A Comparison of Provincial and Territorial Programs Provisions current to October 1 2010
A Comparison of Provincial and Territorial Programs i CANADA Supplementary group employee health benefit programs, as their name implies, supplement benefits provided under provincial public health care insurance programs. The purpose of this document is to provide plan sponsors with a general understanding of these public programs and the obligations they may have in relation to the funding of provincial health care insurance programs. The publicly-funded Canadian health care system is guided at the Federal level by the Canada Health Act, introduced in its current form in 1984. The Canada Health Act sets the standards related to insured health services with which the provinces must comply to receive funding support. This document provides an overview of the key coverage areas and highlights significant differences between provincial plans. Although public heath care insurance programs are universal, the main focus of this document is on those programs available to working and retired Canadians. This document does not review in detail: Programs available only to low income Canadians or those receiving social assistance; Programs provided through non-governmental organizations, community services or charities; Programs sponsored by drug manufacturers or other private organizations; Benefits provided under the Federal Non-Insured Health Benefits (NIHB) Program, or any other programs that are only available to First Nations people or Inuit; Funding arrangements or fees for services of private physicians that are not associated with the provincial plan. Out-of-country health care coverage. Unless otherwise stated, "seniors" are defined in this document as individuals 65 years of age and older. Unless otherwise stated, permanent residents are automatically covered in their province of residence. Individuals immigrating to or emigrating from Canada or changing their province of residence will need to carefully review eligibility rules under the relevant provincial program as well as issues related to transitioning between programs. The charts should be read in conjunction with the actual text of the legislation before implementing or changing any policies, and should not be used or relied upon as a substitute for specific advice or as a basis for formulating business decisions. This document includes the most up-to-date information available as of October 1 2010.
A Comparison of Provincial and Territorial Programs ii Table of Contents British Columbia...... 1 Alberta... 3 Saskatchewan...... 5 Manitoba... 7 Ontario... 9 Quebec...... 11 New Brunswick... 13 Nova Scotia... 15 Newfoundland and Labrador...... 17 Prince Edward Island... 19 Northwest Territories... 20 Nunavut... 22 Yukon... 24
A Comparison of Provincial and Territorial Programs 1 British Columbia Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical PharmaCare Medical Services Plan (MSP) Regional Health Authorities (RHAs) Fair PharmaCare provides premium-free coverage of eligible prescribed drugs (dispensed in British Columbia) to all eligible residents; registration is required to receive maximum financial assistance under Fair PharmaCare. Individuals must pay applicable deductibles. The Fair PharmaCare program provides coverage for 70% of eligible prescription drug expenses after deductible and until an annual family maximum is reached; 100% coverage thereafter. Deductible and annual maximum are determined by net family income. Fair PharmaCare coverage and registration conditional on being first registered with MSP, and the individual having signed a consent form allowing Fair PharmaCare access to certain financial data. Where an individual has coverage through a private plan, Fair PharmaCare is first payer of benefits. There is no obligation for employers to provide supplemental coverage. Fair PharmaCare Enhanced Assistance provides coverage of eligible prescribed drugs (dispensed in British Columbia) to individuals and spouses if born in 1939 or earlier. Registration required. Individuals must pay applicable deductibles. Eligible recipients are covered for 75% of eligible prescription drug expenses after deductible and until an annual family maximum is reached; 100% coverage thereafter. Deductible and annual maximum are determined by net family income. Coverage conditional on being registered with MSP. Where an individual has coverage through a private plan, Fair PharmaCare Enhanced Assistance is first payer of benefits. PharmaCare also provides coverage of eligible prescription drugs for: permanent residents of licensed long-term care facilities; individuals with Cystic Fibrosis; clients of Mental Health Service Centres; and individuals receiving palliative care (physician must apply on behalf of patient). Coverage conditional on being registered with MSP. Where an individual has coverage through a private plan, PharmaCare is first payer of benefits. MSP provides coverage for medically required physicians services. Specialist services must be referred. Coverage conditional on registration and payment of premiums. MSP provides coverage for medically required oral surgical procedures when performed in a hospital by dentists or dental surgeons. Orthodontia for children up to age 21 with certain congenital facial abnormalities. MSP provides coverage for medically necessary eye exams when provided by an ophthalmologist or optometrist. Routine eye exams covered for individuals under age 19 and age 65 or over. Chiropractor, Massage Therapist, Naturopath, Physiotherapist, Podiatrist (non-surgical procedures): MSP provides coverage for certain eligible residents: individuals on premium assistance; residents of long term care facilities; individuals enrolled with MSP as Mental Health Clients. Osteopath: MSP provides coverage if practitioner registered with, and opted into, MSP. Podiatrist (surgical procedures): MSP covers. Psychologist: No coverage.
A Comparison of Provincial and Territorial Programs 2 British Columbia (cont.) Hospital In- Hospital Out- Financing Acute care: Regional Health Authorities (RHAs) cover hospital services and supplies for unlimited number of days: ward accommodation; medically required laboratory, radiological, and other diagnostic procedures; drugs and biologicals; use of operating room, case room and anaesthetic facilities, including equipment and supplies; use of radiotherapy and physiotherapy facilities; and other services approved by the Minister where rendered by persons who receive remuneration from the hospital. Certain rehabilitation services are covered. Residential care: PharmaCare provides coverage for drugs and biologicals, and RHAs cover ward accommodation, nursing and diagnostic procedures. As of January 2010, residential care clients - including those in acute care beds after 30 days of assessment and those in "continuing care" facilities - pay up to 80% of their after-tax income toward room and board costs (up to a maximum of $2,932 per month). The new minimum client rate of $894.40 per month provides most clients with a minimum of $275 per month to cover personal expenses. Accommodation charges do not apply to persons under age 19 or for involuntary psychiatric admission. RHAs provide coverage for most diagnostic procedures available through hospitals, including: emergency services, necessary diagnostic products and supplies; day surgery; minor surgery; psychiatric, rehabilitative, dialysis, diabetic and dietetic counselling and cancer therapy, where available. General: The programs and services are primarily funded through general tax (in regards to MSP) monthly premiums. revenues and Fair PharmaCare: Deductible and family maximum: Family with net annual income less than $15,000: no deductible and family maximum is 2% of net income; Family with net annual income between $15,000 and $30,000: deductible is 2% of net income and family maximum is 3% of net income; Family with net annual income over $30,000: deductible is 3% of net income and family maximum is 4% of net income. The maximum deductible for high income earners (and the default position for individuals who do not register with the plan) is $10,000. Fair PharmaCare Enhanced Assistance: Deductible and family maximum: Family with net annual income less than $33,000, no deductible and family maximum is 1.25% of net income; Family with net annual income between $33,000 and $50,000, deductible is 1% of net income and family maximum is 2% of net income; Family with net annual income over $50,000, deductible is 2% of net income and family maximum is 3% of net income. Medical Services Plan (MSP): Monthly premiums: One person: $57.00 Family of two: $102.00 Family of three or more: $114.00 Individuals must pay premiums unless they qualify for full premium assistance. Premiums are paid directly by the individual or may be submitted by an employer or union as part of a group plan or pension account. Premium assistance available based on income or unexpected financial hardship.
