Eligibility Excluded Categories Registration Dependant's Coverage Residency Out-of-Province Coverage Beneficiary Audit Hospital Insurance Plan F.A.Q.'s Forms MCP Home Contact MCP

Coverage under the Medical Care Plan, the Dental Health Plan, and the Hospital Insurance Plan is available to all residents of Newfoundland and Labrador who meet the qualifying criteria. Eligibility is based on residency and citizenship, not age, health status, or ability to pay. Eligibility The Medical Care Insurance Beneficiaries and Inquiries Regulations identifies those residents who are eligible for coverage under the Medical Care Plan, the Dental Health Plan, and the Hospital Insurance Plan. As the administrator of the Regulations, MCP has established rules to ensure that the Regulations are applied consistently and fairly in the processing of applications. Eligible applicants can be classed into three groups: Canadian Citizens, Landed Immigrants, and Foreign Workers. MCP has identified the documents that applicants from each group must present to prove eligibility under the Plans. Canadian citizens must present documents which confirm citizenship status. This can consist of:

A Social Insurance Card or document containing the Social Insurance Number (SIN) A Canadian passport A Canadian Birth Certificate An official Federal Government Identity Card or Federal Government document containing the SIN and name.

Applications for newborn coverage will require, in most instances, a valid parent's MCP number. A birth or baptismal certificate will be required where the child's surname differs from the parent's.

Applications for coverage for an adopted child will require a copy of the official adoption documents, the birth certificate of the child, or a Notice of Adoption Placement from the Department of Health and Community Services. Applications for coverage for children adopted outside Canada will require Landed Immigrant documents for the child.

Landed Immigrants must present Record of Landing Documents from Immigration Canada. If Landed status was granted in Newfoundland and Labrador, proof of intention to remain in Newfoundland and Labrador may be required.

If applicable, Canadian citizens and Landed Immigrants may also have to provide one of the following:

	a previous province or territory's health care number or card
	proof that Canadian citizenship/landed status has not been forfeited if returning to Canada after a lengthy stay abroad
	proof of discharge from Canadian Armed Forces or Royal Canadian Mounted Police
	proof of release from federal prison.

Foreign workers coming to Newfoundland and Labrador must present an Employment Authorization (Work Visa). The Employment Authorization must be:

	issued before coming to Canada
	for a named Newfoundland and Labrador employer
	for a specific job within the province
	valid for at least 12 months (except foreign health care workers).

All foreign applicants should be prepared to present a valid foreign passport for identification purposes.

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Excluded Categories

The following categories are not eligible for coverage under the Plans, even if living in Newfoundland and Labrador:

	Students from other provinces, territories or countries
	Dependents of residents of another province/territory
	Certified refugees and refugee claimants
	Foreign workers with Employment Authorizations that do not meet the established criteria
	Tourists, transients and visitors
	Dependents of any of the above excluded categories
	Canadian Armed Forces and Royal Canadian Mounted Police personnel
	Inmates of federal prisons
	Armed Forces personnel of other countries stationed in the province

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Registration

To apply for coverage, complete an Application Form and mail, fax, or bring it to MCP's office, along with the appropriate identification and citizenship/immigration documents (photocopies are acceptable). Application forms are available at hospitals and doctors' offices throughout the province, and of course, from MCP.

Properly completed applications with all necessary supporting documents, will be processed within two weeks. There are no direct premiums or charges for registration. If accepted for coverage, each person will receive a plastic MCP Card with a personal health identity number. This card should be presented whenever insured services are received.

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Dependent's Coverage

Dependents who are eligible for coverage will receive their own MCP card and number. A dependent is defined as a person who is a resident and depends upon another resident for maintenance.

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Residency in Newfoundland and Labrador

The Newfoundland and Labrador Medical Care Insurance Act defines a resident as a person... "who makes his or her home and is ordinarily present in the province... ." MCP applies the standard that a resident, who has not received an Out-of-Province Coverage Certificate for an extended absence, must reside in Newfoundland and Labrador for at least four consecutive months in each twelve month period to qualify as a beneficiary.

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Out-of-Province Coverage

MCP will provide coverage under the Medical Care Plan to beneficiaries who temporarily leave Newfoundland and Labrador. Coverage under the Hospital Insurance Plan will also be provided, however, the Department of Health and Community Services can provide more information on the services insured outside Newfoundland and Labrador. Coverage under the Dental Health Plan is not available outside Newfoundland and Labrador.

