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Under the terms of the appropriate reciprocal agreement, BC will fund the cost of physician and acute care hospital services in other Canadian provinces and territories (except Quebec) provided the service meets the following criteria:

  • a)

    it is medically required;

  • b)

    it is provided by a medical practitioner or oral surgeon entitled to practice in the province

or territory where the service is rendered; and

c)

it would be a benefit if performed in BC unless otherwise stipulated by the terms of the reciprocal agreement.

In other Canadian provinces and territories (except Quebec), medical practitioners are encouraged to bill reciprocally rather than bill the beneficiary directly. In most cases, medical practitioners will bill the provincial health care plan where the service is provided and then BC will reimburse the province or territory where services were provided.

In-patient hospital care at approved acute care facilities outside the province will be reimbursed at the rate established in the reciprocal agreement in accordance with the Hospital Insurance Act and Regulations.

2. OUT OF COUNTRY EMERGENCY CARE:

Prior approval is not required for out of country emergency medical care.

The province provides funding for emergency out of country medical and dental/oral surgical services when immediate medical treatment is necessary and the need occurs unexpectedly when a beneficiary is travelling for business or pleasure or studying outside of Canada.

The coverage for medical services outside of Canada allows payment up to the fee rates that have been established in the British Columbia Medical Services Commission Payment Schedule*, in Canadian funds.

The coverage for in-patient hospital care, when care is provided at an approved acute care facility outside of Canada is limited to the rate established under the Hospital Insurance Act, which is currently a maximum payment of $75 per day, in Canadian funds.

The costs for physician and hospital services outside of Canada are very often considerably more than the provincial fee rates; therefore, beneficiaries are very strongly encouraged to purchase additional insurance when travelling outside of the country.

C.

ELECTIVE (NON-EMERGENCY) OUT OF COUNTRY MEDICAL CARE

In order for the province to consider funding for elective out of country medical care, the attending medical specialist must forward the application for coverage prior to the out of country treatment being provided.

In cases where out of country funding is approved, the prior approval enables the province to negotiate a reasonable and fair compensation rate with the out of country service provider. The application process for out of country medical funding is detailed under Appendix 2, Application and Review Process for Funding of Out of Country Medical Care.

In the rare circumstances when an application is received after the provision of out of country medical services, the beneficiary's specialist must provide the appropriate documentation specified in Appendix 2, Application and Review Process for Funding of Out of Country Medical Care

  • *

    Terms with an asterisk are defined in Appendix 1

_________________________________________________________________________________________________________

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

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