A Comparison of Provincial and Territorial Programs 3 Alberta Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Alberta Blue Cross Alberta Health Care Insurance Plan (AHCIP) Dental Assistance for Seniors Program Optical Assistance for Seniors Program Regional Health Authorities (RHAs) Seniors: The Alberta Blue Cross Coverage for Seniors program provides premium-free coverage of approved prescription drugs for seniors and their eligible dependants. Enrollment is automatic for seniors if a proof of age declaration is submitted to Alberta Health and Wellness prior to their 65 th birthday. Applicable co-payment charges apply. Where a senior has coverage through a private plan, Alberta Blue Cross Coverage for Seniors is first payer of benefits. There is no obligation for employers to provide supplemental coverage. Others: The Alberta Blue Cross Non-Group Coverage program is an optional plan that provides coverage of approved prescription drugs for residents under age 65. Quarterly premiums and applicable co-payment charges must be paid to receive coverage. Registration conditional on first being registered with AHCIP and having paid AHCIP premiums. Individuals generally do not enrol in Alberta Blue Cross Non-Group Coverage if coverage is available from a private plan. Where an individual is covered under both the Alberta Blue Cross Non-Group Coverage and a private plan, reimbursement would be pro-rated between the plans. The Alberta Blue Cross Palliative Care Drug Coverage program provides premium-free drug coverage for individuals diagnosed as being palliative and treated at home. Application for coverage must be completed by the individual s physician or nurse practitioner. AHCIP provides coverage for all medically required services of general practitioners and specialists performed in an office, home or hospital. Coverage conditional on registration and payment of premiums. Seniors: The Dental Assistance for Seniors Program provides premium-free coverage for certain basic dental procedures for eligible seniors. One-time application for coverage required. Amount of coverage based on income, to a maximum of $5,000 every five years. Alberta Seniors and Community Supports contracts Alberta Blue Cross to administer dental claims under the Dental Assistance for Seniors Program. Others: AHCIP provides coverage for specified dental/oral surgical procedures when carried out by an oral surgeon. Seniors: AHCIP provides seniors with coverage for one complete, one partial and one diagnostic service eye examination every benefit year. Additional examinations may be covered if medically necessary. The Optical Assistance for Seniors Program provides eligible seniors with partial reimbursement for prescription eyeglasses. Premium free. One-time application for coverage required. Amount of coverage based on income, to a maximum of $230 every three years. Program administered by Alberta Seniors and Community Supports. Others: AHCIP provides coverage for those aged 19 to 64 years with specified medical conditions. Those under age 19 are covered for one complete, one partial and one diagnostic service eye examination every benefit year. Additional examinations may be covered if medically necessary.
A Comparison of Provincial and Territorial Programs 4 Alberta (cont.) Paramedical Hospital In-Patient Care Hospital Out- Care Patient Financing Chiropractor: No coverage Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: AHCIP provides some coverage for medically required services. Physiotherapist: The Community Rehabilitation Program provides services on an assessed needs basis, funded through the individual Regional Health Authorities (RHAs). Patients given a low priority assessment may be ineligible for coverage and would be financially responsible for these services. Podiatrist: AHCIP provides partial funding for basic services up to a maximum of $ 250 per benefit year for all Alberta residents. Patient's portion of expenses can be claimed through a private plan or health spending account before reaching provincial annual benefit limit. Surgical services are fully covered when provided by a podiatrist in a hospital or non-hospital surgical facility under contract to a RHA. Psychologist: Alberta Blue Cross Non-Group Coverage provides coverage of up to $60 per visit to a maximum of $300 per benefit year. Acute care: Regional Health Authorities (RHAs) provide hospital services and supplies for unlimited number of days, including: ward accommodation; necessary nursing services; laboratory, radiological, and other diagnostic procedures; drugs, biologicals, and related preparations when administered in a hospital; use of operating room, case room, and anaesthetic facilities, including equipment and routine surgical supplies; use of radiotherapy and physiotherapy facilities; services rendered by persons who receive remuneration from the hospital; and ambulance transportation within province between hospitals when ordered by a physician. Semi-private or private room if deemed medically required by attending physician. RHAs can set own rates for preferred accommodation and enhanced medical goods and services. Long-term care: Includes nursing homes and auxiliary hospitals. Residents are provided with necessary professional and personal care, and drugs. As of November 1, 2008, the maximum daily accommodation fee is: $44.50 for standard ward; $47.00 for semi-private; $54.25 for private. Alberta Blue Cross Non-Group Coverage provides coverage for private or semi-private accommodation for insurable, differential charges in a public, general, active treatment hospital; ambulance services for ground transportation to or from one of these hospitals. RHAs provide coverage for emergency services and supplies, and most out-patient services, including: diagnostic, laboratory, and radiological procedures; physical, occupational, speech and respiratory therapies; and mental health services. All extra costs for goods and services not considered by the attending physician to be medically necessary are charged back to the patient. General: The programs and services are funded primarily through Alberta s general revenues, and (where applicable) individual premiums. Alberta Blue Cross Non-Group Coverage: Premiums are paid directly by the individual. Copayment: 30% of the cost of prescription drugs to a maximum of $25 for each prescription Monthly premiums effective July 1, 2010: $63.50 for an individual and $ 118.00 for a family. Alberta Blue Cross Coverage for Seniors: Premium-free coverage for eligible Alberta seniors. Copayment: 30% of the cost of prescription drugs to a maximum of $25 for each prescription. Benefit expenses exceeding $25,000 annually, are not covered by the program. On an exception basis, this annual maximum may be raised. Alberta Blue Cross Palliative Care Drug Coverage: Premium-free coverage. Co-payments apply, to a maximum out of pocket amount of $1,000. Alberta Health Care Insurance Plan (AHCIP): Effective January 1, 2009, Alberta Health Care Insurance Plan (AHCIP) premiums have been eliminated for all residents. Group plan administrators must remit premiums owed to December 31, 2008. Monthly premium statements will continue to be issued into 2009, and premiums owing up to December 31, 2008 must be paid in full.
