CSA Special Report 2002 - Member Update

CSA Special Report 2002

Member Update

Our National Evaluation is now underway and we are addressing some interesting "grey areas" which appear in provincial residency requirements. One of the CSA's advocacy focuses is to clarify permissible travel within Canada once the designated out-of-country portion has been used. Our legal team at Blake, Cassels and Graydon has sent letters to the provinces asking for concise answers as to the provinces' application of these laws and regulations.

The CSA has received several letters, primarily from provincial health ministers, which allow for more freedom of travel within Canada than that outlined below. Our National Evaluation will present the results of these inquiries.

The following table outlines the provincial residency requirements necessary to maintain provincial health care coverage:

PROVINCE	*STRICT INTERPRETATION OF WORDING/POLICY**
British Columbia	To maintain "residency," a person must not leave B.C. for any length of time over 24 hours for any reason, once that person has been physically absent from the province for six months (182-3 days). For any time over six months spent outside of B.C. but within Canada, approval may be granted any time for an "extension," so long as a person can prove that he/she maintained "residency" in the province. For any time spent outside of B.C. for the purpose of either working or vacation, approval may be granted once every five years for an "extension," so long as either of the conditions of presence in B.C. or in Canada at the time of departure is met.
Alberta	To maintain "residency" in Alberta, a person must not leave Canada for longer than six consecutive months and/or must not leave Alberta for another province for longer than 12 consecutive months
Saskatchewan	Technically, in order to maintain "residency," a person should not leave Saskatchewan without approval for more than 24 hours once that person has been physically absent from the province for six months (182-3 days). However, in practice, we have been advised that the Saskatchewan government does not require that people obtain approval for short-term absences (the government has not defined a short-term absence, but less than 7 days would likely be safe) from the province once they have been out of the province for six months.
Manitoba	To maintain "residency," a person must not leave Manitoba for any period longer than 24 hours once that person has been physically absent from the province for six months (182-3 days).
Ontario	To maintain "residency," a person must not leave Ontario for any period longer than 24 hours once that person has been physically absent from the province for 212 days. Extensions to the period of absence may be approved every three years.
Quebec	To maintain "residency," a person must not leave Quebec for any period longer than 21 days once that person has been physically absent from the province for 183 days. Once every seven years, an extension of the allowable period of absence may be granted, up to a maximum 12-month period.
New Brunswick	At present, an individual must live in-province for a minimum of 183 consecutive days per year in order to ensure uninterrupted Medicare coverage. New Brunswickers wishing to be absent from the province for any length of time beyond the 182 days allowed annually must obtain prior approval from New Brunswick Medicare before leaving the province.
Nova Scotia	A person who is legally entitled to remain in Canada and who makes his home and is ordinarily present in Nova Scotia, but does not include a tourist, a transient, or a visitor to Nova Scotia..."ordinarily present" is interpreted as more time spent in Nova Scotia (183 days) than outside the province (not just Canada, must be in Nova Scotia) for each 12-month period.
Prince Edward Island	To maintain "residency," a person must not leave P.E.I. for any period longer than 24 hours once that person has been physically absent from the province for six months (182 days).
Newfoundland and Labrador	According to the Canada Health Act Annual Report, a beneficiary must reside in the province for at least four consecutive months in each 12-month period to qualify as a beneficiary. For out-of-province trips lasting more than 30 days, an out-of-province coverage certificate must be obtained as proof of a resident's ability to pay for services while outside the province.
Yukon, Northwest Territory	A 12-month absence is the usual and acceptable period a resident of the territory is permitted to be absent, so long as a six month period of presence upon return is observed. Written notification must be submitted to the Department of Health and Social Services for periods of absence in excess of 90 days.
Nunavut	Nunavut residents who are temporarily living outside the territory for periods up to 12 months continue to be covered by the Nunavut Health Care Plan. Residents who do not return to Nunavut to reside, on or before the first day following the last day of the 12-month period, risk losing their Nunavut coverage.
*"Strict interpretation" means the interpretation that accords with the language of the statute only, and presumes the government interprets it literally. It is unlikely to be this strictly enforced by any of the provinces or territories.

