Dental
When it comes to dental benefits, Nova Scotia MSI doesn’t cover routine dental services. However, it does offer certain dental programs designed to help eligible people access dental care:
Children’s Oral Health Program – provides coverage for basic dental services to children up to 14 years of age. However, it doesn’t cover all preventative dental services.
Oral and Maxillofacial Surgery Program – provides coverage for medically necessary oral/maxillofacial surgical services (delivered in-hospital) such as: dental surgery (surgical operation and pre/post-operative care) and in-hospital consultations requested by a dental/oral maxillofacial surgeon or physician.
Maxillofacial Prosthodontics Program – provides coverage for residents who need rehabilitation of head and neck deficits.
Individuals with Special Needs Oral Health Program – provides coverage for basic dental needs of residents diagnosed with an intellectual disability (which requires in-hospital dental care under a general anesthetic).
Cleft Palate/Craniofacial Program – provides coverage for residents with craniofacial anomalies.
Exceptional Circumstances – coverage for which dentists may apply on behalf of their patients who need medically necessary services that aren’t covered by any Dental Program. Patients must rely on their private dental insurance before the coverage under Exception Circumstances will be considered and approved.
There is no coverage for the aforementioned programs if dental services are performed outside of the province of Nova Scotia.
Dental Costs With MSI
Nova Scotia MSI Health Plan will cover or partially cover only certain dental procedures. In case you need dental services that are not covered by MSI, you will need to supplement your health plan with additional dental insurance.
Prescription Drugs
Pharmacare Programs are a medical services insurance program that Nova Scotians have in order to access different public drug plans. They are designed to help residents with the cost of prescribed drugs (indicated as benefits in the Nova Scotia Formulary) and with the cost for certain services.
Seniors' Pharmacare Program - available to residents 65 years of age and older.
Family Pharmacare Program - available to anyone with a valid Nova Scotia Health Card and helps families without prescription drug coverage or with the cost of drugs they cannot afford due to low household income.
Drug Assistance for Cancer Patients - available to residents diagnosed with cancer and an income less than $25,500.
Palliative Care Drug Program - available to residents and intended for use in end-of-life care at home.
Department of Community Services Pharmacare Benefits – provides drug coverage to Disability Support Program clients, Income Assistance clients, Low Income Pharmacare for Children clients, and children in the care of child welfare.
Prescription Drug Costs with Nova Scotia Pharmacare
To determine allowable mark-ups, maximum professional fees, definitions of cost that pharmacies are allowed to charge for prescriptions, the Pharmacy Association of Nova Scotia negotiates with the Nova Scotia Department of Health and Wellness.
Nova Scotia’s Pharmacare Programs pay the manufacturer's list price (MLP) or actual acquisition cost (AAC) for all drugs submitted to them, unless the drug has been assigned a Pharmacare Reimbursement Price (PRP) or a Maximum Reimbursable Price (MRP). Also, the Pharmacare Programs pay a markup on the cost and the professional fee.
Extended Health Care
Extended health coverage provided by the Nova Scotia Medical Services Insurance plan includes programs such as:
- Drug Assistance for Cancer Patients
- Nova Scotia Diabetes Assistance Program
- Insulin Pump Program
Coverage when Travelling in Canada
If you are travelling through Canadian provinces, all of them have signed the Reciprocal Billing Agreement, except Quebec for physician services. All you have to do is to show your Nova Scotia Health Card to the medical service provider, and everything will be reimbursed to your home province. In case the medical service provider requires you to pay for services, be sure to submit the receipt to MSI for consideration.
In case you plan to be absent from Nova Scotia for more than three months, you should contact MSI at msi@medavie.ca or 902-496-7008 or 1-800-563-8880 (toll free within Nova Scotia) for advising on:
- the date you plan to leave the province
- the intended return date
- the reason for your absence
The period and extent of your health coverage will vary according to the reason and circumstances of your absence.
Prescription drugs purchased in another province are paid only under exceptional circumstances.
Coverage when Travelling Out of Canada
When travelling out of Canada, MSI will provide you with health coverage for emergency medical services.
Canadian funds will cover for:
- Out-of-country in-patient hospitalization that occurred due to sudden illness or accident during your temporary absence.
- Physician Services required due to sudden illness or accident during your temporary absence.
While out of Canada, the MSI program will not cover the following services:
- Routine vision analysis
- Pharmacare and Children’s Dental Programs
- Diagnostic tests, x-ray, and laboratory charges from private, emergency, or out-patient facilities.
For any resident planning to travel out of province, it is strongly recommended to purchase a Travel Health Plan or a Hospital Insurance Program for their period of absence in order to cover other services.