A Comparison of Provincial and Territorial Programs 5 Saskatchewan Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Saskatchewan Prescription Drug Plan (the Drug Plan ) Saskatchewan Medical Care Insurance Plan Regional Health Authorities (RHAs) Seniors: Effective July 1, 2008 the Seniors Drug Plan requires an income-tested application process. Where a senior who qualifies for the Seniors Drug Plan has coverage through a private plan, the Seniors Drug Plan is first payer of benefits. No other catastrophic drug plan coverage is available for those seniors who do not qualify for coverage under the Seniors Drug Plan or any other Drug Plan programs, such as the Special Support Program. Children: Effective July 1, 2008, the premium-free Children s Drug Plan will cap eligible prescription drug costs at $15 per prescription for all children age 14 and under (except those covered under federal programs such as the Non-Insured Health Benefits Program). Coverage is automatic, no application required. Where a child is eligible for coverage through a private plan, the Children s Drug Plan is first payer of benefits. Others: The Special Support Program provides premium-free prescription drug coverage for families who have high drug costs in relation to income. Enrollment is not mandatory but all families are eligible to apply. Applicants must apply for the program every year. Family co-payment is determined by the amount that the family annual drug costs exceed 3.4% of adjusted combined annual income. Income adjustments of $3,500 per dependent under age 18 may apply. Registration conditional on having valid Saskatchewan Health coverage. Where a participant has coverage through a private plan, the Special Support Program is first payer of benefits. Residents with Palliative Care coverage or drug coverage under Saskatchewan Aids to Independent Living (SAIL) may be eligible to receive prescriptions free of cost. Registration conditional on having valid Saskatchewan Health coverage. No other catastrophic drug plan coverage for those under age 65. The Saskatchewan Medical Care Insurance Plan provides premium-free coverage of medically required physicians services rendered at an office, at home or in a hospital. Coverage conditional on registration. The Saskatchewan Medical Care Insurance Plan covers some specified corrective oral surgery procedures. Coverage for orthodontic services for cleft palate when referred by a physician or dentist. The Saskatchewan Medical Care Insurance Plan covers one eye exam per 12 month period for those up to age 18 and seniors. One exam per 24-month period for residents between 18 and 64 years and receiving benefits under Saskatchewan Income Plan, Supplementary Health Program, or Family Health Benefits. Chiropractor: Effective April 1, 2010, only low-income individuals receiving Supplementary or Family Health Benefits or on the Seniors Income Plan are eligible for a maximum of 12 treatments per year. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: Regional Health Authorities (RHAs) provide coverage for services received in hospital out-patient departments and private clinics funded by RHAs. Podiatrist: Patients pay a $30.00 participation fee for podiatry visits obtained through RHAs. Psychologist: Full coverage when funded by RHAs.
A Comparison of Provincial and Territorial Programs 6 Saskatchewan (cont.) Hospital In- Acute care: RHAs provide coverage of hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological, and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic facilities, including equipment and supplies; use of radiotherapy and physiotherapy facilities. Long-term care: A monthly user fee (adjusted quarterly) applies to extended care patients. As of October 1, 2010 resident income tested charges between $984 to $1,871 per month. Residents are billed the standard resident charge ($984) and an additional 50% of the portion of their income between $1,197 and $2,972. No preferred accommodation charges allowed. Hospital Ou RHAs provide coverage for most out-patient services, including: laboratory, radiological and other t- diagnostic procedures; physical, occupational, speech and respiratory therapies; and psychiatric services. Coverage for emergency services and supplies. Financing General: The programs and services are funded primarily through general tax revenues. Seniors Drug Plan: Co-payment: from $0 to $15 maximum per prescription. Seniors (or their spouses) receiving Guaranteed Income Supplement (GIS) pay a $200 semi-annual family deductible. Seniors residing in a special care home and receiving GIS pay a $100 semi-annual family deductible. Seniors (or their spouses) receiving either Saskatchewan Income Plan (SIP) benefits, or Family Health Benefits (FHB) pay a $100 semi-annual family deductible.
A Comparison of Provincial and Territorial Programs 7 Manitoba Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- Pharmacare Manitoba Health Services Insurance Plan Regional Health Authorities (RHAs) Pharmacare provides premium-free coverage of prescription drugs for residents who have high drug costs in relation to income. Registration is required. Residents are eligible for coverage unless their prescription drug costs are 100% covered (i.e., no deductible, cap, or co-payfederal, provincial or municipal program. Plan participants pay deductibles based on Adjusted Total by a private plan or a Family Income (income adjustments may be applicable for a spouse and each dependent under age 18). Coordination with private plans: Private plan members pay out of pocket up to the private plan deductible; the private plan is first payer up to the provincial Pharmacare deductible level; Pharmacare pays 100% of eligible costs that exceed the provincial Pharmacare deductible. The full cost of each prescription covered under a private plan counts toward the provincial Pharmacare deductible, regardless of how much the private plan actually contributes. Example: prescription costs $100; private plan pays $80; plan member pays remaining $20 co-pay. The full amount of $100 counts towards the provincial deductible requirement. The Manitoba Health Services Insurance Plan provides premium-free coverage for all medically required physicians services rendered at an office, at home or in a hospital. Coverage conditional on registration. The Manitoba Health Services Insurance Plan provides dental coverage when prior approval is given, and surgery is performed in hospital by dental surgeons or periodontists. Cleft lip/cleft palate treatment and rehabilitation programs are available for residents registered under the program by their 18 th birthday. The Manitoba Health Services Insurance Plan covers one routine eye examination in a fixed 24 month benefit period for those under age 19 and seniors. No coverage for those age 19-64 unless medically necessary. Limited coverage for eyeglasses for seniors. Coverage for initial fitting of contact lenses following congenital cataract surgery and for infants with congenital eye defects. Chiropractor: The Manitoba Health Services Insurance Plan covers a maximum 12 visits per benefit year. Private plans can pay for items not insured by the public plan. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: Regional Health Authorities (RHAs) provide coverage only where recommended by a physician and performed in an accredited facility, hospital or Personal Care Home. Podiatrist: No coverage. Psychologist: No coverage. Acute care: RHAs provide coverage for hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological, and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic facilities, including equipment and supplies; use of radiotherapy and physiotherapy facilities. Long-term care: RHAs provide some coverage for residents of a personal care home, patients in a long-term care facility and patients in hospitals awaiting placement in a long-term care facility. Individuals pay a portion of the cost based on their previous year s income. As of August 1, 2010, daily charge ranges from $31.30 to $73.40.
