Overview
Every plan under the Newfoundland and Labrador Prescription Drug Program (NLPDP) has criteria to be met before a resident is accepted to the program. Residents may qualify for eligibility under the following plans:
- Foundation Plan
- Access Plan
- Assurance Plan
- 65 Plus Plan
- 65 Plus Plan for Landed Immigrants
- Select Needs Plan
The Department of Health and Community Services has an appeal process to ensure that all persons who receive or request coverage under the NLPDP are given the opportunity to have their individual circumstances reviewed. This is achieved through an informal level of review, as well as a formal level of review and an independent appeal board.
Foundation Plan
No application is necessary. A Prescription Drug Program card is automatically issued when the Department of Health and Community Services is notified that an individual is in receipt of income support benefits through the Department of Advanced Education, Skills and Labour, and certain individuals receiving services through the Regional Health Authorities, including children in the care of the Department of Children, Seniors and Social Development, and individuals in supervised care.
Access Plan
To apply for The Access Plan, you must complete an application form (226 KB). You may also call 1-888-859-3535 and ask that an application be mailed to you.
In order to process an application, the Department requires:
- A completed application form.
- The individual’s/family’s net income as reported on line 236 minus line 117 of their income tax return.
- All adults in a family must file a Revenue Canada tax return for the previous tax year (to allow for income assessment for the plan).
- Consent of all adult applicants (located at the bottom of the application)
Access Plan Eligibility
The Department of Health and Community Services re-evaluates financial entitlement annually, using the most recent Canada Revenue Agency (CRA) information. This process is completed by June 30 of each calendar year with updated plan coverage commencing August 1. Recipients are required to have CRA taxation records updated annually to comply with the re-registration procedures. New co-pays established for plan recipients are effective August 1 to July 31 each year.
To be eligible for the Access Plan a person must:
- Be a resident of Newfoundland and Labrador.
- Be eligible for and in receipt of a Medical Care Plan (MCP) card.
- Fall within specific income thresholds.
- Have in cases where there are 2 applicants (married, family unit) valid tax returns for both adults on the application to verify total household income
Access Plan Reassessment
Recipient(s) may notify the Access Plan of any changes that could affect their eligibility for and degree of coverage under the program. The following table outlines the various changes which could affect coverage under the Access Plan and the documentation required in order to verify these changes.
| Changes in Circumstances | Documentation Required (if any) |
|---|---|
| Address | Documentation by request only. |
| Drop in income greater than 10%; recently unemployed, retired, or income decreases for a period of 90 days | Proof of income previous 90 day period; cheque stubs, record of employment, CRA Notice of Assessment |
| Additions to family; new baby, adoption | Birth Certificate, Adoption Certificate, Medical Care Plan (MCP) number |
| Marital status; married, separated, divorced, widowed | Marriage Certificate, Separation or Divorce Papers, Death Certificate |
| Alternate Drug Insurance; addition or loss of | Letter of Acceptance or Discontinuation. |
Upon receipt of required information the application is reviewed by a Financial Assessor. Any changes resulting in the reassessment is entered to adjust the co-pay amounts.
After completion of the reassessment, the applicants are notified in writing within 2 days of the results and further notified of their right to appeal if they are dissatisfied with the decision.
There will be no emergency cards given under the Access Plan as eligibility is based on net family income as confirmed by CRA.
Assurance Plan
To apply for The Assurance Plan, you must complete an application form (226 KB). You may also call 1-888-859-3535 and ask that an application be mailed to you.
In order to process an application, the Department will require:
- the individual’s/family’s net income as reported on line 236 of their income tax return, requiring both applicant and spouse to have a valid current year CRA tax return
- a print out of all prescription drugs purchased in past year as obtained from a pharmacy provider. In the case of expensive drugs for which the individual/family could not afford to purchase, a letter from physician indicating the diagnosis and the need for the drug will be required.
- signature of consent located at the bottom of the application.
- The Department of Health requires that both adults in a family file Revenue Canada tax return in the previous tax year in order for the individuals in the family to be assessed for coverage
Assurance Plan Eligibility
The Department of Health and Community Services re-evaluates financial entitlement annually and re-evaluates drug costs every 6 months.
