Prince Edward Island health coverage

PEI residents with a valid health card are covered for standard ward room accommodations and medically necessary hospital services. If a ward room is unavailable, private or semi-private rooms may be covered, though they are not covered by default.

PEI Health acts as the payer of last resort, providing drug coverage only when no other insurance options are available. Residents aged 65 and older qualify for the Seniors’ Drug Program, which requires a co-payment and a professional pharmacy fee for eligible prescription drugs. Coverage may also be available for residents with specific medical conditions who meet certain criteria. PEI’s Biosimilars Initiative ensures that only biosimilar versions of eligible drugs are covered under the provincial drug program.

There is no general coverage for eye exams, glasses, or contact lenses under the PEI Health Plan. However, through the Eye See…Eye Learn program, children in pre-kindergarten and kindergarten can get a free eye exam and a free pair of glasses if needed, and the Program for Elementary Eye Care covers yearly eye exams and glasses for students in grades 1 to 6, after any private insurance.

Routine dental services are not covered for individuals aged 18 and over. However, limited coverage is available for residents between the ages of 3 and 17 who do not have private dental insurance. Long-term care residents may also be eligible for certain dental benefits under provincial programs.

There is no coverage available for paramedical services under the Prince Edward Island health plan. Residents are responsible for covering the costs of services like chiropractic care, acupuncture, or physiotherapy through private insurance or out-of-pocket payments.

Some coverage for hearing aids is available through Audiology Services for residents up to the age of 21; residents over 21 will need to explore private insurance or government assistance programs. The Insulin Pump Program covers insulin pumps and associated supplies for residents under 25 with type 1 diabetes, and residents may qualify for coverage of ostomy supplies through the Ostomy Supplies Program, depending on medical need and eligibility.

Residents of Prince Edward Island are required to pay a flat fee for land ambulance services. The fee applies regardless of the medical necessity or urgency of the situation. Air ambulance services are generally not covered under the provincial plan.

The Home Care Program in PEI provides access to various health and support services, including nursing care, personal support, and rehabilitation. Coverage is available for those who qualify, allowing residents to receive necessary medical care in their homes or communities.

PEI residents may be eligible for limited coverage for emergency medical services received outside of the country. The level of coverage is determined on a case-by-case basis, and residents may be responsible for costs beyond what is covered by the province.

There is no coverage for accidental death and dismemberment under the PEI health plan. Residents will need to look into private insurance for such coverage.