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Appendix 3

EXCLUSIONS UNDER THE RECIPROCAL AGREEMENTS

Effective April 1, 1989

Medical Practitioners in other Canadian provinces and territories (except Quebec) are encouraged to bill reciprocally rather than bill the beneficiary directly. The following are medical services excluded under the inter-provincial agreements for the reciprocal processing of out of province medical claims:

  • Surgery for alteration of appearance (cosmetic surgery)

  • Gender reassignment surgery

  • Surgery for reversal of sterilization

  • Therapeutic abortions

  • Routine periodic health examinations including routine eye examinations

  • In-vitro fertilization, artificial insemination

  • Acupuncture, acupressure, transcutaneous elector-nerve stimulation (TENS), moxibustion, biofeedback, hypnotherapy

  • Services to persons covered by other agencies: RCMP, Armed Forces, Worker's Compensation Board, Department of Veteran's Affairs, Corrections Services of Canada (federal penitentiaries).

  • Services requested by a "third party"

  • Team conferences

  • Genetic screening and other genetic investigations including DNA probes

  • Procedures still in the experimental or developmental phase

  • Anaesthetic services and surgical assistant services associated with all of the foregoing

  • Supplementary practitioners’ services, (e.g. chiropractic, physiotherapy, naturopathy)

  • Oral surgery/dental surgery may be reimbursable however the scope of treatment may vary according to terms of other individual provincial benefit plans.

_________________________________________________________________________________________________________

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

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