Canada Health Act
Frequently Asked Questions
The Canada Health Act Division responds to enquiries regarding the Canada Health Act and health insurance issues from the public, government departments, stakeholder organizations and the media. For information beyond what is available here, please contact us in writing at:
Canada Health Act Division
Health Policy Branch
Health Canada
PL# 0908B1
Ottawa, Ontario
K1A 0K9
Does Canada have a national health insurance plan?
Who is eligible for health care in Canada?
What health care services are insured by the provinces and territories?
What other health care services do provinces and territories provide?
What health care services are not covered by provinces and territories?
Are alternative forms of health care (i.e. chiropractic, acupuncture, herbal medicines) covered under my medicare plan?
How do I replace a lost provincial health card?
Who do I contact for a change of address for my provincial health care?
What should I do if I am moving to another province or territory?
Do I need private health care coverage when travelling within Canada?
Do I need private health care coverage when travelling outside Canada?
As a Canadian, how do I resume my health care coverage when returning to Canada following a lengthy absence from abroad?
Why do some provinces have health care premiums?
How do I register a complaint against a doctor or dentist?
Does Canada have a national health insurance plan?
Canada does not have a single national health care plan, but rather a national health insurance program, which is achieved through a series of thirteen interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage, with slight differences. Under the Canada Health Act, our national health care program is designed to ensure that all residents of Canada have reasonable access to medically necessary hospital and physician services on a prepaid basis, and on uniform terms and conditions.
Who is eligible for health care in Canada?
Our national health insurance program is designed to ensure that all residents of Canada have access to medically necessary hospital and physician care on a prepaid basis. Residence in a province or territory is the basic requirement for insured health care coverage. The Canada Health Act defines a resident of a province or territory as:
"a person lawfully entitled to be or to remain in Canada who makes his home and is ordinarily present in the province, but does not include a tourist, a transient or a visitor to the province."
Each province and territory is responsible for determining its own minimum residence requirements with regard to an individual's eligibility for benefits under its health insurance plan. The Canada Health Act gives no guidance on such minimum residence requirements beyond an initial three-month waiting period to establish eligibility for and entitlement to insured health services. Provinces may require minimum residence annually in the province, and evidence of intention of returning to the province for that minimum residence period each year.
The federal government is responsible for:
- setting and administering national principles or standards for the health care system through the Canada Health Act;
- assisting in the financing of provincial health care services through fiscal transfers;
- delivering direct health services to specific groups including veterans, native Canadians living on reserves, military personnel, inmates of federal penitentiaries and the Royal Canadian Mounted Police; and
- fulfilling other health-related functions such as health protection, disease prevention and health promotion.
The provincial and territorial governments are responsible for:
- managing and delivering health care services;
- planning, financing, and evaluating the provision of hospital care;
- physician and allied health care services; and
- managing some aspects of prescription care and public health.
What health care services are insured by the provinces and territories?
Under the Canada Health Act, provincial and territorial health insurance plans are required to provide coverage to their residents for all medically necessary hospital and physician services on a prepaid basis.
What other health care services do provinces and territories provide?
Provinces and territories may also offer "additional benefits" under their respective health insurance plans, at their discretion, and on their own terms and conditions. While these services vary from province to province, some examples include prescription drug benefits, dental care, optometric services, chiropractic services, hearing aids, transportation services and home care programs.
What health care services are not covered by provinces and territories?
Services not covered are generally those considered not to be medically necessary. Some examples include: cosmetic surgery, health examinations for employment purposes and tattoo removal. However, there can be exceptions; for example, the removal of concentration camp tattoos or reconstructive cosmetic surgery following a trauma.
Are alternative forms of health care (i.e. chiropractic, acupuncture, herbal medicines) covered under my medicare plan?
Although Canada's current health care system is based on the practice of traditional western medicine, this does not mean that there is no room for alternative forms of health care. Some alternative health care is covered, at least partially, by the provincial and territorial health insurance plans. Under the federal health insurance legislation, the Canada Health Act, the provinces and territories are required to provide medically necessary hospital and physician services to all their eligible residents on a prepaid basis. In addition to the provision of medically necessary hospital and physician services, provincial and territorial governments may also offer "additional benefits" at their own discretion. Chiropractic, acupuncture and naturopathy services are examples of the additional benefits provided by the provinces and territories on their own terms and conditions.
How do I replace a lost provincial health card?
The provinces and territories, rather than the federal government, are primarily responsible for the administration and delivery of health care services. You should contact your local provincial Ministry of Health office - the number can be found in the blue pages of your phone directory. That office will assist you with your enquiry. Alternatively, you could visit your provincial Ministry of Health web site to locate the information there.
Who do I contact for a change of address for my provincial health care?
The provinces and territories, rather than the federal government, are primarily responsible for the administration and delivery of health care services. You should contact your local provincial Ministry of Health office - the number can be found in the blue pages of your phone directory.
What should I do if I am moving to another province or territory?
