Questions and Answers about Health Care Coverage

Transcription

1 Manitoba Health Questions and Answers about Health Care Coverage This page outlines benefits administered by the Insured Benefits Branch of Manitoba Health and also provides information on eligibility and registration. Please click on any of the questions below: Eligibility Am I eligible for coverage? I'm new to Manitoba. How do I apply for coverage? I'm new to Canada. How do I apply for coverage? I lost my Manitoba Health Card. How do I replace it? Hospital/Medical Coverage in Manitoba What medical services are insured by Manitoba Health? Which hospital services are insured? What insured benefits are available to personal care home residents? What health services are not insured? If I need an ambulance, is it covered by Manitoba Health? Am I eligible for the Northern Patient Transportation Program? Moving (Temporarily or Permanently) I'm moving away from Manitoba. Is my health care still covered?

2 Out of Country Referrals What if I require medical care that is not available in Manitoba or Canada? Emergency Care or Medical Attention Outside of Manitoba or Canada What if I have to see a doctor while in another province? Am I covered for emergency care outside of Canada? Student Information I m a student. What do I have to do to maintain Manitoba Health coverage if I study in another province or country? Am I eligible for coverage? To be eligible for Manitoba Health coverage you must: Be a Canadian citizen or have Immigration status as outlined in The Health Services Insurance Act Establish a permanent residence in Manitoba, and Reside (physically) in Manitoba six months in a calendar year The following are not eligible for coverage: tourists transients visitors students other than Manitoba residents Students temporarily absent from other countries or other provinces and territories in Canada to attend educational institutions in Manitoba are not eligible for registration with the Manitoba Health Plan. I'm new to Manitoba. How do I apply for coverage?

3 If you are eligible (i.e., legally entitled to be in Canada and live in Manitoba for at least 183 days of the year), coverage will begin on the first day of the third month after your arrival in Manitoba. For example, if you arrive on April 29, April will count as the first month, with May and June as the following two. Therefore, in this case your coverage would begin July 1. When you register, Manitoba Health requires your Social Insurance Number, previous health card, birth certificate and/or driver s license. Until your health coverage begins you should maintain your coverage with your previous health plan. Please report changes such as a new address, birth, adoption, death, marriage, divorce, or legal separation to the Insured Benefits Branch. Documentation is required for some changes. Where can I register for Manitoba Health coverage? Client Service Centre Manitoba Health 300 Carlton Street Winnipeg, Manitoba R3B 3M9 For more information call: (204) Fax: (204) Toll free: TDD/TTY: (204) TDD/TTY Relay Service outside Winnipeg: 711 or or City of Winnipeg 510 Main Street Winnipeg, MB R3B 1B9 or Rural areas: Contact the city or municipal office in your area. For more information, call toll-free For TTY/TDD, call 711 or Remember: It is an offence to allow anyone, other than those listed on your registration certificate, to use your certificate.

4 I'm new to Canada. How do I apply for coverage? If you are a new resident and would like to apply for Manitoba Health coverage, please present your passport and all other original Citizenship and Immigration Canada documents which have been issued to you and your dependants. Providing the document you have been issued is acceptable as outlined in The Health Services Insurance Act, you may be eligible for coverage. Who is eligible for Manitoba Health coverage? Returning Canadians You are eligible for coverage the day you arrive in Manitoba, when proof of your Canadian citizenship and residence status are provided. Permanent Resident You are eligible for coverage on your date of arrival in Manitoba or the date permanent residence is granted. Work Permit If your Work Permit is valid for at least 12 months in Manitoba, you and any family members listed on the Work Permit, are eligible for coverage as of the date it was issued. If your Work Permit is less than 12 months, you are not eligible until you receive an extension allowing you to stay in Manitoba for at least 12 months. You will then be covered as of the date of extension. Visitor/Student Record You are not eligible for coverage unless you are accompanying a spouse or parent who has a Work Permit valid for 12 months or more. The Visitor/Student Record must be valid for at least 183 days. Dependants who reach the age of 18 must be attending a recognized educational institution or have a Work Permit to be eligible for further benefits. Where can I register for Manitoba Health coverage? Client Service Centre Manitoba Health 300 Carlton Street Winnipeg, Manitoba R3B 3M9 For more information call: (204) Fax: (204) Toll free: TDD/TTY: (204) TDD/TTY Relay Service outside Winnipeg: 711 or or

