Canada does not have a single national health care plan, but rather a national health insurance program, which is achieved by a series of thirteen interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage. Under the Canada Health Act, our national health insurance 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.
Our national health insurance program is designed to ensure that all insured persons have access to medically necessary hospital and physician services on a prepaid basis. The Canada Health Act defines insured persons as residents of a province. The Act further defines a resident 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.”
Therefore, residence in a province or territory is the basic requirement for provincial/territorial health insurance coverage. 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 residence requirements beyond limiting waiting periods to establish eligibility for and entitlement to insured health services to three months. Most provinces and territories also require residents to be physically present 183 days annually, and provide evidence of their intent to return to the province.
Provincial and territorial health insurance plans are required to provide insured persons with coverage of insured health services, which are: hospital services provided to in-patients or out-patients, if the services are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness, or disability; and medically required physician services rendered by medical practitioners.
Provinces and territories may also offer “additional benefits” under their respective health insurance plans, funded and delivered on their own terms and conditions. These benefits are often targeted to specific population groups (e.g. children, seniors, social assistance recipients), and may be partially or fully covered. While these services vary across different provinces and territories, examples include prescription drugs, dental care, optometric, chiropractic, and ambulance services.