Apply for pre-approval for medical services outside Nova Scotia: Health Card

Eligibility

Healthcare providers who need to refer a patient for medical services outside of Nova Scotia can apply for pre-approval.

An appropriate healthcare provider (Nova Scotia physician who treats the patient and has a relevant specialty for the referred medical services) needs to complete the referral. They need to apply for pre-approval on the patient’s behalf to the Nova Scotia Health Insurance Program. The patient can’t apply or refer themselves.

The Nova Scotia Health Insurance Program doesn’t coordinate patient care. All referrals must be initiated by the referring healthcare provider based on clinical judgment.

Out of province within Canada referral requirements

Out of province within Canada referrals need to include:

• description of the patient’s relevant medical history and medical evidence supporting the requested service
• description of the requested health service and the anticipated clinical benefit
• contact information for the treating physician and facility outside Nova Scotia
• documentation of reputable clinical trials beyond Phase III published in peer reviewed medical literature for new or emerging services
• information on available services within Nova Scotia and reasons the services are not clinically adequate for the patient’s needs
• description of the patient follow-up requirements (including identification of the local provider responsible for ongoing care or confirmation that the referring physician assumes responsibility for follow up care within the province)
• written recommendation supporting the referral and confirmation the service is medically necessary and not provided solely at the patient’s request
• written confirmation of the medical requirement for a travel companion if needed for persons 19 and older (residents 18 or younger are automatically approved to be accompanied by 1 travel companion)

Out of country referral requirements

Out of country referrals need to include:

• description of the patient’s relevant medical history and medical evidence supporting the requested service
• description of the requested health service and the anticipated clinical benefit
• contact information for the treating physician and facility outside Canada
• documentation of reputable clinical trials beyond Phase III published in peer reviewed medical literature for new or emerging services
• information on available Canadian services and reasons the services are not clinically adequate for the patient’s needs
• description of follow up requirements (including identification of the local provider responsible for ongoing care or confirmation that the referring physician assumes responsibility for follow up care within the province)
• written recommendation supporting the referral, confirming the service is medically necessary and not solely at the patient’s request
• written confirmation of the medical requirement for a travel companion, if needed for persons 19 and older (residents 18 or younger are automatically approved to be accompanied by 1 travel companion)

Additional requirements for gender affirming surgery referrals

Gender affirming referrals need to complete the Gender Affirming Surgery Application Form (PDF) and meet criteria outlined in the form. You should also review the Gender Affirming Care Policy (PDF).

How to apply

1. Prepare a referral package (including all required supporting documents).
2. Send your completed referral package by mail or fax.

How long it takes

It should take 4 weeks for the MSI Medical Consultant to review your application and let you know if your application is approved. If your application is approved, the MSI Medical Consultant sends you a pre-approval letter (your patient, receiving healthcare provider and the Department of Health and Wellness also receive the letter). It can take longer if more information is needed or if your application is incomplete.

Cost

There is no cost to apply for pre-approval.