To ensure that coverage remains intact while outside Newfoundland and Labrador, an Out-of-Province Coverage Certificate should be obtained from MCP. This provides a maximum of twelve months' out-of-province coverage to eligible beneficiaries, with the following qualifications:

	Beneficiaries leaving for vacation purposes may receive an initial Out-of-Province Coverage Certificate for up to twelve months' coverage. The normal four month residency requirement must be met immediately following their return to Newfoundland and Labrador. Further Out-of-Province Coverage Certificate's will only be issued to provide up to eight months' coverage.
	Beneficiaries leaving for work purposes (temporarily absent workers) may receive an Out-of-Province Coverage Certificate for up to twelve months' coverage. Beneficiaries who are employees of a Newfoundland and Labrador company or business may renew their Out-of-Province Coverage Certificate each year to provide up to three years' out-of-province coverage.
	Beneficiaries leaving for study purposes may receive an Out-of-Province Coverage Certificate for up to twelve months' coverage. This is renewable each year upon verification of full time enrolment in an educational institution. Approval is conditional upon the beneficiary's intention to return to Newfoundland and Labrador upon completion of their educational program.

Rates Payable-Services Obtained in Canada

Insured medical services obtained in other provinces and territories are payable at the rates established by the medical care plan in those jurisdictions. This means that, with some exceptions which are outlined below, you will not have to pay for any portion of the physician's charges for insured medical services.

There are several situations where you may receive a bill for services. These are as follows:

	Services provided in the province of Quebec
	Services excluded from those covered by the inter-provincial agreement mentioned below.
	Certain physicians in some provinces have decided not to participate in the agreement adopted by the provinces. When a physician has intentions of billing you outside of the medical care plan, he/she should make you aware of this. In your own best interests, if you obtain medical care services in another province, you should determine how the physician will bill for the service.

With the exception of Quebec, all provinces and territories have an agreement whereby physicians in each province or territory submit claims to their local medical care plan for services provided to residents of the other Canadian jurisdictions. The fees for the services are paid to the physician and the costs are then charged to the resident's home plan.

Rates Payable-Services Obtained Outside Canada

With certain exceptions, claims for insured medical services obtained outside Canada are paid at MCP rates, which are the rates paid to Newfoundland and Labrador physicians. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility. It should be noted that the costs of medical care in certain countries, particularly the United States, are significantly higher than the rates paid by MCP. It is strongly recommended that additional travel insurance be obtained whenever traveling outside Canada. For more information on travel insurance, please contact one of the insurance companies listed in the yellow pages of our local Telephone Directory under Insurance - Life and Health.

A) Rates Payable-Services Available in Newfoundland and Labrador

Claims for insured medical services obtained outside Canada, that are available in Newfoundland and Labrador, are paid at MCP rates, which are the rates paid to Newfoundland and Labrador physicians. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.

B) Rates Payable-Services Available in Canada but not in Newfoundland and Labrador

Insured medical services obtained outside of Canada which are not available in Newfoundland and Labrador but are available in another province are payable at the rates established by the medical care plan in that province. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.

C) Rates Payable-Services Not Available in Canada

If you are planning to have insured medical treatment which you think may not be available in Canada, and if you wish to claim reimbursement of related medical costs through MCP, you must ask your physician to request prior approval from MCP before obtaining such treatment in another country. By doing so you will be made aware in advance of the rate at which your medical bills will be reimbursed.

If you are granted prior approval based on the unavailability of the services in Canada, the Medical Care Plan will provide coverage for medically necessary physician services. Payment will be in the currency of the country where the services are received provided the rates are deemed to be fair and reasonable as determined by the Department of Health and Community Services. Prior approval is mandatory to receive payment at rates higher than those published in the MCP or other provincial physician fee schedules. If a patient opts to travel outside the country for medical service/treatment and prior approval has not been granted, payment will be in accordance with the established rates outlined in A) or B) above, and any balance remaining is the responsibility of the patient.

Claim Submission Requirements

If you have been treated by a physician in Canada who is not participating in the interprovincial arrangement, or have obtained services which are excluded firm the agreement, it will be necessary for you to submit an Out-of-Province Claim Form. This claim may be submitted on your behalf by the physician, in which case you will be asked to sign the form.

If the physician elects not to submit a claim on your behalf or you obtain medical services outside Canada, you should obtain letterhead billing which contains an itemized statement of the charges and services. This information is required so that we may substantiate and assess your claim. You will then be required to submit an Out-of-Province Claim Form, accompanied by the letterhead billing.

Beneficiary Audit

Beneficiaries, while having a right to receive insured services from providers, may not make unnecessary use of medical services.

When MCP suspects that a beneficiary is making unnecessary use of services, a Utilization Audit may be conducted into the beneficiary's use to determine the nature and the cost of any abuse. Each suspected case of abuse is decided on its own merits, in consideration of the individual circumstances and the beneficiary's medical history. A chronically ill beneficiary who validly requires numerous services for treatment of a serious illness will not be audited.

The Newfoundland and Labrador Medical Care Insurance Act allows MCP to assess a beneficiary for abuse of services, and to recover the cost of those services through court action. MCP may also require a beneficiary to enter into a contract to restrict the beneficiary to receiving services from only one physician.

If MCP determines that a physician is encouraging a beneficiary to over utilize the Medical Care Plan, an audit into that physician's practice may be conducted.

The information presented on this site has been compiled as a guide to programs and services under the Medical Care Plan and does not represent the complete Program rules. For more information, please contact MCP. This information is subject to change without notice.