To be eligible for The Assurance Plan a person must:
- Be a resident of Newfoundland and Labrador.
- Be eligible for and in receipt of a Medical Care Plan (MCP) card.
- Have high drug costs in relation to income.
- Have a net annual income less than $150,000 as verified by Canada Revenue Agency (Line 236 Income Tax return).
- Have in cases where there are 2 applicants (married, family unit) valid tax returns for both adults on the application to verify total household income
Assurance Plan Reassessment
Recipient(s) may notify the Assurance Plan of any changes that could affect their eligibility for and degree of coverage under the program. The following table outlines the various changes which could affect coverage under the Assurance Plan and the documentation required in order to verify these changes.
| Changes in Circumstances | Documentation Required (if any) |
|---|---|
| Address | Documentation by request only. |
| Drop in income greater than 10%; recently unemployed, retired, or income decreases for a period of 90 days | Proof of income previous 90 day period; cheque stubs, record of employment, CRA Notice of Assessment |
| Additions to family; new baby, adoption | Birth Certificate, Adoption Certificate, Medical Care Plan (MCP) number |
| Marital status; married, separated, divorced, widowed | Marriage Certificate, Separation or Divorce Papers, Death Certificate |
| Alternate Drug Insurance; addition or loss of; Increase or change in prescription medication and eligible drug costs | Letter of Acceptance or Discontinuation. Notification of prescription from prescriber identifying dosage and duration or pharmacy printout |
Upon receipt of required information the application is reviewed by a Financial Assessor. Any changes resulting in the reassessment are entered to adjust the co-pay amounts.
After completion of the reassessment, the applicants are notified in writing within 2 days of the results and further notified of their right to appeal if they are dissatisfied with the decision.
There will be no emergency cards given under the Assurance Plan as eligibility is based on net family income confirmed by CRA and documented eligible drug costs.
65 Plus Plan
There is no Program specific application to be completed for coverage unless the resident is a landed immigrant. The Program is notified by Services Canada that a resident is in receipt of the Guaranteed Income Supplement (GIS) and Old Age Security benefits. This is usually after the resident has received their first GIS payment. An eligibility letter is sent out to the resident asking for his/her Medical Care Plan (MCP) number, date of birth, and gender so that an NLPDP drug card can be issued.
65 Plus Plan for Landed Immigrants
To apply for The 65Plus Plan for Landed Immigrants, you must complete an application form (104 KB). You may also call 1-888-859-3535 and ask that an application be mailed to you.
If the applicant indicates he/she is in receipt of Old Age Security from Service Canada, he/she does not have to provide the information below because if eligible to receive the Guaranteed Income Supplement payment as part of the Old Age Security benefit, are 65 years of age and older, and have residency status in Canada, then he/she is automatically entitled to receive a drug card through The 65Plus Plan. Otherwise, the applicant will be required to provide the following information:
- Details of residency during the previous 10 years
- Status as a Canadian Citizen
- Date of Naturalization, if applicable
- Income for the previous 12 months
- Application must be signed by the applicant.
- Application must be signed by a Commissioner of Oaths, Notary Public or Justice of the Peace and must also include the authorizing person’s stamp or seal.
Select Needs Plan
No application is necessary. The Program is notified by Eastern Health that a resident has been diagnosed with Cystic Fibrosis or Growth Hormone Deficiency and meets the medical criteria. An eligibility letter is sent out to the resident asking for his/her Medical Care Plan (MCP) number, date of birth, and gender so that an NLPDP eligibility can be established.
Appeal Process
The Department of Health and Community Services has an appeal process to ensure that all persons who receive or request coverage under the NLPDP are given the opportunity to have their individual circumstances reviewed. This is achieved through an informal level of review, as well as a formal level of review and an independent appeal board. The following describes the steps to take if you are not satisfied with any decision made by an employee of the Department.