A Comparison of Provincial and Territorial Programs 8 Manitoba (cont.) Hospital Out- Financing RHAs provide coverage for: laboratory, radiological, and other diagnostic procedures; physical, occupational, speech and respiratory therapies; and psychiatric services. Coverage for emergency services and supplies and most services available in hospitals normally provided by out-patient departments. General: The programs and services are primarily funded through general tax revenues. PharmaCare: Income adjustments (deductions) made for a spouse and dependents under age 18: $3,000 each. Deductible rates as of April 1, 2010: For adjusted family income of $15,000 or less, deductible is 2. 71% of adjusted family income. For adjusted family income between $15,001 and $21,000, deductible is 3.84% For adjusted family income between $21,001 and $22,000, deductible is 3.88% For adjusted family income between $22,001 and $23,000, deductible is 3.94% For adjusted family income between $23,001 and $24,000, deductible is 4.00% For adjusted family income between $24,001 and $25,000, deductible is 4.04% For adjusted family income between $25,001 and $26,000, deductible is 4.09% For adjusted family income between $26,001 and $27,000, deductible is 4.13% For adjusted family income between $27,001 and $28,000, deductible is 4.17% For adjusted family income between $28,001 and $29,000, deductible is 4.22% For adjusted family income between $29,001 and $40,000, deductible is 4.25% For adjusted family income between $40,001 and $42,500, deductible is 4.62% For adjusted family income between $42,501 and $45,000, deductible is 4.73% For adjusted family income between $45,001 and $47,500, deductible is 4.82% For adjusted family income between $47,501 and $75,000, deductible is 4.89% For adjusted family income over $75,000, deductible is 6.12%. Minimum annual deductible: $100. Health and Post-Secondary Education Tax Levy: A payroll based levy payable by employers. For years after 2007, the Health and Post-Secondary Education Tax Levy applies as follows: 4.3% on payroll amounts between $1,250,000 and $2,500,000, with an exemption for the first $1,250,000 of payroll; and 2.15% on total payroll where payroll exceeds $2,500,000.
A Comparison of Provincial and Territorial Programs 9 Ontario Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- Ontario Drug Benefit Program (ODB) Trillium Drug Program (TDP) Ontario Health Insurance Plan (OHIP) Seniors: The Ontario Drug Benefit Program (ODB) covers ODB formulary drugs dispensed in Ontario as prescribed by Ontario licensed prescribers for seniors. Seniors are automatically entitled to benefits on turning 65 if they have a valid Ontario health card. Seniors must pay applicable deductibles and per prescription charges. Where a senior has coverage through a private plan, the ODB Program is the first payer of benefits. Others: The Trillium Drug Program (TDP) provides benefits to residents who have high drug costs relative to their household net income. The TDP covers ODB formulary drugs and drugs approved for coverage through the Exceptional Access Program dispensed in Ontario as prescribed by Ontario licensed prescribers. Individuals must apply for coverage and pay applicable deductibles. Where a participant has coverage through a private plan, TDP is second payer of benefits. TDP deductibles cannot be reimbursed or covered by a private plan. Ontario Health Insurance Plan (OHIP) provides premium-free coverage of medically necessary physicians services when rendered at an office, at home, an institution (e.g. hospital), a licensed private laboratory or an independent health facility (e.g. X-ray facility). OHIP coverage conditional on registration. OHIP covers specified surgical-dental procedures only when medically necessary, and performed by a dental or oral surgeon in an approved hospital. OHIP covers one eye exam per year when performed by an optometrist or physician for seniors, those ages 19 and under, and those with specific medical conditions affecting the eyes (e.g. diabetes, glaucoma, cataracts). Others: No coverage. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage Physiotherapist: OHIP provides coverage for seniors and individuals under age 20, long-term care residents of all ages and individuals of all ages requiring short-term physiotherapy in their home or through a Community Care Access Centre. Individuals age 19 and under and seniors are covered for up to 100 insured services per year. Patients aged 20 to 64 are not eligible unless they meet one of the above criteria, or physiotherapy is required following acute hospitalization, for which up to 50 insured services per year may be covered. An additional 50 services per patient per year may be covered if medically necessary. Podiatrist: Co-payment system whereby OHIP pays $16.40 for the initial visit, $11.45 per subsequent visit to maximum of $135 per benefit year. Remainder may be covered by private plan. Psychologist: No coverage. Acute care: OHIP covers: ward accommodation, necessary nursing services; laboratory, radiology, and diagnostic services; drugs, biologicals; radiotherapy, physiotherapy; operating room, case room and anesthetic equipment, including necessary supplies. Long-term care: Coverage provided by OHIP. Patient co-payment required; partial exemptions depending on monthly income and full exemptions for children. Long-stay co-payment rates effective July 1, 2010: basic accommodation $1,619.08 monthly, $53.23 daily; semi-private room $1,862.41 monthly, $61.23 daily; private room $2,166.58 monthly, $71.23 daily. Patients in an acute care hospital awaiting placement are also subject to co-payment.
A Comparison of Provincial and Territorial Programs 10 Ontario (cont.) Hospital Out- Financing OHIP provides coverage for: laboratory, radiological, and other diagnostic procedures; and physical, occupational, speech and respiratory therapies. Emergency services and most services available in hospitals normally provided by out-patient departments are covered. General: The programs and services are primarily funded through general tax revenues. Ontario Health Premium (OHP): An individual income tax that the government has indicated will be used exclusively for provincial health care programs and other government health initiatives. Employers are required to withhold OHP from employment income and remit this tax in the same way as regular income tax. For taxable income less than $20,000, no OHP For taxable income between $20,001-$25, 000, OHP is 6% of amount over $20,000, to a maximum of $300 For taxable income between $25,001-$36,000, OHP is $300 For taxable income between $36,001-$38,500, OHP is $300 plus 6% of amount over $36,000, to a maximum of $450 For taxable income between $38,501-$48,000, OHP is $450 For taxable income between $48,001-$48,600, OHP is $450 plus 25% of amount over $48,000, to a maximum of $600 For taxable income between $48,601-$72,000, OHP is $600 For taxable income between $72,001-$72,600, OHP is $600 plus 25% of amount over $72,000, to a maximum of $750 For taxable income between $72,601-$200,000, OHP is $750 For taxable income between $200,001-$200,600, OHP is $750 plus 25% of amount over $200,000, to a maximum of $900 For taxable income over $200,600, OHP is $900 Employer Health Tax (EHT): A payroll based levy payable by employers. Generally, 1.95% of total annual Ontario remuneration in excess of $400,000. Special rules apply to the public sector, non- Employers with taxable government agencies and tax exempt private companies and organizations. annual total Ontario remuneration in excess of $600,000 are required to remit monthly EHT installments. Eligible employers with annual total Ontario remuneration of $600,000 or less make one EHT payment per year, along with their Annual Returns. Ontario Drug Benefit Program (ODB): Seniors with income of less than $16,018 per year ($24,175 per year for couples) pay up to $2 per prescription for eligible drug products; other seniors must satisfy a $100 deductible per person per benefits year and then pay up to $6.11 per prescription. Trillium Drug Program (TDP): Income based deductible based on household income that must be paid out of pocket (deductible cannot be reimbursed through a private plan) and up to $2 per prescription for eligible drug products.