5 City of Winnipeg 510 Main Street Winnipeg, MB R3B 1B9 or Rural areas: Contact the city or municipal office in your area. For more information, call toll-free For TTY/TDD, call 711 or I lost my Manitoba Health Card. How do I replace it? If your Manitoba Health card is lost, stolen, or damaged, please contact the Insured Benefits Branch immediately for replacement. What medical services are insured by Manitoba Health? Manitoba Health directly pays physicians services that are medically required for you or your dependants. If you are a Manitoba resident, and are physically present in the province for 183 days, you are eligible for insured medical services. Benefits include the following services: Patients who are billed for insured services by physicians who practice outside the plan are entitled to reimbursement from Manitoba Health Physicians services Surgery / anaesthesia X-ray and laboratory services in approved facilities when ordered by a physician What other practitioners services am I insured for? Optometrists If you are under 19 years of age or 65 and over you may receive one complete routine eye exam every two years. Exams for all ages will be covered if deemed medically necessary by your physician or optometrist.

6 Chiropractors Manitoba Health will insure a maximum of 12 visits per Manitoba resident per calendar year. The adjustment of the spinal column, pelvis and extremities are insured chiropractic services. Dental Surgeons Manitoba Health will insure certain dental procedures when hospitalization is required. Which hospital services are insured? You are insured for the following hospital services: Accommodation and meals at the standard level Necessary nursing services Laboratory, x-ray and diagnostic procedures Medications administered in a hospital Use of the operating room, care room and anaesthetic facilities Routine surgical supplies Occupational, speech and physiotherapy Dietetic counselling What insured benefits are available to personal care home residents? If you have always lived in Manitoba, you are eligible for personal care home benefits. If you are a newcomer to Manitoba you are eligible after living in the province for 24 consecutive months. If you formerly lived in Manitoba for 30 years or more you are eligible on the date you return to Manitoba as a permanent resident, after an absence of less than 10 years. The waiting period requirement does not apply to a person who has been a resident of a province or territory of Canada for five consecutive years and immediately establishes himself or herself as a resident of Manitoba. The need for placement in a Manitoba personal care home is determined by an assessment panel authorized by Manitoba Health. If a Manitoba assessment panel determines that you require care in a personal care home and you meet the residency requirements, you may receive insured benefits.

7 Some of these benefits include: standard accommodation basic nursing care assistance with and/or supervision of the activities of daily living physiotherapy and occupational therapy medical and surgical supplies prescribed drugs and related preparations approved by Manitoba Health meals including special diets laundry and linen services For more information on any of the above programs contact: Client Service Centre Manitoba Health 300 Carlton Street Winnipeg, Manitoba R3B 3M9 For more information call: (204) Fax: (204) Toll free: TDD/TTY: (204) TDD/TTY Relay Service outside Winnipeg: 711 or Everyone who lives in a Manitoba Personal care home is required to pay a daily residential fee established by Manitoba Health. For details write or telephone: Residential Charge Program Financial Services Manitoba Health 300 Carlton St. Winnipeg MB R3B 3M9 Telephone: (204) What health services are not insured? Services not insured include the following: personal care home benefits outside of Manitoba

8 health services performed at the request of a third party, such as examinations for employment, drivers' licences, insurance, travel, immigration or emigration care and treatment covered by the Workers' Compensation Board, the Department of Veterans' Services or by other statute services that are not medically required preparation of records, reports, certificates or communications, or testimony in a court drugs, medications, vaccines, sera or biological products, materials and surgical supplies, except as provided for under the regulations ambulance and transportation subsidies except as listed in the regulations private nursing additional charges for a private or semi-private room television and radio-telephone services services performed by psychologists and dietitians outside a hospital or institution services performed by chiropodists and podiatrists services performed by audiologists, speech therapists, occupational therapists and physiotherapists in private practice chiropractic services other than adjustments acupuncture telephone advice services provided by any other practitioner in the healing arts except as listed in the regulations Effective April 1, 1996 routine complete eye examinations for persons 19 years of age or older but under the age of 65 Effective August 1, 1996 chiropractic treatments as a result of a motor vehicle accident covered by Manitoba Public Insurance services such as examinations, laboratory tests, x-rays and other procedures related to uninsured services If I need an ambulance, is it covered by Manitoba Health? Manitoba Health will cover medically-necessary, land ambulance inter-facility transports when patient is being transported between designated health-care facilities for diagnostic tests or treatment, or from a more specialized level of care to another facility closer to home for rehabilitation or recovery. Eligibility criteria for coverage of inter-facility medical transports includes: the patient must be a resident of Manitoba with a valid Manitoba Health card, the patient must medically require transportation by ambulance as determined by a physician, and