Prescription Drugs
There is no national standard on prescription medication (under the provincial drug benefit plans) that one can access prior to travelling. Some provinces allow for drug supplies equal to the days out of province; others offer no 'vacation supply' at all. The following table outlines current practices in each province.

PROVINCE	OUT-OF-PROVINCE DRUG POLICIES
British Columbia	No "vacation supply" of drugs. For short-term drug prescriptions and first-time prescriptions for maintenance drugs, Pharmacare coverage is limited to a maximum 30-day supply. The first prescription for a maintenance drug is limited to 30 days, to prevent wastage by ensuring that the drug will be effective in treating the condition. Repeat prescriptions of maintenance drugs are covered for a maximum 100-day supply. There is no provision for reimbursement under the B.C. Pharmacare Program.
Alberta	Depending upon the medication, Alberta Blue Cross will provide approval for up to a six-month supply of prescription drugs purchased prior to leaving Alberta, for clients covered by the Alberta Health and Wellness-sponsored Alberta Blue Cross supplementary health plans. Prescriptions purchased outside the province or country will be reimbursed, for eligible products, when the prescription is written by a licensed practitioner, according to Alberta price policy and benefit coverage. Alberta Blue Cross must be able to confirm that the prescription drug is an eligible program benefit. Reimbursement is subject to all conditions stipulated in the Alberta Health and Wellness/Alberta Blue Cross supplementary health coverage brochures. For travel within and beyond Canada/U.S. borders, if it can be confirmed that the prescription drug is equivalent to a product listed on the Alberta Health and Wellness drug benefit list, reimbursement will be forthcoming according to Alberta price policy and benefit coverage.
Saskatchewan	In most cases, the drug plan will not pay benefits or credit deductibles for more than a three-month supply of a drug at one time. The agreement also contains a list of two-month and 100-day-supply drugs. Prescribing and dispensing should be in these quantities once the medical therapy of a patient is in the maintenance stage, unless there are unusual circumstances that require these quantities not to be dispensed. Original receipts for medication purchased outside of Saskatchewan (and inside Canada) may be submitted upon completion of travel and the cost will be credited towards the deductible, if applicable. If there is no deductible and a patient needs it for insurance purposes, the drug plan will provide a statement for the private insurance company.
Manitoba	Notwithstanding any other provision of this regulation, in any 90-day period, no benefit is payable for more than the following number of days' supply of a specified drug: a) 100; and b) up to an additional 100, if the prior approval of the minister has been obtained, and the person will be outside Canada for more than 90 consecutive days.
Ontario	Ontario Drug Benefit recipients travelling outside the province for between 100 and 200 days may obtain a second 100-day supply of medication before leaving Ontario. The ODB program does not reimburse prescription drugs purchased outside Ontario.
Quebec	At the discretion of prescribing physician and pharmacist. Quebec will not reimburse for medication purchased outside Quebec.
Nova Scotia	Pharmacare will provide up to a 180-day supply of medication with pharmacist and doctor's approval. Seniors who are eligible for Pharmacare coverage through the Department of Community Services are limited to a 100-day maximum. Pharmacare does not pay for prescriptions obtained outside of Nova Scotia.
Newfoundland and Labrador	Newfoundland and Labrador Prescription as written by physician to a maximum of three months. Provincial plan covers the cost of medication purchased in the province.
Prince Edward Island	No "vacation supply" of drugs. Recipients of the Seniors' Drug Cost Assistance Plan may access one prescription's worth of drugs. Depending on the medication, it may be for 30 or 90 days. Receipts for prescription medications purchased elsewhere by those under this plan must be submitted within six months and will be reimbursed at P.E.I. rates.
New Brunswick	Travellers may access a three-month supply of medication and then purchase, at full price, an additional three-month supply. Receipts (along with a letter stating that travel has taken place) may be submitted for reimbursement after three months.
Northwest Territory	One-month supply any additional drugs needed are purchased and the purchaser is reimbursed once travel is completed.
Nunavut	At the discretion of the doctor and pharmacist travellers purchasing prescription medication abroad will be reimbursed at the Canadian rate.
Yukon	Yukon will cover a three-month supply and will reimburse for any additional medication needed once travel is completed.

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