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Coverage for Out-of-Province Medical Services

Am I Covered for Out-of-Province Services?

The following is the general policy for out-of-province benefits:

• The Department will pay the full cost of (PEI insured) medical and/or hospital services obtained within Canada with the exception of Quebec, (which is not a party to the interprovincial agreements) which are provided to you as a result of an EMERGENCY or SUDDEN ILLNESS. Coverage extends only to those services medically required at the time of the emergency or sudden illness. Any related non-emergency or elective service is not covered unless you have received the prior approval of the Department.
• You are required to obtain prior approval from the Department before receiving non-emergency out-of-province medical or hospital services. PEI residents seeking such out-of-province services can apply for prior approval through a PEI physician. Full coverage may be provided for (PEI insured) non-emergency or elective services, providing that your physician makes application to the Department. Applications may be approved in the following circumstances.

The insured (in Prince Edward Island) medical and/or hospital service is not available within the province;

There exists within Prince Edward Island only 1 medical practitioner in the required specialty;

In the opinion of an Island physician and the Medical Director of the Department of Health and Social Services, adequate service is not available within the province;

In the opinion of the Medical Director of the Department of Health and Social Services, extenuating circumstances exist and are documented that permit services to be provided in another province or territory.

Each approval for a service or related service may cover a period of not more then 12 consecutive months.

If you do not receive prior approval from the Department for a non-emergency medical and/or hospital service to be obtained out-of-province, you will be held responsible for the total cost of the services rendered.

Please note that prior approval is not needed in cases of emergency or sudden illness requiring immediate medical attention not available within the province.

For more information on out-of-province coverage, please contact the Department.

Contact

Montague

126 Douses Road

Byrne, Bob (Out-of-Province Claims Clerk)