For eligible beneficiaries, while temporarily away from Newfoundland and Labrador, MCP will cover some of the costs of insured services that are specified under the Medical Care Plan and the Hospital Insurance Plan. However, the full costs of medical services received in another province, territory or country may not be covered, especially outside of Canada. MCP will not cover any cost for medevac or ground and air ambulance outside the province, and most likely these services will not be provided freely by the province, territory, or country in which you are travelling. The costs of medical transportation, emergency assistance, and other health care services outside Newfoundland and Labrador can be very significant and may not be fully or even partially covered by MCP, even within Canada. Travelers are strongly advised to obtain additional insurance for these services from a private insurer prior to leaving the province, for any length of time.
If you are leaving the province for more than 30 days, an Out-of-Province Coverage Certificate should be obtained in order to ensure that your MCP coverage will not expire.
- Eligible beneficiaries who have been registered with MCP for at least one year may leave Newfoundland and Labrador for vacation purposes for up to eight months each year, and once every five years, may leave for up to one full year. After a year in which the total period of absence exceeds eight months, in each of the following four years, absences must not exceed eight months. Newly registered beneficiaries in their first year of registration may not leave for vacation purposes for a period of time longer than they have been registered as an MCP beneficiary (i.e., no more than six months total).
- 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 your employer, on company letterhead, stating the dates and location 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.
Note: MCP may require a copy of an applicant’s Notice of Assessment for the most recent tax year indicating Newfoundland and Labrador as the applicant’s province of residence before granting extended out of province coverage.
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 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.