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MEDICAL SERVICES COMMISSION OUT OF PROVINCE AND OUT OF COUNTRY MEDICAL CARE GUIDELINES

A. PREAMBLE

The primary purpose of the Medicare Protection Act is "to preserve a publicly managed and fiscally sustainable health care system for British Columbia (BC) in which access to necessary medical care is based on need and not an individual's ability to pay."

The Medical Services Commission (“MSC”) has authority pursuant to the Medicare Protection Act, R.S.B.C. 1996 c.286, s.29, the Medical and Health Care Services Regulation, B.C. Reg.426/97, s.35, the Hospital Insurance Act, R.S.B.C. 1996 c.204, s.24 and the Hospital Insurance Act Regulations, B.C. Reg. 25/61, s.6, to give prior written approval for elective (non-emergency) medically necessary out of country medical care. This includes dental/oral surgical services for beneficiaries of the Medical Services Plan (MSP) when such services are provided by licensed medical practitioners*, dental/oral practitioners or a facility approved by the MSC. The actual administration of the prior written approval process is conducted by the Medical Services Branch (MSB), and its service provider Health Insurance BC on behalf of the MSC.

The purpose of these Guidelines is to clarify the criteria used when considering provincial funding for emergency or elective out of country medical services.1 The underlying objective of the Guidelines is to ensure funding decisions do not encourage beneficiaries or physicians to bypass appropriate and acceptable medical services in BC and elsewhere in Canada. The Guidelines are administered in a manner consistent with the Medicare Protection Act, the Medical and Health Care Services Regulations, the Hospital Insurance Act and the Hospital Insurance Act Regulations.

In order for elective out of country medical care to be funded, prior written approval must be provided by MSB. In cases where out of country funding is appropriate, the pre-approval process enables MSB to negotiate a reasonable and fair compensation rate from out of country service providers prior to the provision of the service.

  • B.

    PRIOR APPROVAL NOT REQUIRED FOR CERTAIN CATEGORIES OF CARE

    • 1.

      OUT OF PROVINCE (WITHIN CANADA) MEDICAL CARE:

Prior approval is not required for medically necessary care obtained by a beneficiary in another province or territory of Canada.

Medical coverage is portable in Canada. A resident of BC who is eligible for MSP coverage may use medically necessary services in another province or territory within Canada. The medical services must be medically necessary, insured services that are provided by a physician who is entitled to practice medicine in the province where the services are obtained. Medical services in other provinces will be paid at the appropriate provincial rates without prior approval unless otherwise stipulated by a reciprocal agreement*. (see Appendix 3, Exclusions under the reciprocal agreements.)

1 The terms “emergency” and “elective” refer to provincial coverage, rather than to the level of urgency for medical care. Provincial coverage for emergency medical treatment applies to a BC resident who unexpectedly requires medical care while travelling in another country. Provincial coverage for elective medical treatment must be pre- approved for a BC resident who travels to another country for the purpose of obtaining a medical treatment.

  • *

    Terms with an asterisk are defined in Appendix 1

_________________________________________________________________________________________________________

Medical Services Commission Out of Country Funding Guidelines January 19, 2011

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