Nova Scotia Provincial Health Insurance Plan

 

Nova Scotia's Health Insurance Programs are designed to provide eligible residents with coverage for medically required hospital, medical, dental, and optometric services with some restrictions.

 

The Medical Services Insurance Programs are administered by Medavie Blue Cross on behalf of the Nova Scotia government.

 

As of August 1, 2014, Nova Scotia residents are permitted out of the province for vacation by one additional month. This will allow Nova Scotians to have a vacation outside of the province for 7 months in each calendar year and continue to be eligible for Medical Services Insurance (MSI).

DENTAL
- What is covered: The Medical Services Insurance (MSI) currently covers some basic dental care services for children from birth up to the end of the month in which they turn 15. Once a year, the program covers: One routine dental exam; One fluoride application (a second application may be eligible in some cases); Two routine x-rays. In addition to the above, one preventive service – for example, brushing and flossing instruction, and/or cleaning. Molar sealants, fillings, and necessary extractions are also covered by the program.  Coverage through the Dental Surgical program for certain surgical-dental procedures that are medically necessary to be performed in a hospital. Special programs for residents with a cleft palate, and for the mentally challenged.
- What is NOT covered: Medical Services Insurance (MSI) does NOT cover routine dental services (e.g. cleanings, fillings, scalings, etc.) with the exception of people under the age of 15.

DRUGS
- What is covered: Under the Seniors’ Pharmacare Program: Coverage for residents aged 65 and over who are not covered by private extended health insurance. Seniors pay an annual maximum premium of $424 and a copayment of 30% of the cost of each prescription. The annual maximum of co-payment is $382. Seniors receiving the Guaranteed Income Supplement are exempt from paying the premium. Some coverage is available under the Family Pharmacare program for families who have no drug coverage or if the cost of prescription drugs becomes a financial burden. The annual out-of-pocket cost is capped at a percentage of family income.

TRAVEL INSURANCE
- What is covered:  Emergency services obtained outside Canada are paid at Nova Scotia health insurance rates. The current rate for emergency in-patient services is $525 per day plus 50% of ancillary fees incurred while an in-patient.
- What is NOT covered: The Medical Services Insurance (MSI) only pays for emergency services obtained outside Canada. Out-patient services received outside Canada are NOT covered under the provincial health insurance plan. Residents are cautioned that charges for insured services are considerably higher outside Canada. Payment for any difference between the fee charged and the MSI payment is the responsibility of the patient. Residents visiting other countries are advised to obtain private medical insurance for the period that they are absent from Nova Scotia.

VISION
- What is covered: Nova Scotia provincial health insurance plan covers routine vision analysis once every two years for children under age 9 and seniors aged 65 and over. Optometric exam and continuing care covered if referred by a physician or ophthalmologist.
- What is NOT covered: Vision care (e.g. glasses, contact lenses, and eye examinations for residents aged 10 to 64) are NOT covered by the provincial healthcare insurance.

PARAMEDICAL
- What is covered: Coverage for physiotherapy when performed in a hospital.
- What is NOT covered: Medical Services Insurance (MSI) does NOT cover chiropractors, optometrists, podiatrists, naturopaths, osteopaths, physiotherapists in non-hospital facilities, or other paramedical personnel.

HOSPITAL ROOM
- What is covered: Coverage for standard ward rooms only. The following inpatient services are insured: Accommodation and meals at the standard ward level; All necessary nursing services; All laboratory, X-ray, and diagnostic procedures; All drugs prescribed by the physician or dentist and administered in the hospital; Operating room, case room, and anesthetic facilities; Routine surgical supplies; Radiotherapy services; Physiotherapy services; Blood or therapeutic blood fractions.
- What is NOT covered: Private and semi-private hospital accommodation is not covered under the provincial health insurance plan.

PRIVATE DUTY NURSING AND MEDICAL EQUIPMENT
- What is covered: Medical Supplies - Coverage for eligible residents when deemed necessary by a physician: a replacement prosthetic once every 2 years for residents age 17 and younger; once every 4 years for residents age 18 and older. Mastectomy prosthesis up to a maximum of $150 per prosthesis once every two years. Insulin Pump Program covers for families with lower incomes, the cost of insulin pumps and pump supplies for residents who are age 25 years old or younger (new as of April 2015). Home care is provided for residents of all ages through the Department of Health’s Continuing Care program. Eligibility is based on a needs assessment. Caregiver allowance of $400/month for those meeting eligibility criteria.
- What is NOT covered: Durable medical equipment such as crutches or wheelchairs; most orthotic and prosthetic appliances except those insured under the MSI Prosthetic Services Program that insures for limb prostheses, ocular prosthesis and mastectomy prosthesis.

HEARING AIDS
- What is covered: Hearing aids for children up to 21 years of age (who are in an educational setting) are provided at wholesale cost through the Atlantic Provinces Special Education Authority (APSEA).
- What is NOT covered: No coverage for hearing unless you are eligible for a supplemental provincial health insurance program.

AMBULANCE
- What is covered: Transportation fee for residents is $146.55.
- What is NOT covered: Nova Scotia health insurance plan does NOT cover ambulance services or other transportation except interfacility transit.

Helpful links:

- Nova Scotia Health and Wellness programs and services

- Nova Scotia Formulary

 

Visit www.ExtendedHealth.ca or call toll free 1-877-838-0020 to get a quote or apply for Extended Health care insurance.

 

 

 

IMPORTANT NOTE: The information on this web page is for illustration purposes only. Every effort has been made to ensure the accuracy of the information. Coverage details are subject to change. For complete benefits, terms, conditions, limitations, and exclusions, please contact the Nova Scotia Department of Health.

 

Last revised in September 2020.