It is important that you inform both your "home" province/territory of your new address and the new province/territory upon your arrival. Residents moving from one province/territory to another continue to be covered by their "home" province/territory during any minimum waiting period, not to exceed three months, imposed by the new province/territory of residence. After the waiting period, the new province/territory of residence assumes your health care coverage.
Do I need private health care coverage when travelling within Canada?
The portability criterion of the federal health insurance legislation, the Canada Health Act, requires that the provinces and territories extend medically necessary hospital and physician coverage to their eligible residents during temporary absences from the province or territory. This allows individuals to travel or be absent from their home province or territory and yet retain their health insurance coverage. Individuals should seek prior approval for out-of-province health care services from their home province insurance plan for non-emergency health care services. Within Canada, the portability provisions are generally implemented through a series of bilateral reciprocal billing agreements between the provinces and territories for hospital and physician services. These agreements are interprovincial, not federal, and signing them is not a requirement of the Canada Health Act. The rates prescribed within these agreements are host-province rates, and the agreements are meant to ensure that Canadian residents, for the most part, will not face point-of-service charges for medically required hospital and physician services when they travel in Canada.
Reciprocal billing is a convenient administrative arrangement, and it is but one method of satisfying the portability criterion of the Act. A requirement for patients to pay "up front" and seek reimbursement from their home province or territory also satisfies the portability criterion of the Act as long as access to a medically necessary insured service is not denied due to the patient's inability to pay.
The provision of prescription drug benefits outside hospitals falls within the range of "additional benefits" that provinces and territories may include under their respective health insurance plans, on their own terms and conditions and are generally not portable outside one's home province/territory.
Do I need private health care coverage when travelling outside Canada?
In relation to out-of-country health insurance coverage, the federal health insurance legislation, the Canada Health Act, requires provincial and territorial health insurance plans to provide portability of coverage for insured medically necessary hospital and physician services when temporarily outside one's home province or territory. The portability criterion of the Act does not entitle one to seek services in another country, but is more intended to entitle one to receive necessary services in relation to an emergency when the absence is temporary, such as on business or vacation. However, because of the high costs associated with health care in some foreign countries, reimbursement for emergency health care by a province or territory may not be made at the full amount. Therefore, it is recommended that when travelling outside Canada, individuals are encouraged to purchase private insurance to ensure adequate coverage. Individuals who seek treatment out-of-country without prior approval from their provincial or territorial health insurance plans may be required to bear the cost of the services received.
As a Canadian, how do I resume my health care coverage when returning to Canada following a lengthy absence from abroad?
Residence in a province or territory is the basic requirement for insured health care coverage. The Canada Health Act defines a resident of a province or territory as "a person lawfully entitled to be or to remain in Canada who makes his home and is ordinarily present in the province, but does not include a tourist, a transient or a visitor to the province." Under the Canada Health Act, the health insurance plan of a province or territory must not impose any minimum period of residence, or waiting period, in excess of three months before residents of the province or territory are eligible for or entitled to insured health services. With the exception of this initial three-month waiting period, the Act does not give guidance on minimum residence requirements. Beyond the initial waiting period, each province and territory is responsible for determining its own minimum residence requirements with respect to an individual's eligibility for benefits under its health insurance plan. In the case of Canadians returning to live in Canada, coverage may be, and often is, provided from the date of re-establishment of residence, or following a waiting period, according to the requirements of the individual province or territory.
Since the delivery of health care services is primarily a provincial and territorial responsibility, you should contact the provincial Ministry of Health in the province or territory in which you intend to establish your residence.
Why do some provinces have health care premiums?
Each province and territory has considerable leeway in determining how its share of the cost of its health insurance plan will be financed. Financing can be through the payment of premiums (as is the case in Alberta and British Columbia), payroll taxes, sales taxes, other provincial or territorial revenues, or by a combination of methods. Health insurance premiums are permitted as long as residents are not denied coverage for medically necessary hospital and physician services because of an inability to pay such premiums.
Provinces that levy premiums have also instituted premium assistance schemes that are based on income, and those who cannot afford to pay premiums may apply for assistance through the provincial health insurance plans.
How do I register a complaint against a doctor or dentist?
Since the provinces and territories, rather than the federal government, are primarily responsible for the administration and delivery of health care services and the management of health human resources, you should contact your local provincial Ministry of Health office - the number can be found in the blue pages of your phone directory. You may also wish to contact the Royal College of Physicians and Surgeons or the Royal College of Dentists of Canada for more information on the provincial licensing bodies for these professions.
 Royal College of Physicians and Surgeons of Canada
774 Echo Drive
Ottawa ON, K1S 5N8
Telephone: 613 730-8177
Toll Free: 1-800-668-3740
Fax: 613 730-8250
Email: info@rcpsc.edu
Royal College of Dentists of Canada
5075 Yonge Street, Suite 405
Toronto, Ontario, Canada M2N 6C6
Telephone: (416) 512-6571
Fax: (416) 512-6468
E-mail: office@rcdc.ca
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