Provincial health insurance is managed by provinces and territories
In Canada, each province and territory has its own publicly funded health insurance plan. These plans are administered by the provinces and territories, with funding from the federal government through the Canada Health Transfer. All plans must meet common standards under the Canada Health Act.
Who is eligible
All eligible residents of a province or territory can apply for public health insurance. Each province or territory decides who is an eligible resident. To get and keep coverage, you must:
- Register for coverage in your province or territory
- Renew your coverage and stay in your province or territory for a certain number of days each year (as determined by the province or territory)
You may temporarily leave for school, work, or other reasons and keep your coverage, but you must inform your plan if you will be away for extended periods.
What is covered
Under the Canada Health Act, plans must cover medically necessary hospital, physician, and certain surgical-dental services. Provinces and territories decide what is medically necessary, often consulting medical professionals.
They also fund other services like prescription drugs, dental, optometric, chiropractic, and ambulance services, often targeted to specific groups.
What is not covered
Services not considered medically necessary are not covered and must be paid by the patient. Examples include cosmetic procedures, private duty nursing, hospital phone/TV, preferred accommodation unless prescribed, and medical certificates for work, school, or insurance.
Travelling outside your province
Emergency hospital and physician services are covered if you leave for a few hours, days, or weeks. Non-medically necessary services like prescription drugs and ambulance may not be covered. For non-emergency care, you usually need prior approval from your plan.
Travelling outside Canada
Your plan will cover some costs for emergency services if you become ill or have an accident. The amount covered is based on what the province or territory would pay for similar services at home. You pay the difference if costs are higher.
Moving to another province or territory
You must inform your old plan and register with your new plan. Your old plan covers you for 3 months. After that, your new plan begins if you have registered.
Returning to Canada
When you return, you must register with your province or territory to establish or re-establish coverage. There may be a waiting period of up to 3 months before coverage starts.
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