Step 1 – Consult the Processing Manager
You should always speak with the Processing Manager of the Stephenville Office of the Department of Health and Community Services before submitting an Application for Review. If you are dissatisfied with the decision the office has made, the Processing Manager can review the decision at your request. The issue may be resolved at this level. However, if it is not, then you should proceed with Step Two – The First Formal Level of Appeal.
Step 2 – The First Formal Level of Appeal – The Internal Review
If you do not agree with the decision of the Processing Manager, you can forward an Application for Review to the Stephenville Office to request an Internal Review within 60 days of the decision. Applications received after 60 days shall not be accepted.
You should submit all relevant information with your Application for Review for consideration during the Internal Review. The Internal Review will consist of an examination of written documentation, but may include direct contact with you via telephone. The person or persons conducting the Internal Review will be employed by the Department of Health and Community Services but shall not have been involved in the decision you are appealing. Composition of the Internal Review committee is the Director, a Financial Assessor and administrative support (Review Committee Secretary).
An Internal Review shall be performed within 20 days of receipt of your Application for Review by the Department. A written response shall be mailed to you within five business days of a decision.
Step 3 – The Second Formal Level of Appeal – The Income and Employment Support Appeal Board
If you are not satisfied with the decision of the Internal Review you can appeal to the Income and Employment Support Appeal Board. To do this you must forward an Application for Appeal to the Executive Secretary of the Board.
The following are some commonly asked questions, and answers, concerning the process of your Second Level of Appeal.
How much time do I have to make an appeal to the Appeal Board?
You have 60 days from the date of the Internal Review to appeal, in writing, to the Appeal Board. Appeals received after 60 days shall not be considered.
Appeal Process Frequently Asked Questions
- What can I appeal to the Appeal Board?
- Who are the Appeal Board members?
- When will I receive notification from the Appeal Board about my appeal?
- What will happen at the Appeal?
- When will I be notified of the Appeal Board’s decision?
- What can I do if I am dissatisfied with the Appeal Board’s decision?
1. What can I appeal to the Appeal Board?
In all cases, decisions made by the Stephenville Office must first undergo an Internal Review. If you are not satisfied with the decision of the Internal Review then you can appeal that decision to the Appeal Board. Only decisions confirmed by an Internal Review can be appealed to the Appeal Board.
2. Who are the Appeal Board members?
Members of the Appeal Board are not employees of the provincial government. The Board is made up of people from the community, appointed by government. One member shall be a former or current recipient of Income or Employment Support. An employee of Advanced Education, Skills and Labour serves as the Executive Secretary to the Board but is not involved in decision making.
3. When will I receive notification from the Appeal Board about my appeal?
The Executive Secretary of the Appeal Board will let you know when the Board has received your Application for Appeal. The person or persons who conducted the Internal Review will send all written information about your case to the Appeal Board. The Board meets regularly to hold hearings. Your hearing will be held within 30 days of the Board receiving your request. You will receive a written notice with the date and time of the Hearing at least seven days prior to same. If you have to travel, the Department can arrange to pay these costs after the Hearing.
4. What will happen at the Appeal?
At the Appeal Hearing, Board members will ask questions and provide you with an opportunity to state your case. If you believe that another person, friend or relative, can help you present your appeal, you can ask him/her to come with you.
If you plan to have a lawyer present, you must inform the Board of this, in writing, at least one week before the hearing so the Department may have the option to have legal counsel present to act on its behalf. Failure to give proper notice may result in your Hearing being postponed.
If you need to cancel or postpone your Hearing please inform the Executive Secretary of the Board immediately. You can do this by phone at (709) 729-2479 – (call collect if outside of St. John’s), or in writing if there is enough time. You must inform the Board if you want to cancel or delay your Hearing. If you do not, the Board will hear the case without you, and make a decision based only on the information they have.
5. When will I be notified of the Appeal Board’s decision?
You will not be given a decision at the end of the Hearing. The Board will send you a written decision within five days after a decision is made.
6. What can I do if I am dissatisfied with the Appeal Board’s decision?
If you do not agree with the Appeal Board’s decision you may take the matter to the Supreme Court of Newfoundland and Labrador, Trial Division. It would be advisable to have a lawyer assist you in taking this step.
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