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 insurance plan. Rather, the 13 provinces and territories have their own health insurance plans, which share certain common features and basic standards of coverage defined by the Canada Health Act, Canada's federal health care insurance legislation. The Act sets out the criteria and conditions related to medically necessary hospital, physician, and certain surgical-dental services, also referred to as insured health services, that the provincial and territorial health insurance plans must fulfill in order for the them to receive the full federal cash contribution available under the Canada Health Transfer. These principles relate to such matters as the comprehensiveness of insured health services covered, reasonable access to insured health services without impediment by way of user charges, portability of benefits, public administration of the health insurance plans on a non-profit basis, and the universality of eligible population covered. The Act also prohibits patient charges for insured health services. The purpose of the Act is to ensure that all eligible residents of Canada have reasonable access to insured health services, on uniform terms and conditions, and without patient charges.
Health care coverage in Canada is designed to ensure that all insured persons have universal access to medically necessary hospital, physician and certain surgical-dental services on a prepaid basis. The Canada Health Act defines insured persons as residents of a province or territory "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 or territorial health insurance coverage. Each province and territory is responsible for determining its own minimum residence requirements with respect to an individual's eligibility for benefits under its health insurance plan. The Canada Health Act gives no guidance on residence requirements, beyond limiting the waiting period to establish coverage under a provincial or territorial health insurance plan to three months.
Provincial and territorial health insurance plans are required to provide insured persons with coverage for medically necessary hospital, physician and certain surgical-dental services, which are also referred to as insured health services.
The Canada Health Act does not define medical necessity. It is up to the provinces and territories, who usually consult with the medical profession to determine which services are medically necessary for the purpose of coverage under their respective provincial or territorial health insurance plans.
Any health service that has been deemed medically necessary by a province or territory must be delivered in a manner that meets that requirements of the Act, on uniform terms and conditions, and without patient charges.
Along with insured health services covered under the Canada Health Act, all provinces and territories offer additional benefits under their respective health insurance plans, which are 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 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. Therefore all enquiries related to health cards should be directed to your provincial or territorial Ministry of Health - contact information can be found on the inside back cover of the current Canada Health Act Annual Report.
When you move from one province or territory to another you continue to be covered by your "home" province or territory during any minimum waiting period, not to exceed three months, imposed by the new province or territory of residence. After the waiting period, the new province or territory of residence assumes your health care coverage.
It is your responsibility to inform your provincial or territorial health insurance 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 coverage for medically necessary hospital and physician services provided to their eligible residents when they are temporarily absent from the province or territory. This allows individuals to travel or be absent from their home province or territory and yet retain their health insurance coverage.
Within Canada, the portability provisions are implemented through a series of bilateral reciprocal billing agreements between the provinces and territories for hospital and physician services (except Quebec). This generally means that your provincial or territorial health card will be accepted, in lieu of payment, when you receive an insured hospital or physician services in another province or territory.
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 or 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 health 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.
However, coverage for services that are not insured under the Canada Health Act, commonly referred to as "additional benefits" (e.g., prescription drugs, ground and air ambulance services), is generally not portable outside one's home province or territory. Therefore, individuals may be charged the actual cost of these services when received outside their home province or territory of residence. Most private health insurance plans provide coverage for "additional benefits" provided outside the home province or territory. It is always recommended that whenever possible, Canadians purchase private health insurance to ensure coverage for unexpected medical expenses when travelling outside their home province or territory.
When outside of Canada, provincial or territorial health insurance coverage is usually limited to emergency health services resulting from a sudden illness or an accident. Furthermore, these services are covered on the basis of the amount that would have been paid by the province or territory for similar services rendered in the province or territory. As a result, the cost of health care services received abroad may not be fully covered by a provincial or territorial health care insurance plan. For that reason, it is highly recommended that whenever possible, Canadians purchase private health insurance before departing Canada to ensure adequate coverage.
The portability criterion of the Canada Health Act does not entitle persons to seek care outside their home province or territory. Prior approval by your provincial or territorial health insurance plan may be required before coverage is extended for elective (non-emergency) health services obtained in another province or territory, or outside Canada. Individuals who seek elective treatment outside their home province or territory without obtaining approval from their provincial or territorial health insurance plans may be required to pay for the services received.
All provinces and territories require that returning residents register with the health insurance plan to establish or re-establish coverage. A three-month waiting period may be applied before coverage starts. For information on requirements and conditions for establishing health insurance coverage, contact the Ministry of Health of the province or territory where you intend on living upon returning to Canada - contact information can be found on the inside back cover of the current Canada Health Act Annual Report.
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 or territorial Ministry of Health - the phone numbers and websites are located on the inside 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.