Pre-approval for medical services outside Nova Scotia: Health Card

If you want to be considered for coverage under the Nova Scotia Health Insurance Program and financial assistance for travel and accommodation, you need to have written pre-approval before you travel, make financial arrangements or schedule any appointments or services.

Pre-approval

Pre-approval means written approval (from the MSI Medical Consultant) for specific medically necessary inpatient, outpatient or professional services (including virtual care) and facility where the approved services will be received outside Nova Scotia. The pre-approval also includes an expiry date. If additional services are required or the expiry date needs to be extended, the referring healthcare provider needs to reapply for pre-approval.

Pre-approval doesn’t mean that the receiving healthcare provider will perform the referred medical services. The receiving healthcare provider determines if the referred medical services are performed based on clinical assessment and when the services can be scheduled.

The services requested must not be available in Nova Scotia for within Canada referrals and must not be available within Canada for outside of Canada referrals.

Pre-approval is considered only as a last resort when all other treatment options are exhausted and medically necessary services are not available in Nova Scotia for within Canada referrals or within Canada for outside of Canada referrals.

Your pre-approval may also include a travel companion to provide medically necessary support when you travel and receive medical services outside Nova Scotia.

How to apply for pre-approval

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

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.

All referrals are reviewed by the MSI Medical Consultant within 30 days of receiving a pre-approval application. The out of province treatment must be done in a medical facility that’s approved by the MSI Medical Consultant. The MSI Medical Consultant corresponds with the referring healthcare provider if an incomplete application is submitted or if the referral is denied.

If your pre-approval is approved, the MSI Medical Consultant sends you a pre-approval letter to confirm you’re eligible for coverage and financial assistance for travel and accommodation. Your referring healthcare provider, receiving healthcare provider and the Department of Health and Wellness also receive the letter.

The receiving healthcare provider determines if the referred medical services are performed based on clinical assessment and when the services can be scheduled.

After your pre-approval is approved, the Department of Health and Wellness sends you a travel and accommodation package (including the Out of Province Travel and Accommodation Expense Claim Form and instructions on how to submit your claim for financial assistance for travel and accommodation reimbursement).

Pre-approval for a travel companion

As part of your referral, your referring healthcare provider may request a travel companion to provide medically necessary support when you travel and receive medical services outside Nova Scotia.

Your travel companion must be 16 or older, able to provide medically necessary support and pre-approved by the MSI Medical Consultant.

Residents 18 or younger are automatically approved to be accompanied by 1 travel companion.

Travel planning

Outside of Canada you’re responsible to complete additional forms and get travel documents that are needed to enter or remain in a country.

If you make payment or financial arrangement, or receive a service without pre-approval, the Nova Scotia Health Insurance Program will not cover the service and you’re responsible for the cost and are not reimbursed.

Travel insurance

You should get medical travel insurance to avoid unexpected costs when you travel outside Nova Scotia.

If you require medical care while travelling, you’re responsible for non-insured services. You’re also responsible to pay the difference between the cost for the insured service and the amount that the Nova Scotia Health Insurance Program covers for the service using Nova Scotia rates in Canadian funds.

If you access medical services outside of the pre-approved provider, services or facility, and the medical services are not insured or reciprocally billed to Nova Scotia, you’re responsible for the costs not covered by the Nova Scotia Health Insurance Program.

Getting medical services in other countries can be expensive. Getting medical travel insurance helps protect you from healthcare costs.

Claims

You may be eligible to make a claim if you have written pre-approval for medical services outside Nova Scotia.

The Department of Health and Wellness sends you a travel and accommodation package (including the Out of Province Travel and Accommodation Expense Claim Form and instructions on how to submit your claim for financial assistance for travel and accommodation reimbursement).

If you receive any financial assistance for medical, travel or accommodation from another jurisdiction (federal, provincial or territorial government department, agency or health authority), you need to identify the amount received on your claim form. Any financial assistance provided by the Department of Health and Wellness combined with the amounts you receive from other sources can’t exceed the maximum allowable amounts for out of province travel and accommodation cost assistance.

Keep all official documents and receipts for any insured healthcare services you receive while travelling outside Nova Scotia. To make a claim, you need to submit the Out of Province Travel and Accommodation Expense Claim Form.

You may also be eligible to make a claim if you’re hospitalized due to an accident or sudden illness or paid for services that may be insured under the Nova Scotia Health Insurance Program.

Appeals

If you don’t agree with a decision that MSI or Department of Health and Wellness makes for you, you can submit an appeal request in writing. You can also authorize someone to appeal a decision on your behalf.