Wednesday, October 26th, 2016

Federal Legislation

The Canada Health Act is the federal health care insurance legislation passed in 1984 outlining the requirements the provinces and territories must meet in order to qualify for federal funding through the Canada Health Transfer.

The act contains the following criteria and conditions:

Five Criteria (Sections 8-12):

 1) Public administration – The health care insurance plan must be administered by a public authority on a non-profit basis. The public authority is subject to public audits of its accounts and financial transactions.

 2) Comprehensiveness – The plan must cover all insured (medically necessary) health services provided by hospitals, doctors or dentists and any other services by any other health care providers as determined by provincial laws.

 3) Universality – Health care insurance for insured health services must be provided to all residents on uniform terms and conditions. 

 4) Portability – The plan must cover insured health services for residents who are temporarily away from their province/territory or the country. A provincial/territorial health insurance plan may require that a resident obtain prior approval from the public authority responsible for administering plan within their province/territory for any elective (non-emergent) insured health services received out-of-province or out-of-country.  

Individuals relocating are covered by their home province until the coverage of their new province of residence becomes effective. The waiting period for initial eligibility for health coverage in their new province cannot exceed 3 months. 

Payment for health services in another province is made at rates agreed to by the province/territory providing the service or by some other mutual agreement between the insuring province and the servicing province. Payment for out-of-country services is made at the rate that would normally be incurred in the insuring province.    

 5) Accessibility – The plan must provide residents with insured health services on uniform terms and conditions and ensure reasonable access to services without financial or other barriers. The plan must also provide payments to hospitals and medical practitioners or dentists for insured health services as determined by its provincial/territorial laws.

 2 Conditions (Section 13):

 1) The provinces and territories must submit information on insured and extended health services to the Minister of Health.

 2) The provinces and territories must recognize federal financial contributions toward the provision of health services.

 Extra-billing and User Charges (Sections 18-20):

In order to receive their full amount of federal funding the provinces/territories are not permitted to institute extra-billing or user charges for insured health services. If they participate in either of these practices the amount of federal funding is reduced by the amount the province/territory received through extra-billing and user charges.

Extra-billing: Any amount charged to an individual for an insured health service already covered by a provincial plan.

User charges: Any amount (other than extra-billing) charged to an individual for an insured health service that is allowed under a provincial plan and not payable by the plan.

The act also contains information on regulations for administering the act and penalties for non-compliance. 

The Canada Health Act does not apply to uninsured health services which are determined at the provincial/territory level and to certain groups of people that are covered directly under federal programs and therefore excluded from provincial/territorial plans. Groups with coverage under separate federal programs include politicians, judges, and other federal public service employees, members of the Canadian Forces, Veterans, RCMP (Royal Canadian Mounted Police), First Nations and Inuit people, refugees and federal inmates.   



Consolidation of Canada Health Act

Canada Health Act Annual Report 2007-2008

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