Coverage of Publicly Funded Canadian Provincial Health Benefits
Each Canadian province determines the level of public health care that it provides to residence and how to fund the program. While the coverage is fairly similar for primary care, specialty care and hospital care, there are significant differences in extended care. The intent of this page is to highlight the common elements of most provincial plan. For specific details please follow the Provincial Health Links.
Most provinces require eligible residents to enrol themselves and their dependents.
Permanent residents who are Canadian Citizens or lawfully admitted for permanent residence who are physically present at least 6 months per year, and convention refugees are typically eligible for coverage regardless of health, age or financial status.
Landed immigrants and persons on student or employment authorization are typically covered after three months.
Members of the Canadian Armed Forces, R.C.M.P., tourists, transients and visitors, or individuals serving terms in penitentiaries are typically not eligible for benefits.
Date Coverage Begins
Some provinces begin coverage immediately upon arriving in the province while others delay coverage for up to 3 months. There are reciprocal agreements amongst provinces to facilitate travel and migration.
Date Coverage Terminates
Most provinces extend coverage for up to three months after leaving to establish full-time residence outside the province.
Most provinces cover the following services for patients who are admitted to a hospital for 24 hours or more:
- standard ward accommodation and meals (room and board)
- semi-private or private accommodation if medically required
- necessary nursing service
- laboratory and x-ray procedures for diagnosis and treatment of illness, injury or disability
- drugs administered in hospital (except when the hospital visit is solely for the administration of drugs)
- use of operating room, case room and anaesthetic facilities
- routine surgical supplies
- use of radiotherapy or physiotherapy facilities
- use of respiratory equipment
- services of hospital personnel
- other approved services rendered by employees of the hospital
- active treatment of certain types of chronic illnesses or disability in a general, rehabilitation, chronic or convalescent hospital
Most provinces cover the following services for patients who receive health care but are not admitted to a hospital for 24 hours or more:
- emergency and out-patient services
- diagnostic laboratory and radiological procedures
- minor surgery and surgical supplies
- physiotherapy, occupational and speech therapy
- psychiatric therapy
- drugs, biologicals and related preparations prescribed and administered in the hospital
Most provinces partially or fully subsidise the cost of medically necessary ground and air transportation by ambulance.
Diagnostic Laboratory & X-rays (other than in hospital)
Most provinces cover the cost of diagnostic aids such laboratory tests and X-rays requested by a physician.
Patients are free to choose the physician of their choice and physicians are free to choose their patients (they are not obligated to treat any insured person).
Payments to physicians are made for insured services based on the fee schedule negotiated between the provincial government and provincial college of physicians and surgeons.
Typical list of insured services:
- all medically required services
- diagnosis and treatment of illness and injury
- medically required surgical procedures
- obstetrical care, including prenatal and postnatal care
- administration of anaesthetics
- laboratory services in the office (x-rays, electrocardiogram, hemoglobin, urinalysis, etc.)
Coverage for the following professional services varies widely by provinces:
Nursing Homes/Homes for the Aged
Some provinces subsidise the cost a standard ward fees for an insured person requires continuous nursing service and regular medical supervision in a nursing home.
Most provinces provide the following to patients requiring 24 hour a day skilled nursing services and regular medical attention but without the resources of an acute or rehabilitation hospital.
- standard ward (room and board)
- necessary nursing
- drugs, biological and related preparations
- laboratory and radiological procedures and the necessary interpretations
- other necessary services rendered by persons paid by the chronic and convalescent hospital
Utilization fees may apply during the entire stay or only after a certain number of days.
Some provinces provide the following services on a visitation basis when a physician certifies the necessity and needs cannot be met on an out-patient basis:
- nurse, physiotherapist, occupational therapist, speech therapist, social worker, nutritionist, or a homemaker
- provision for dressings and medical supplies, diagnostic and laboratory services, hospital and sick-room equipment
- transportation to and from home to a hospital, health facility, or attending physician's office
- use of respiratory equipment
Some provinces subsidise the cost of assistive devices such as prostheses orthopaedic appliances and hearing aids.
Pharmaceuticals (in Hospital)
The cost of drugs prescribed and administered while an inpatient in hospital.
Pharmaceuticals (out of hospital, or in hospital when visit solely for administration of drugs)
Drug coverage varies widely amongst provinces. Some provide no coverage, some provide limited coverage or coverage to certain residences (elderly or financially disadvantaged) while others provide comprehensive coverage.
Most provinces cover the cost of dental and oral surgery performed in an operating room by a dental surgeon when medically necessary for the insured person to be admitted as an in-patient.
Most provinces subsidise cost of specialized dental treatment for children and young people with cleft lip and palate.
Some provinces cover the cost of dental care for the young, elderly or financially disadvantaged.
Out of Province but Within Canada
Interprovincial agreements and federal-provincial agreement facilitate treatment in any province based on the coverage of the province of residence.
Out of Country Coverage
Most provinces provide limited coverage for medically necessary emergency in-patient and out-patient services for which the patient would have been admitted on an emergency basis to a public hospital in the province of residence. The coverage is usually limited to a daily maximum based on the level of care and far below the amount actually charged by the foreign hospital or clinic.