Premium assistance (95% subsidy) is available for certain individuals who satisfies the Commission that
for the immediately preceding taxation year they had a taxable income for $2,500 or less, or are unable to pay the premium because of unemployment, illness, disability or financial hardship.
Premium assistance (55% subsidy) is available for certain individuals who satisfies the Commission that for the immediately preceding taxation year their a taxable income was more than $2,500 but not more than $6,500.
Utilization Fees
Cost can range from $23.70 to $36 per day in a chronic/extended care hospital, depending on income, marital status and if over 18 years of age. However, newborns, persons admitted involuntary to a psychiatric unit under the Mental Health Act and the beneficiaries who are involuntarily undergoing treatment for tuberculosis are excluded from the above charges.
Paramedical services such as physiotherapy, chiropractic, massage therapy, podiatric and naturopathic have a $10 per visit fee paid by the patient. The Medical Services Plan will pay the patient visit charge for those individuals receiving premium assistance.
Hospitals may charge a semi-private or private differential if such accommodation was at patient's request.
Extra Billing
Participating Physicians
Participating physicians may not extra-bill.
Differential billing is permissible where a patient seeks the services of a specialist on a non-referred basis. The patient is responsible for the difference between the specialist's fee and the general practice fee paid by the plan.
Non-participating Physicians
Non-participating physicians may extra-bill if they give patient notice of extra-billing in writing and the patient agrees, in writing, to extra amount. The difference between the amount billed and the amount paid
by the provincial plan is the responsibility of the patient
Billing and Payment
Participating practitioners submit claims directly to the Commission
Non-participating practitioners bill patients directly providing
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the physician has given prior written notice of intention to do so, and
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there is a written agreement between the physician and patient as to any charges exceeding the schedule of fees
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the individual may submit an itemized claim to the commission for reimbursement
Private Insurance
Private insurers are not allowed to duplicate coverage provided by the provincial plan (unless specifically licensed to do so by the Medical Services Plan).
Private insurers are allowed to provide coverage over and above the provincial plan as noted below.
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Hospital:
anything over standard ward accommodation may be insured
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Physicians:
no private insurance permitted
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Ambulance:
the patient costs
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Laboratory:
any charges not paid for by the provincial plan
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X-rays:
any charges not paid for by the provincial plan
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Optometrists:
Other than examination and prescribing lenses
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Chiropractors:
any amount above yearly limit also the utilization fee
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Chiropodists/Podiatrists:
any amount above yearly limit also the utilization fee
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Physiotherapists:
any amount above yearly limit also the utilization fee
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Naturopaths:
any amount above yearly limit also the utilization fee
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Special Nursing:
if cost not paid by the provincial plan
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Chronic/Extended Care:
the utilization fee
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Home Care:
any charges not paid for by the provincial plan
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Services Outside Province/ Country:
the difference between the amount charged and the amount paid by the Plan
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Dental:
out-of-hospital charges not covered by the Medical Services Plan
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Drugs:
that portion not paid by the Medical Services Plan (i.e. the co-payment charges for senior citizens)
Third Party Liability
Insured individuals are free to recover expenses from a third party but must repay the Medical Services Commission any payments made on account of that injury to the extent such expenses are recovered.
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