9 the patient is being transferred between designated health-care facilities for diagnostic tests or treatment, or from a more specialized level of care to another facility closer to home for rehabilitation or recovery. Consistent with practices in many other provinces, patients will still be responsible for emergency ambulance transportation costs. These costs may be covered by other insurance coverage. First- or third-party insurers will continue to cover these services for their clients. Examples of first- or third-party insurers include the Royal Canadian Mounted Police, National Defence, the Worker's Compensation Board and Manitoba Public Insurance. Out of Province Transport of Manitobans If you require an ambulance while out of the Province there are no subsidies/coverage from the Manitoba government. You will be charged by the ambulance service/company that provides the service at full cost recovery. The rate for out of province ambulance service may be substantially higher than rates charged local residents, as local subsidies will not apply. A Manitoba ambulance may transport you if you require routine medical care in a bordering province to a neighbouring provincial facility. Ambulance costs would be billed at local Manitoba rates. Manitoba Physicians in border areas should be aware that referrals to neighbouring provinces may have significant financial consequences to you, the patient. Should the physician in the bordering hospital elect to refer you for specialized care within that province, you would be subject to the full cost recovery fee charged by that Province at a non-resident rate for transport. Transportation costs from out of province hospitals are not an insured service. Air Ambulance Transfers Air ambulance transfers may be an insured service in one of three ways: 1. Patients meeting the acuity requirements for transportation under the Manitoba Lifeflight Air Ambulance program are fully insured for the air component of the transport but are responsible for all costs associated with land ambulance transport to and from the airport 2. Patients located north of the 53 rd parallel qualify for the Northern Patient Transportation Program for medically necessary transportation 3. First nation residents living on reserves may also qualify for medical air or land transportation under federal programs Physicians are encouraged to contact Manitoba Health Out-of-Province claims or Lifeflight prior to referring any patient to an out of province hospital.

10 Am I eligible for the Northern Patient Transportation Program? You may be eligible for northern transportation subsidy to help pay for transportation costs if you live north of the 53 rd parallel in Manitoba and are required to travel long distances for specialty medical care. For more information about the Northern Patient Transportation Program, please click here. I'm moving away from Manitoba. Is my health care still covered? Moving from Manitoba permanently: If you are leaving Manitoba permanently, you should apply to the Insured Benefits Branch for an Out-of-Province Certificate. You will be eligible for coverage: If you are moving to another province or territory Coverage by the Manitoba Plan is provided for the remainder of the month in which you arrive at your new residence plus two additional months (except personal care home benefits). Immediately on arrival be sure to contact the health insurance plan in the new province of residence to arrange for continuity of coverage. If you are moving to another country Coverage by the Manitoba Plan is provided for the remainder of the month in which you leave Manitoba, plus two additional months. If you are a student leaving Manitoba to study, please click here. Moving for a temporary employment opportunity: If you are employed outside of Canada with plans to return, you must provide Manitoba Health with a copy of your work contract that indicates the length of your work term. If you intend to return to Manitoba, Manitoba Health may extend your coverage for up to 24 months. Note: If you plan on taking your spouse or children with you, please inform Manitoba Health to ensure their continued coverage. Taking a vacation, or an extended leave, but plan on returning:

