Newfoundland Medical Care Plan
Newfoundland Medical Care Plan: Summary of Benefits
The Newfoundland and Labrador public healthcare plan is called the Newfoundland Medical Care Plan (MCP). Please use the following as a brief summary of MCP coverage and benefits
Coverage Summary
Services Covered by Newfoundland Medical Care Plan
Medically necessary physician and hospital visits (accommodations and meals).
Home visits may also be covered.
Surgical, diagnostic and therapeutic procedures (including anesthetic supplies and services).
Medically necessary pre-care and post-care.
Maternity care.
Radiology (X-ray) interpretive services.
Some medically necessary dental-surgical procedures when performed in a hospital by a dentist or oral surgeon.
The only dental services that are covered for all residents regardless of age are surgical procedures that are deemed medically necessary (via the Surgical Dental Program). For these services to be covered they must be performed in a hospital by a dentist or an oral surgeon. Note that there are exceptions if you qualify for one of the specialty programs listed below.
Services Not Covered by Newfoundland Medical Care Plan
Physician travel times and any related expenses.
Prescription drugs and vaccines (drug coverage MAY be available if you qualify for the Prescription Drug Program, see below).
Medical examinations required by a third party.
Advice from a doctor over the phone.
Eye examinations (for corrective lenses), glasses and contact lenses.
Paramedical services e.g. acupuncture, chiropractor, optometrist, osteopath, naturopath, podiatrist and physiotherapist services.
Services that are not medically required such as cosmetic surgeries.
Reversal of a sterilization procedure.
Sex changes UNLESS recommended by the Clarke Institute of Psychiatry.
Routine dental services (e.g. cleanings, scalings, fillings, etc.) UNLESS you are covered by one of the specialty dental programs listed below.
Hypnotherapy.
Drug and alcohol addiction treatment OUTSIDE of Canada.
Ambulance services: there is a standard $115 fee per ground ambulance trip and $130 fee for an air ambulance trip. Residents receiving Income Assistance MAY have the ground cost covered by the Department of Human Resources, Labour and Employment.
Other Programs
Special Assistance Program
This is a special provincial program that offers assistance to qualified residents for basic medical supplies and equipment that assists with day-to-day tasks and activities. For eligibility information please click here.
Children’s Dental Health Program
Coverage for children under the age of 13 years old.
Examination every 6 months.
Cleaning every 12 months.
Fluoride treatments every 12 months (unless child has access to the School Rinse Program).
Extractions and fillings that are routine.
Sealant treatments.
Low Income (Access) Program
Available to teens aged 13 – 17 years old who are enrolled in the Access Plan of the Newfoundland and Labrador Prescription Drug Program (NLPDP).
Similar benefits and ineligible services as those receiving Income Support Program (see above).
Routine extractions and fillings.
Some things that are not covered by this program are:
Extraction of impacted teeth.
Sealants.
Cleanings.
Adult Dental Program
Only available to adults enrolled in the Foundation Plan (part of Newfoundland and Labrador Prescription Drug Program.
Covers routine services along with standard dentures. Basic services available every 3 years, while dentures are available once every 8 years.
No coverage for any preventive services (e.g. cleanings or fluoride treatments).
Covers an examination and two x-rays every three years.
MCP Covers routine fillings every three years.
Covers extractions along with standard dentures
Income Support Program
Available to teens aged 13 – 17 years old whose family is receiving Income Support.
Examinations every other year.
Routine extractions and fillings.
Doesn’t cover: removal of impacted teeth; fluoride and cleanings; or sealants.
Prescription Drug Program (NLPDP)
Generally speaking, prescription drugs are not covered unless they are administered in a hospital. However, financial assistance for drug coverage is provided by the Newfoundland and Labrador Prescription Drug Plan for residents of the province who are eligible for:
The Foundation Plan: 100% coverage for people who are in financial need (for example, those receiving financial support from the government).
The 65Plus Plan: for seniors aged 65 and up who receive OAS (Old Age Security Benefits) and GIS (Guaranteed Income Supplement). Note that people who qualify for the 65Plus Plan also automatically qualify for the “Ostomy Subsidy Program” (for ostomy supplies).
The Access Plan: access to eligible prescription drugs by individuals/families with low incomes. Eligibility as follows:
Families with children (includes single parents) who have a net annual income of $42,870 or less.
Couples with no children who have a net annual income of $30,009 or less.
Single residents who have a net annual income of $27,151 or less.
The Assurance Plan: for individuals/families experiencing high drug costs when compared to income. Coverage based on the following:
5% or more of net income spent on drugs when earning less than $40,000.
7.5% or more of net income spent on drugs when earning $40,000 to $74,999.
10% or more of net income spent on drugs when earning $75,000 to $149,999.
The Select Needs Plan: 100% coverage for residents with disease-specific medications who suffer from cystic fibrosis or growth hormone deficiency.
Newfoundland Hospital Insurance Plan
Services Covered by the Hospital Insurance Plan:
Accommodations and meals at standard rates. Semi-private or private rooms only covered if medically necessary or if a standard room is not available.
Nursing services.
Diagnostic procedures, i.e. laboratory, x-rays, nuclear medicine, respiratory therapy.
Drugs, medical and surgical supplies.
Rehabilitative services such as physiotherapy, audiology, speech therapy and occupational therapy.
Labour, delivery and operating room.
Radiotherapy isotopes and services (if available).
Surgical and medical day procedures.
Rehabilitative services such as physiotherapy, audiology, speech language and occupational therapies.
Anti-rejection drugs for transplant patients (e.g. AZT for people with HIV/AIDS).
Various lab, X-ray and diagnostic procedures.
Services Not Covered by the Hospital Insurance Plan:
Ambulance services except for inter-hospital transfer.
In vitro fertilization and other procreative treatments.
Drugs and appliances for use outside of hospital, unless specifically covered via the Insured Outpatient Services.
Private duty nursing.
Services without specific medical indication i.e. x-rays for cosmetic procedures, etc.
Preferred accommodations (semi-private and private hospital rooms).
RCMP and Canadian Armed Forces members who are otherwise covered by some federal insurance program.
Bedside devices like TVs, radios and telephones, unless used for teaching purposes.