A Comparison of Provincial and Territorial Programs 11 Quebec Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Public Prescription Drug Insurance Plan ( Public Plan ) Quebec Health Insurance Plan Quebec Hospital Insurance Plan The Public Prescription Drug Insurance Plan ( Public Plan ) provides residents with coverage of eligible prescription drugs dispensed in Quebec. Residents must have prescription drug coverage in either a private-sector plan or the Public Plan. Those who are not eligible for coverage by an employer, private- pay an annual income- sector or any other group insurance plan must register with the Public Plan and tested premium, applicable deductibles and co-payment charges to a monthly out-of-pocket maximum. Public Plan coverage conditional on registration and payment of premiums. Residents under age 65 who become eligible for an employer, private-sector or any other group insurance plan must immediately terminate their Public Plan registration. Individuals under age 65 can only be registered with one plan, either the Public Plan or a private-sector plan. The children, within the meaning of the law, of residents covered under the Public Plan do not pay premiums, deductibles or co- payment fees. Employers who operate in Quebec and offer health or disability plans must also provide a drug plan that complies with the legislated requirements set out under An Act respecting prescription drug insurance. Participation in the employer s drug plan is mandatory up to age 65 unless an individual can provide proof of coverage elsewhere (i.e., under a spouse s plan). Children and spouse must also be covered under an employer s drug plan. Seniors: Seniors who have access to an employer, private-sector plan or any other group insurance plan may choose to remain in that plan or to cancel their private coverage and be covered under the Public Plan. Seniors may also choose to opt for private plan coverage that supplements their Public Plan coverage. Where a senior has coverage through a private plan, the Public Plan is first payer of benefits. Seniors receiving 94% or more of the maximum Guaranteed Income Supplement (GIS) are exempt from paying any co-insurance, monthly deductible, or premium for Public Plan coverage. The Quebec Health Insurance Plan provides premium-free coverage of medically required physicians services rendered at an office, at home or in a hospital (including specialist services). Eligible services related to assisted procreation treatments are also covered. Quebec Health Insurance Plan coverage conditional on registration. The Quebec Health Insurance Plan covers specified oral surgical procedures performed in a hospital or university facility. Subject to certain restrictions, routine dental care is covered for children under age 10. The Quebec Health Insurance Plan provides coverage for residents under age 18 and seniors with respect to certain services (eye examinations, measurement of eye function, specific vision related tests) provided by an optometrist once every 12 months. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: The Quebec Hospital Insurance Plan covers certain physical rehabilitation treatments if provided in a hospital. Podiatrist: No coverage. Psychologist: No coverage.
A Comparison of Provincial and Territorial Programs 12 Quebec (cont.) Hospital In- Hospital Out- Financing The Quebec Hospital Insurance Plan covers: Acute care: Hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological, and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic equipment; use of radiotherapy and physiotherapy facilities. Long-term care: For extended care in short-term care hospital and accommodation in long-term care facility, maximum cost to patient per day as of January 1, 2010: $33.91 for ward; $45.62 for semiprivate; $54.38 for private. These rates are income tested. The Quebec Hospital Insurance Plan covers: laboratory, radiological and other diagnostic procedures; physiotherapy; occupational, speech and respiratory therapies; and psychiatric services. Coverage for emergency services and supplies and most services available in hospital out-patient departments. Certain services for hearing, speech and visual difficulties are covered. General: The programs and services are primarily funded through employer contributions to the Health Services Fund and general tax revenues. Effective July 1 2010, Quebec introduced a Health Contribution tax which will be collected annually upon the filling of income tax returns for individuals age 18 and over, whose income exceed prescribed low-income threshold. The Contribution will be paid into a dedicated fund that will provide financing to health and social services institutions. This contribution will be phased as follows: In 2010: $25 per adult (50% of an annual amount of $50) In 2011: $100 per adult In 2012: $200 per adult Public Prescription Drug Insurance Plan ( Public Plan ): Effective July 1, 2010, annual premium: $0 to $600 depending on personal or family net annual income and situation. Deductions are allowed in the calculation of family income. Seniors who receive 94% and over of the maximum GIS are exempted from paying a premium. The children, within the meaning of the law, of residents covered under the Public Plan do not pay premiums, deductibles or co-payment fees. Residents under age 65: Monthly deductible $16.00; co-insurance 32%; maximum monthly contribution $80.25. Seniors: Individual deductibles and co-payment charges for seniors depend on whether the individual receives GIS benefits, and if so, what proportion of the maximum GIS they receive. Those receiving 94% or more of the maximum GIS pay no premiums, deductibles or co-payment fees. Those receiving less than 94% of the maximum GIS: deductible $16.00; co-payment 32%; maximum monthly contribution $49.97. Those seniors who don t receive GIS: deductible $16.00; co-payment 32%; maximum monthly contribution $80.25. Employer-sponsored drug plans: To comply with the requirements under An Act Respecting Prescription Drug Insurance, co-insurance and out-of-pocket levels allowed under private plans are limited to the corresponding amounts allowed under the public plan. Private plans may continue to provide for a deductible, subject to the out-of-pocket maximum. Premiums for private plans are determined by the parties involved. Towers Watson prepares a Client Advisory each year detailing the annual updates to the financial parameters under the public plan. Health Services Fund (HSF): A payroll based levy payable by employers. Graduated contribution rate ranging from 2.7% to 4.26% depending on employer s total annual Quebec payroll. Certain public-sector employers must pay a contribution of 4.26% regardless of total payroll.
A Comparison of Provincial and Territorial Programs 13 New Brunswick Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- New Brunswick Prescription Drug Program (PDP) Medavie Blue Cross Seniors' Prescription Drug Program New Brunswick Medicare Regional Health Authorities (RHAs) Seniors: The New Brunswick Prescription Drug Program Plan A (Seniors) (PDP) provides premium- Income free coverage of approved prescription drugs for seniors who receive the Guaranteed Supplement (GIS), are registered with New Brunswick Medicare, and do not receive prescription drug benefits from any other plan after age 65. Seniors must apply for coverage and pay any applicable per- are not in prescription co-payment charges. Some PDP coverage is also available to seniors who receipt of GIS, but meet an income test. Residents in a registered nursing home are covered under the PDP and are not subject to a co-payment. Where a senior has coverage through a private plan, PDP is second payer of benefits. PDP coverage conditional on registration. Those who do not qualify for PDP may apply for coverage from the Medavie Blue Cross Seniors Health Program. Medavie Blue Cross Seniors Health Program is an optional plan for seniors and their qualifying spouses, where both are covered under New Brunswick Medicare and neither has entitlement to any other prescription drug plan with similar benefits to the Medavie plan. Plan provides the same benefit coverage as PDP. Seniors must apply within 60 days following their 65 th birthday or 60 days following the termination of their previous prescription drug plan. Subscriber is responsible for monthly premium payments, and the per-prescription co-payment authorized by PDP. Coverage conditional on plan registration and payment of premiums. Others: PDP provides prescription drug coverage for individuals who hold a valid health card issued by the Department of Family & Community Services. Per-prescription co-payment charges apply. No other catastrophic drug plan coverage for those under age 65. New Brunswick Medicare provides premium-free coverage for medically required services performed by opted-in physicians. Medicare coverage conditional on registration. Medicare may provide premium-free coverage for certain specified surgical/dental procedures performed in hospital by dental surgeons. No coverage for eye examinations, except for seniors who purchase coverage through the Medavie Blue Cross Seniors Health Program. Chiropractor: No coverage except for seniors who purchase coverage through the Medavie Blue Cross Seniors Health Program. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: The Regional Health Authorities (RHAs) provide coverage for in-patient hospital services, or through the Extra-Mural Program. Podiatrist: No coverage except for seniors who purchase coverage through the Medavie Blue Cross Seniors Health Program. Psychologist: No coverage. Acute care: RHAs provide coverage for hospital services and supplies for unlimited number of days: ward accommodation, laboratory, radiological and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic equipment; use of radiotherapy and physiotherapy facilities. As alternative to in-patient care, some acute care available at home through the Extra-Mural Program. Long-term care: No coverage for nursing homes under Medicare but financial assistance available from Department of Health. As of May 1, 2009, the maximum daily nursing home fee is $83.00..
