health Act.
In addition, the provision of "additional benefits" (e.g. prescription drugs, ground and air ambulance services) that provinces and territories may include under their respective health insurance plans are generally not portable outside one's home province/territory. Most private health insurance plans provide coverage for ambulance services, prescription drugs and other additional benefits provided outside the home province/territory. Therefore, you may wish to purchase private insurance for such services before you leave your home province/territory, to ensure adequate coverage.
While travelling within Canada, the portability criterion of the Canada Health Act requires that insured hospital and physician services are covered at host-province/territory rates. When outside the country, coverage is required to be at home-province/territory rates. As a result, health care services received abroad may not be fully covered by a provincial or territorial health insurance plan. For that reason, it is highly recommended that you purchase private insurance before departing Canada, to ensure adequate coverage.
Prior approval by your provincial/territorial health insurance plan may be required before coverage is extended for elective (non-emergency) health services obtained outside Canada. Individuals who seek elective treatment out-of-country without obtaining approval from their provincial or territorial health insurance plans may be required to bear the cost of the services received.
A three-month waiting period is usually applied before coverage is reinstated. For information on requirements and conditions for reinstating health insurance coverage, contact the Ministry of Health of the province or territory to which you intend to return.
Provinces and territories have considerable leeway in determining how to finance health insurance plans. Financing can be through the payment of premiums (as in British Columbia), payroll taxes, sales taxes, other provincial or territorial revenues, or by a combination of methods. Health insurance premiums are permitted as long as residents are not denied coverage for medically necessary hospital and physician services because of an inability to pay such premiums. Provinces/territories that levy premiums also offer financial assistance based on income so that low-income residents can have their payments reduced or be entirely exempted from paying premiums.
Since the provinces and territories, rather than the federal government, are primarily responsible for the administration and delivery of health care services and the management of health human resources, you should contact your local provincial/territorial Ministry of Health - the phone numbers and websites are located inside the back cover of the current Canada Health Act Annual Report. You can also contact your province or territory's College of Physicians and Surgeons, which is the organisation that governs physician licensing and conduct. Links to each provincial and territorial medical regulatory authority can be found on the College of Physicians and Surgeons of Canada website.
Canada Health Act Division
August 19, 2011