Health PEI
Health PEI: Summary of Benefits
Prince Edward Island offers residents the Health PEI provincial healthcare plan, which covers basic hospital and medical treatment as well as other benefits. The following summarizes Health PEI coverage. Affordable Health & Dental Plans.
Coverage Summary
To be eligible all insured services MUST BE medically necessary.
Most physician services in a doctor’s office, hospital or home.
Surgical services if necessary.
Obstetrical services (e.g. pre-natal and post-natal care).
Certain oral surgery when performed by an oral surgeon in a hospital when medically required.
Male and female sterilizations; reversals are not insured.
Treatment of dislocations and fractures.
Certain insured specialist services when referred by an attending physician.
Services Covered by Health PEI
Services Not Covered by Health PEI
Doctor’s travel time.
Immunizations (e.g. for travel and the flu shot).
Third-party examinations.
Telephone advice or prescriptions given over the phone.
Routine dental services such as examinations, fillings, cleanings and extractions (unless medically necessary and done in hospital).
Any cosmetic surgery that is not medically required.
Eye glasses, lenses and medical appliances such as hearing aids and artifical limbs.
Acupuncturists, acupressurists, audiologists, chiropodists, chiropractors, dieticians, homeopaths, naturopaths, optometrists, physiotherapists, podiatrists, osteopaths, and services done by a dentist.
There are ambulance user fees, unless an ambulance is considered “urgent” and the resident is a senior (65+ years old). For more information go here.
Please notify Health PEI if you are traveling out-of-province for more than one month. This will help to avoid any delay in payment for an out-of-province service. In addition, know that for out-of-country medical costs, Health PEI may not pay the full costs you incur (for this reason, private travel insurance is recommended when travelling).
Hospital Services
Covered Hospital Services
Meals and accommodations at the standard ward rates (semi-private and private rooms are covered at the standard ward rate).
Nursing services that are medically necessary.
Laboratory, x-rays and diagnostic procedures.
Radiotherapy and physiotherapy.
Operating room, routine surgical supplies, and anesthetic facilities.
Drugs that are prescribed by a doctor and administered in a hospital.
Surgical supplies.
Not Covered Hospital Services
Ambulance user fees within the province; all ambulance fees outside of the province.
Some prosthetic devices, crutches.
Dental extractions, unless patient is medically required to be in hospital or unless there is prior approval.
Semi-private and private rooms.
Covered Homecare Services
Nursing care (IV therapy, injections, wound care, etc.).
Home support assistance with daily living activities such as dressing and bathing.
Palliative care.
Dietician (e.g. diet) assistance.
Physiotherapy: to help with independence, mobility and overall function.
Occupational therapy (includes help modifying the home with special devices that assist with daily living).
Adult protection.
Long-term care: assessment for admission to nursing homes.
Adult day programs.
Drug Programs
Generally speaking, prescription drugs are not covered by Health PEI. However, you may be eligible for full or partial coverage of prescription drug costs if you are a senior, meet some financial criteria, and/or have a specific disease. Just some of the drug programs available are:
AIDS/HIV Drug Program
Catastrophic Drug Program
Children in Care Drug Program
Community Mental Health Drug Program
Cystic Fibrosis Drug Program
Diabetes Drug Program
Erythropoietin Drug Program
Family Health Benefit Drug Program
Financial Assistance Drug Program
Generic Drug Program
Growth Hormone Drug Program
Hepatitis Drug Program
High Cost Drug Program
Home Oxygen Program
Immunization Program
Institutional Pharmacy Program
Insulin Pump Program
Meningitis Drug Program
Nursing Home Drug Program
Nutrition Services Program
Phenylketonuria (PKU) Supplement Program
Quit Smoking Drug Program
Rabies Vaccine Program
Seniors Drug Program
Sexually Transmitted Disease Drug Program
Transplant Anti-Rejection Drug Program
Tuberculosis Drug Program