A Comparison of Provincial and Territorial Programs 14 New Brunswick (cont.) Hospital Out- Financing RHAs provide coverage for: laboratory, radiological and other diagnostic procedures; physical, occupational, speech and respiratory therapies; and psychiatric services. Emergency services and supplies and most services available in hospital out-patient departments. General: The programs and services are primarily funded through general tax revenues. Prescription Drug Program: Seniors in receipt of GIS - Co-payment: $9.05. Annual maximum: $250 per person. Seniors who are not in receipt of GIS, but meet an income test - Co-payment: $15 (no annual maximum). Social Development clients - Co-payment: children (under age 18) $2.00; adults (age 18 and over) $4.00. Annual family maximum co-payment: $250. Medavie Blue Cross Seniors Health Program: Monthly premium: Effective August 1, 2009 $105 per person.
A Comparison of Provincial and Territorial Programs 15 Nova Scotia Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Nova Scotia Pharmacare Nova Scotia Medical Services Insurance (MSI) Nova Scotia Hospital Insurance Plan Seniors: The Seniors Pharmacare Program is an optional plan that provides coverage of eligible prescription drugs for seniors who have no other drug coverage. Seniors with private drug or other public coverage are not eligible to join. Annual premiums and per-prescription co-payment charges apply (to an annual cap). Premium exemption or reduction available based on income. Seniors who receive the Guaranteed Income Supplement (GIS) pay no premium. Seniors have three months from their 65 th birthday to elect coverage; elections after this period are subject to a waiting period and a higher premium. If an individual who had private drug coverage after turning 65 loses that private coverage for any reason, the late entry penalty does not apply. If a senior s drug co-payments through their private plan are more than they would have paid under Seniors Pharmacare for premiums and co- difference, provided the drugs payments together, the senior may be eligible for a reimbursement of the would be covered under the Pharmacare Program. Seniors Pharmacare Program coverage conditional on registration and payment of premiums. Note: where an employer provides prescription drug plan coverage to retirees in other provinces, it must also offer prescription drug benefits to Nova Scotia retirees. Others: The Family Pharmacare Program is an optional plan that provides coverage of eligible prescription drugs for families with no other drug coverage or families with high drug costs not covered by their private plan. Families must pay applicable co-payment charges and deductibles. Pharmacare coverage is 100% after annual deductible and co-payment maximums are reached. Family Pharmacare Program coverage conditional on registration. Where a participant has coverage through a private plan, Pharmacare is second payer of benefits. Pharmacare also provides coverage of eligible prescription drugs for: clients of Department of Community Services; individuals with cancer; individuals with diabetes; individuals with cystic fibrosis. Nova Scotia Medical Services Insurance (MSI) provides premium-free coverage for medically required physicians services rendered at an office, at home or in a hospital. Specialist services must be referred. MSI coverage conditional on plan registration. MSI covers medically necessary dental and oral surgical procedures when performed in a hospital by dental surgeons. For those children with private plan coverage, MSI covers any associated co- provided for certain dental services, including one complete orthodontic service payments. Coverage (braces), for patients registered with the Craniofacial/Cleft Palate Program (up to age 23). MSI covers one routine eye examination every two years for those under age 10 and seniors. No coverage for those age 10-64 unless medically necessary. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: No coverage for private services. Podiatrist: No coverage. Psychologist: No coverage.
A Comparison of Provincial and Territorial Programs 16 Nova Scotia (cont.) Hospital In- The Nova Scotia Hospital Insurance Plan provides coverage for: laboratory, radiological and other diagnostic procedures; physical, occupational, speech and respiratory therapies; and psychiatric services. Coverage for emergency services and supplies and most services available in hospital out- patient departments. Hospital Out- Financing Acute care: The Nova Scotia Hospital Insurance Plan provides coverage for hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic equipment; use of radiotherapy and physiotherapy facilities. Long-term care: Income based financial assistance available from Department of Health. Effective November 1, 2009, maximum daily accommodation charges are: $94.75 ( nursing home); $54.50 (residential care facility); $48.00 (community-based option). Daily respite charge: $30.90. General: The programs and services are funded through the general revenues of the province. Seniors Pharmacare Program: Maximum annual premium: $424. Per-prescription co-payment: 30% effective April 1, 2009. Maximum annual co-payment: $382. Family Pharmacare Program: Maximum annual deductible: 20% of adjusted family income. Copayment: 20% per prescription. Maximum annual family unit co-payment: 15% of adjusted family income.