11 To remain eligible for Manitoba Health coverage, you must be present in Manitoba for at least 183 days of the calendar year, which do not have to be consecutive. In this event, apply for a term certificate. If you plan to be away for longer than 90 days, please contact Manitoba Health for more information. If you are planning on moving, either temporarily or permanently, and wish to apply for continued health coverage, please contact Manitoba Health at: Registration Manitoba Health 300 Carlton Street Winnipeg, MB R3B 3M9 For more information call: (204) Toll free: FAX: (204) TTY/TDD: (204) TDD/TTY Relay Service outside Winnipeg: 711 or Please note: We recommend you explore private insurance options along with your Manitoba Health coverage. What if I have to see a doctor while in another province? Manitoba has agreements with all Canadian provinces (except Quebec) to allow physicians to bill your provincial health plan, although some physicians may choose to bill you directly. If you are admitted to an approved hospital anywhere in Canada, Manitoba Health will pay the standard rate. Because some services are excluded, you are encouraged to obtain additional health insurance before travelling. Contact Manitoba Health for more information. Note: You must show your Manitoba Health card to the doctor or hospital. Am I covered for emergency care outside of Canada? Doctor Bills - Manitoba Health will pay for emergency doctors services outside of Canada at a rate equal to what a Manitoba doctor would receive for a similar service. Hospital Bills - Emergency hospital care is paid on an average daily rate established by Manitoba Health.

12 You may be charged more than the amount paid by Manitoba Health for services provided outside Canada. The difference above the covered amount may be substantial and is your responsibility. Bring or mail your original bill to the Out-of-Province Claim Section at Manitoba Health within 6 months of receiving care. If you have made payments on your bills, Manitoba Health requires a receipt showing the amount paid. If you do not include your receipt, Manitoba Health will pay the hospital or doctor directly. For more information contact: Manitoba Health 300 Carlton Street Winnipeg, MB R3B 3M9 For more information call: (204) Toll free: Ext TDD/TTY: TDD/TTY Relay Service outside Winnipeg: 711 or I m a student. What do I have to do to maintain Manitoba Health coverage if I study in another province, territory, or country? Any Manitoba resident who leaves the province temporarily to attend an accredited educational institution is eligible, provided the following requirements are met. If you are a Manitoba resident leaving the province to attend school on a full-time basis, the following letters must be provided to Manitoba Health prior to your departure: 1. A letter from you requesting continued coverage from Manitoba Health. This letter should contain your full name, permanent Manitoba address and temporary new address, the date of departure and expected date of return to Manitoba, Manitoba Health number, and the names of any family members accompanying you. 2. A letter from an accredited educational institution confirming your full-time attendance and duration of studies. You must reapply for coverage and provide confirmation for each subsequent year. After these letters are received, a term certificate confirming your eligibility during your absence will be sent to you. Where can I send/drop off my materials?

13 Manitoba Health 300 Carlton Street Winnipeg, Manitoba R3B 3M9 For more information call: (204) FAX: (204) Toll free: TDD: (204) TDD/TTY Relay Service outside Winnipeg: 711 or What happens if I need to see a doctor or receive medical attention? In Canada: Show your Manitoba Health card to the physician. The physician will either bill Manitoba Health directly for the services, or bill you, in which case you need to obtain an itemized receipt. Manitoba Health will pay you according to that province or territory s fee schedule rate. Outside Canada: Payment of the bill may be your responsibility. Submit your original receipt to Manitoba Health for consideration of payment. You will be reimbursed according to the rate which would have been paid had the same care been received in Manitoba. Please note: It is recommended you obtain additional medical insurance before leaving. The Manitoba Health Services Insurance Plan is financed from general revenues of the Province of Manitoba and with funds provided by the Government of Canada. All statements are subject to the provisions of The Health Services Insurance Act and Regulations. For more information: Insured Benefits Branch Manitoba Health 300 Carlton Street Winnipeg MB R3B 3M9 CANADA Phone Numbers: Voice: (204) Toll Free: Fax: (204) Deaf Access Line TTY/TDD: (204) Residents within the province from outside Winnipeg: Deaf Access Line TTY/TDD: Call the Manitoba Relay Service at 711 or to reach the above number. Manitoba Pharmacare Program: Voice: (204)

14 Toll-Free: Health Care Abuse/Fraud Line: Voice: (204) Toll-Free: Is Your Question Still Not Answered? the Insured Benefits Branch Residents should carry their registration certificate (Manitoba Health card) at all times to present when they or their dependants require health services.