A Guide to Newfoundland and Labrador Health Plan – MCP Medical Care Plan

The Dental Health Plan is a part of NL public insurance health program and it is divided into five programs:

Children’s Dental Health Program: 0-12 years

The program provides dental services for children up to 12 years of age. Covered services include: cleanings every 12 months; examinations every 6 months; sealants; routine fillings and extractions; and fluoride applications for those aged 6-12 years every 12 months.

Income Support Program Youth: 13-17 years

The program provides basic dental services (which are listed in the Dental Health Plan Payment Schedule). Services are available to people aged 13-17 whose family receives Income Support. Covered services include: Examinations every two years and routine fillings/extractions.

Low Income (Access) Program Youth: 13-17 years

The program provides basic dental services (which are listed in the Dental Health Plan Payment Schedule) to people aged 13-17 who meet eligibility criteria and have enrolled in this plan. Covered services are the same as for the Income Support Program.

Adult Dental Program: 18+ years

The program provides basic dental services (which are listed in the Dental Health Plan Payment Schedule). There is the addition of a denture component, with a limitation to standard dentures only. Covered basic services can be received every 3 years, and dentures every 8 years.

The costs of standard dentures will be paid by the Adult Dental Program, while any additional costs are the responsibility of the patient. Before commencing with a treatment, it is advised that you talk with your dental provider about the expenses.

Surgical Dental Program

The program provides insured dental services under the Medical Care Insurance Act. Such services are defined as those that are:

• Deemed medically necessary
• Listed in Section 3 (b) or the Medical Care Insured Services Regulations

There is no co-payment for eligible services received under any of these dental programs. However, there is a certain annual cap per patient. However, there is an annual cap for services received under the Adult Dental Program - $300 for basic dental services and $1,500 for dentures.

Unless they are administered in a hospital, prescription drugs are not covered by the NL MCP. However, there are programs designed to provide financial help for prescription drug coverage. There are five prescription drug coverage plans, including:

The Foundation Plan

Provides complete cost coverage for residents in financial need, such as those receiving governmental financial support.

The Access Plan

Provides prescription drug coverage for individuals and families with low incomes. Those who meet the eligibility criteria for this plan are:

• Single residents with a net annual income of $27,151 or less.
• Couples with no children with a net annual income of $30,009 or less.
• Families with children with a net annual income of $42,870 or less (this also includes single parents).

The 65Plus Plan

Provides prescription drug coverage for senior residents (65 years old and up) who receive Guaranteed Income Supplement (GIS) and Old Age Security Benefits (OAS). Those eligible for the 65Plus Plan are automatically qualified for the Ostomy Subsidy Program.

The Assurance Plan

Provides prescription drug coverage for individuals and families who are experiencing high drug costs (relative to their net annual income). According to this plan, drug coverage is based on the following:

• 10% or more of net income spent on prescription medication when earning $75,000-$149,999.
• 7.5% or more of net income spent on prescription medication when earning $40,000-$74,999.
• 5% or more of net income spent on prescription medication when earning less than $40,000.

The Select Needs Plan

Provides full prescription drug coverage for all residents who suffer from growth hormone deficiency or cystic fibrosis, and need to take disease-specific medications.

The Hospital Insurance Plan is the third main component of NL’s public insurance health program, and it offers the following in-patient hospital coverage:

• Diagnostic procedures (such as respiratory therapy, nuclear medicine, laboratory, x-rays).
• Nursing services.
• Accommodations and meals at standard rates. Semi-private or private rooms only covered if medically necessary or if a standard room is not available.
• Rehabilitative services (such as occupational therapy, physiotherapy, speech therapy and audiology).
• Drugs, medical and surgical supplies.
• Radiotherapy isotopes and services (if available).
• Labour, delivery and operating room.

Furthermore, there is some coverage for certain out-patient hospital services, such as:

• Various diagnostic, X-ray and laboratory procedures.
• Anti-rejection drugs for transplant patients.
• Rehabilitative services (such as occupational therapy, physiotherapy, speech therapy and audiology).
• Surgical and medical day procedures.

The hospital plan doesn’t cover the following services:

• Private nursing.
• In vitro fertilization and other procreative treatments.
• Ambulance services.
• Drugs and appliances for use outside of a hospital setting (unless covered by the Insured Outpatient Services).
• Preferred accommodations (semi-private and private hospital rooms).
• Services without specific medical indication (such as x-rays for cosmetic procedures, etc).
• Bedside devices (such as phones, radios and TVs), unless used for teaching purposes.
• Canadian Armed Forces and RCMP members covered by some federal insurance program.

Since 2007, health care coverage under the MCP has been extended to foreign students attending post-secondary educational institutions in NL. It applies to any non-Canadian individual who received a study permit issued by Citizenship and Immigration Canada. They must attend a recognized post-secondary institution in NL for at least one full year.

Health coverage for international students (and their dependents) becomes effective on the day of enrollment in an educational program, and it’s renewable each year. If eligible, you’re required to present a letter of enrollment from the educational institution.

As for the medical services, international students can only receive services listed under the Medical Care Insured Services Regulations and the Hospital Insurance Plan Regulations. Other services, such as NLPDP, are available to them if they purchase additional coverage through their post-secondary educational institution.

The coverage and services that seniors receive as MCP beneficiaries include the 65Plus Plan (prescription drug coverage) and access to personal care homes and long-term care facilities.

When it comes to residential options, there are a variety of them available to senior NL residents. The Department of Health and Community Services provides funds for subsidies to eligible senior residents who reside in:

• Protective Community Residences
• Personal Care Homes
• Long-Term Care Facilities