A Comparison of Provincial and Territorial Programs 17 Newfoundland and Labrador Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- Newfoundland and Labrador Prescription Drug Program (NLPDP) Newfoundland and Labrador Medical Care Plan (MCP) Newfoundland and Labrador Dental Health Plan Newfoundland and Labrador Hospital Insurance Plan Seniors: The Newfoundland and Labrador Prescription Drug Program (NLPDP) 65Plus Plan provides premium-free coverage of eligible prescription drugs for seniors who are in receipt of Old Age Security (OAS) and the Guaranteed Income Supplement (GIS). Enrollment is automatic. Senior pays dispensing fee. Where a senior has coverage through a private plan, NLPDP is second payer of benefits. Others: The NLPDP Assurance Plan provides premium-free prescription drug coverage for individuals and families whose drug costs are high in relation to their net family income. Registration required. The cost of prescription drugs is capped at a specified percentage of the net family income. Where a participant has coverage through a private plan, the NLPDP Assurance Plan is second payer of benefits. NLPDP provides 100% coverage of drugs and supplies for cystic fibrosis and growth hormone patients, and for residents receiving income support benefits and specified social services. The Medical Care Plan (MCP) provides premium-free coverage of medically required physicians services rendered at a physician s office, at home or in a hospital. Specialist services must be referred. MCP coverage conditional on registration. The MCP Surgical-Dental Program covers specified surgical dental procedures carried out by a dental surgeon in a hospital. The Children s Dental Health Program provides basic dental care for children up to and including age 12. Coverage is automatic. No co-payment charges for preventive services, variable co-payment for all other treatments (e. g. fillings, extractions). Orthodontic coverage when necessary for treatment of cleft palate. Coverage for topical fluoride treatments only for those 6 to 12 years of age once every 12 months. The Children s Dental Health Program is second payer to any other coverage available through a private plan. No coverage. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: The Hospital Insurance Plan provides coverage when service performed in a hospital. Coverage conditional on registration with MCP. Podiatrist: No coverage. Acute care: The Hospital Insurance Plan provides coverage for ward accommodation, nursing services; diagnostic services (e.g., laboratory, radiology, respiratory therapy); rehabilitation services (e.g., physical and occupational therapies, audiology, speech language pathology); emergency and outpatient services, drugs and support services; use of operating room, case room, anaesthetic equipment, and radiotherapy facilities. Long-term care: Financial assistance for nursing homes available from Department of Health.
A Comparison of Provincial and Territorial Programs 18 Newfoundland and Labrador (cont.) Hospital Out- Financing The Hospital Insurance Plan provides coverage for diagnostic services (e.g., laboratory, radiology, respiratory therapy); rehabilitation services (e.g., physical and occupational therapies, audiology, speech language pathology). Coverage for emergency and out-patient clinic visits, day surgery and supplies, and services available in hospital out-patient departments. Anti-rejection drugs for transplant patients; AZT for AIDS patients. General: The programs and services are primarily funded through the general revenues of the province. Newfoundland and Labrador Prescription Drug Program (NLPDP) Assurance Plan: Individual or family annual out-of-pocket drug costs are capped at either 5%, 7.5% or 10% of net family income. Those with net incomes up to $39,999 - cap is 5% of net annual income; those earning from $40,000 up to $74,999 - cap is 7.5% of net annual income; those earning $75,000 up to $149,999 - cap is 10% of net annual income. Health & Post Secondary Education Tax: A payroll based levy payable by employers. Employers pay 2% of taxable remuneration in excess of an exemption threshold. Effective January 1, 2008 the exemption threshold is $1 million.
A Comparison of Provincial and Territorial Programs 19 Prince Edward Island Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- Hospital Out- Financing Prince Edward Island Seniors Drug Cost Assistance Plan Prince Edward Island Hospital and Medical Services Plans Seniors: The Seniors Drug Cost Assistance Plan provides premium-free coverage for approved prescribed drugs for seniors. Enrollment automatic when eligible residents reach 65 years of age. Seniors are responsible for $8.25 of the ingredient cost plus the pharmacy professional fee. Where a senior has coverage through a private plan, the Seniors Drug Cost Assistance Plan is first payer of benefits. Others: Other Provincial Drug Plans provide premium-free coverage for medications required for specific disease-related conditions (e.g., diabetes, cystic fibrosis). Registration required. Where a participant has coverage through a private plan, the Provincial plans are first payer of benefits. No other catastrophic drug plan coverage is available for those under age 65. The PEI Hospital and Medical Services Plans provide premium-free coverage for medically required physicians services rendered at an office, at home or in a hospital. Specialist services must be referred. Physicians may opt-out of the provincial plan. Coverage conditional on plan registration. The PEI Hospital and Medical Services Plans provide premium-free coverage for dental and oral surgical procedures when medically required to be performed in a hospital by a dental surgeon. Routine dental care is provided for children age 3 to 17 inclusive. Annual registration fee for children s dental program is $15 per child to a maximum of $35 per family. Parents are also expected to pay 20% of any treatment cost. Parents with an annual family income of less than $30,000 can apply to have the 20% fee waived. No coverage. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: The PEI Hospital Services Plan provides coverage when service performed in a hospital. Podiatrist: No coverage. Acute care: The PEI Hospital and Medical Services Plans provide coverage for hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic equipment; use of radiotherapy and physiotherapy facilities. Long-term care: No coverage for nursing homes under the PEI Hospital and Medical Services Plans but government financial assistance is available. The PEI Hospital and Medical Services Plans provide coverage for: laboratory, radiological, and other diagnostic procedures; physical, occupational, speech and respiratory therapies; and psychiatric services. Emergency services and supplies and most services available in hospital out-patient departments. Charges applicable for some supplies and medications. General: The programs and services are primarily funded through the general revenues of the province.
A Comparison of Provincial and Territorial Programs 20 Northwest Territories Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- Extended Health Benefits (EHB) Northwest Territories Health Care Plan Seniors: The Extended Health Benefits (EHB) program provides eligible seniors (age 60 and over) with premium-free prescription drug coverage of up to 100 percent of the cost of approved prescription drug products. EHB registration and coverage is conditional on first being registered with the NWT Health Care Plan. EHB programs are administered by Alberta Blue Cross. Where a participant has coverage through a private plan, EHB is second payer of benefits. Others: EHB provides up to 100 percent coverage of approved prescription drug products for those with specified disease conditions. Where a participant has coverage through a private plan, EHB is second payer of benefits. No other catastrophic drug plan coverage for those under age 60. The NWT Health Care Plan provides premium-free coverage for medically required physicians services rendered at an office, at home or in a hospital. Specialist services must be referred. Coverage conditional on plan registration. The EHB Seniors Program provides premium-free coverage for seniors ( age 60 and over) for specified oral surgical procedures carried out by a dental surgeon in a hospital. Coverage is 100 percent up to an annual maximum of $1,000. The EHB Seniors Program provides coverage for one pair of eyeglasses every two years for seniors (age 60 and over). Frames and standard lenses are paid up to the approved contracted rate with the optical companies. Residents who require glasses as a result of diabetes are also eligible for this benefit. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: The Health Care Plan will only provide coverage when services are performed in a hospital. Podiatrist: No coverage. Psychologist: The Health Care Plan will only provide coverage when services are performed in a hospital. Acute care: The Health Care Plan provides coverage for hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological, and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic equipment; use of radiotherapy and physiotherapy facilities. Long-term care: Programs and financial assistance for nursing homes available from the Department of Health and Social Services.
