Newfoundland and Labrador Provincial Health Insurance Plan

 

The Newfoundland and Labrador Medical Care Plan (MCP) is a comprehensive plan of medical care insurance designed to cover the cost of physician services for residents of the province.

 

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 an absence that exceeds eight months in a single year, absences must not exceed eight months in each of the next four years.

 

DENTAL
- What is covered: The Children’s Dental Health Program provides universal access to eligible dental services for children aged 12 years and under. The eligible services are: Examinations at six-month intervals; Cleanings at 12-month intervals; Fluoride applications for children aged six to twelve years at 12-month intervals (except where the School Rinse Program is in place); Routine fillings and extractions; Sealants. The Income Support Program provides ‘Basic Services’ only, as listed in the Dental Health Plan Payment Schedule. For youths aged 13 – 17 years inclusive, whose family is/are in receipt of Income Support. Services limited to a two-year cycle. The Adult Dental Program provides ‘Basic Services’ as listed in the Dental Health Plan Payment Schedule. There is also a denture component. Dentures are limited to ‘Standard Dentures’ only. Basic services limited to a three-year cycle. Dentures are limited to an eight-year cycle. Coverage for certain surgical-dental procedures that are medically necessary to be performed in hospital by a dentist or oral surgeon.
- What is NOT covered: The provincial health insurance does NOT cover routine dental services (e.g. cleanings, scalings, fillings, etc.) unless you are covered by one of the specialty dental programs listed above.

DRUGS
- What is covered: Under the Prescription Drug Program: 100% coverage for recipients of income support benefits; Coverage for those aged 65 and over receiving Old Age Security and the Guaranteed Income Supplement; Coverage for families with low incomes; coverage amounts are based on net income level; Coverage under The Assurance Plan to protect against extreme high drug costs; coverage is determined by net income and annual out-of-pocket drug costs are capped at 5%, 7.5% or 10% of net family income; Select Needs Plan: 100% coverage for residents with Cystic Fibrosis and Growth Hormone Deficiency.
- What is NOT covered: The provincial health insurance does NOT cover prescription drugs for use outside the hospital. However, financial assistance for drug coverage is provided by the Newfoundland and Labrador Prescription Drug Plan (NLPDP) for residents of the province who are eligible for one of the NLPDP plans.

TRAVEL INSURANCE
- What is covered:  With certain exceptions, claims for insured medical services obtained outside Canada are paid at the Medical Care Plan (MCP) rates, which are the rates paid to Newfoundland and Labrador physicians.
- What is NOT covered: 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 the Medical Care Plan (MCP). It is strongly recommended that additional travel/health insurance be purchased from a private insurer before you leave the province – even if only for one day.

VISION
- What is NOT covered: Eye examinations (for corrective lenses), glasses, and contact lenses are NOT covered by the Medical Care Plan.

PARAMEDICAL
- What is covered: The provincial health insurance provides some coverage for physiotherapy, occupational therapy, speech therapy, and audiology when performed in a hospital.
- What is NOT covered: The Newfoundland and Labrador Medical Care Plan does NOT cover chiropractors, optometrists, podiatrists, naturopaths, osteopaths, physiotherapists in non-hospital facilities, nurses, or other paramedical personnel.

HOSPITAL ROOM
- What is covered: Coverage for standard ward rooms only. Insured In-Patient Services: Accommodation and meals at the standard ward rate. Private and semi-private room charges are covered if provided for medical reasons or if standard accommodation is not available. Nursing services. Laboratory, x-ray and other diagnostic procedures; e.g., EKG, Nuclear Medicine, Respiratory Therapy; Drugs (in hospital); Medical and surgical supplies; Operating Room, Labour & Delivery; Use of radiotherapy facilities and radioactive isotopes where available; Rehabilitative Services; e.g., Physiotherapy, Occupational Therapy, Audiology, Speech-Language Pathology
- What is NOT covered:  Uninsured Services (Services Not Covered): Additional charges for preferred accommodation (private and semi-private rooms which are not medically required); Services provided in private non-approved Canadian diagnostic imaging facilities (e.g. MRI, CT, X-ray, etc.).

PRIVATE DUTY NURSING AND MEDICAL EQUIPMENT
- What is covered: Home care is managed by Regional Health Authorities and is assessed on the need of the recipient.
- What is NOT covered: Private duty nurses retained by the patient; Appliances issued for use outside the hospital are NOT covered by The Newfoundland and Labrador Medical Care Plan.

HEARING AIDS
- What is NOT covered: No coverage for Hearing Aids under The Newfoundland and Labrador Medical Care Plan.

AMBULANCE
- What is covered:  Financial assistance available to cover travel costs for those travelling to access specialized insured medical services not available within their area of residency. Some coverage of transportation costs is available under other policies of the Department of Health and Community Services. For example, the Ground Emergency Ambulance Program, the Emergency Air Ambulance Program, or the Medical Transportation Assistance Program.
- What is NOT covered: Ambulance service and other patient transportation (except when an in-patient of one hospital is conveyed to another hospital for special tests or treatment but remains an in-patient of the first hospital) are NOT covered by The Newfoundland and Labrador Medical Care Plan.

 

Helpful links:

- Newfoundland and Labrador Health

- Newfoundland and Labrador Medical Care Plan (MCP)

 

Visit www.ExtendedHealth.ca or call toll free 1-877-838-0020 to get a quote or apply for Extended Health care insurance.

 

 

 

IMPORTANT NOTE: The information on this web page is for illustration purposes only. Every effort has been made to ensure the accuracy of the information. Coverage details are subject to change. For complete benefits, terms, conditions, limitations, and exclusions, please contact the Newfoundland & Labrador Medical Care Plan.

 

Last revised in November 2022.