A Comparison of Provincial and Territorial Programs 21 Northwest Territories (cont.) Hospital Out- Financing The Health Care Plan provides coverage for: laboratory, radiological and other diagnostic procedures; physical, occupational, speech and respiratory therapies; and psychiatric services. Coverage for emergency services and supplies and most services available in hospital out-patient departments. General: The programs and services are primarily funded through federal Territorial Formula Financing (TFF), in addition to other forms of federal transfers, and a payroll tax. Territorial Formula Financing: An annual unconditional transfer from the Government of Canada to the three territorial governments that gives territorial residents access to a range of public services comparable to those offered by provincial governments, at comparable levels of taxation. NWT Payroll Tax: A payroll tax levied on all employees that work, perform duties, or provide services in the NWT, regardless of the province or territory of residence of the employee or employer, or the employee's age. Employers must deduct the payroll tax at source and remit to the NWT government. Payroll tax rate: 2% gross NWT remuneration. Where an employee normally works in the NWT (i.e., more than 50% of the time), payroll tax is calculated on all earnings.
A Comparison of Provincial and Territorial Programs 22 Nunavut Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- Extended Health Benefits (EHB) Program Nunavut Health Care Plan Seniors: The Extended Health Benefits (EHB) program provides eligible seniors (age 65 and over) with premium-free prescription drug coverage of up to 100 percent of the cost of approved prescription drug products. Registration required. Where a participant has coverage through a private plan, EHB is second payer of benefits. Others: EHB provides up to 100 percent coverage of approved prescription drug products for those with specified disease conditions. Where a participant has coverage through a private plan, EHB is second payer of benefits. No other catastrophic drug plan coverage for those under age 65. The Nunavut Health Care Plan provides premium-free coverage for medically required physicians services rendered at an office, at home or in a hospital. Specialist services must be referred. Coverage conditional on plan registration. EHB provides premium-free coverage for eligible seniors (age 65 and over) for dental services provided by a dental practitioner which are listed in the Nunavut Health Dental Fee Schedule to an annual maximum (this limit includes charges for dentures); and one pair of dentures every five years within the limitation above. EHB provides premium-free coverage for eligible seniors (age 65 and over) for one pair of eyeglasses and one eye examination every 24 months. Frames are covered to a maximum rate established by the Deputy Minister. The full cost of standard glass lenses is covered. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: The Health Care Plan will only provide coverage when services are performed in a hospital. Podiatrist: No coverage. Psychologist: The Health Care Plan will only provide coverage when services are performed in a hospital. Acute care: The Health Care Plan provides coverage for hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic equipment; use of radiotherapy and physiotherapy facilities. Long-term care: No coverage.
A Comparison of Provincial and Territorial Programs 23 Nunavut (cont.) Hospital Out- Financing The Health Care Plan provides coverage for: laboratory, radiological and other diagnostic procedures; physical, occupational, speech and respiratory therapies; and psychiatric services. Coverage for emergency services and supplies and most services available in hospital out-patient departments. General: The programs and services are primarily funded through federal Territorial Formula Financing (TFF), in addition to other forms of federal transfers, and a payroll tax. Territorial Formula Financing: an annual unconditional transfer from the Government of Canada to the three territorial governments that gives territorial residents access to a range of public services comparable to those offered by provincial governments, at comparable levels of taxation. Nunavut Payroll Tax: A payroll tax levied on all employees that work, perform duties, or provide services in Nunavut, regardless of the province or territory of residence of the employee or employer, or the employee's age. Employers must deduct the payroll tax at source and remit to the Nunavut government. Payroll tax rate: 2% gross Nunavut remuneration. Where an employee normally works in the Nunavut (i.e. more than 50% of the time), payroll tax is calculated on all earnings.
A Comparison of Provincial and Territorial Programs 24 Yukon Sources of Coverage Drugs (out of hospital) Physicians Services Dental Vision Care Paramedical Hospital In- Pharmacare and Extended Health Care Benefits Chronic Disease and Disability Benefits Program Yukon Health Care Insurance Plan (YHCIP) Hospital Insurance Services Plan Yukon Home Care Program Seniors: The Pharmacare Program provides premium-free coverage of approved prescribed drugs for eligible seniors (age 65 and over, or age 60 and over if married to a Yukon resident age 65 and over). Pharmacare registration and coverage is conditional on first being registered with the Yukon Health Care Insurance Plan (YHCIP). Where a participant has coverage through a private plan, Pharmacare is second payer of benefits. Others: The Chronic Disease and Disability Benefits Program provides premium-free coverage of approved prescribed drugs for persons with specified chronic diseases. Deductibles may apply, but an income test can be applied to reduce or waive deductible. Program coverage is 100% after deductible is reached. Application for coverage must be completed by the individual s physician or nurse practitioner. Coverage not available if individual has access to benefits through any other available private plan coverage. No other catastrophic drug plan coverage for those under age 65. The Yukon Health Care Insurance Plan (YHCIP) provides premium-free coverage of medically required physicians services rendered at an office, at home or in a hospital. Specialist services must be referred. YHCIP coverage conditional on registration. Seniors: The Pharmacare Program provides some coverage for eligible seniors (age 65 and over, or age 60 and over if married to a Yukon resident age 65 and over) for dentures or rebases once in a fiveof $1,400 in any two-year period. year period, to a maximum Others: YHCIP provides coverage for medically required specified oral surgical procedures performed in an approved hospital. The Pharmacare Program provides some coverage for eligible seniors (age 65 and over, or age 60 and over if married to a Yukon resident age 65 and over) for one eye examination, one pair of new lenses and $100 towards eyeglass frames once every two years. The cost of an additional medically required eye examination may also be covered. Chiropractor: No coverage. Massage Therapist: No coverage. Naturopath: No coverage. Osteopath: No coverage. Physiotherapist: The Hospital Insurance Services Plan may provide coverage when service performed in a facility approved by the Territorial Commissioner. Podiatrist: No coverage. Psychologist: No coverage. Acute care: The Hospital Insurance Services Plan provides coverage for hospital services and supplies for unlimited number of days: ward accommodation; laboratory, radiological and other diagnostic procedures; drugs and biologicals; use of operating room, case room, and anaesthetic equipment; use of radiotherapy and physiotherapy facilities. Long-term care: Coverage available through the Yukon Home Care Program.
A Comparison of Provincial and Territorial Programs 25 Yukon (cont.) Hospital Out- Financing The Hospital Insurance Services Plan provides coverage for: laboratory, radiological, and other diagnostic procedures; physical, occupational, speech and respiratory therapies; psychiatric services; minor procedures; and surgical procedures not requiring admission (day surgery). Coverage for emergency services and supplies and most services available in hospital out-patient departments. General: The programs and services are primarily funded through federal (TFF), in addition to other forms of federal transfers. Territorial Formula Financing Territorial Formula Financing: an annual unconditional transfer from the Government of Canada to the three territorial governments that gives territorial residents access to a range of public services comparable to those offered by provincial governments, at comparable levels of taxation. Chronic Disease and Disability Benefits Program: Maximum deductible: $250 per person, $500 per family.