Health Coverage Outside of Saskatchewan and Canada

Your Saskatchewan health coverage covers most medically necessary services (hospital and physician) provided in a publicly funded facility, as these services are covered by a reciprocal billing arrangement.

You must present a valid Saskatchewan Health Services card. If you cannot do so, the hospital or physician has the right to ask you to pay for your services. This also applies to health services in Saskatchewan.

Certain services covered in Saskatchewan are excluded from the reciprocal billing arrangement. In such cases, you may be billed directly. If this happens, Saskatchewan will reimburse you at Saskatchewan rates for physician services and at agreed-upon rates for out-patient or hospital services.

Some services in another province may require prior approval from Medical Services Branch. For more information, you can refer to the Information Sheet for Patient health coverage within Canada or talk to your health care provider or call 306-787-3475 or 1-800-667-7523.

Community Based Health Services

Out-of-province health services, including mental health, alcohol and drug, problem gambling and rehabilitation/therapy services are not covered by a reciprocal billing agreement.

Approval must be obtained from the Ministry of Health prior to receiving these services. Requests for out-of-province assessment or treatment can only be accepted from the Saskatchewan Health Authority or the Physician Support Program of the Saskatchewan Medical Association.

For more information on eligibility for community based health services you can refer to the Out of Province Assessment/Treatment Program for Community Based Health Services fact sheet, contact the Saskatchewan Health Authority or call 306-787-3479.

How to submit your claim

If the health service you received:

• Does not require prior approval; or
• You paid for it because you were unable to present your valid Saskatchewan Health Services card.

You should submit your bill to Saskatchewan Ministry of Health, Claims Unit using the Out of Province Claim Form.

We will reimburse you at Saskatchewan rates for physician services and at reciprocal billing rates for qualifying hospital services.

For more information, refer to How to obtain a refund for physician or hospital services below.

Things to consider when receiving services

Hospital services

Before you are admitted, hospital staff will ask you to sign a form declaring that you have valid coverage from Saskatchewan.

Physician services received in Quebec

The reciprocal arrangement for physician services applies to every province except for Quebec. Submit your physician bill and your Saskatchewan health coverage will pay for insured services provided in Quebec at Saskatchewan rates.

Drug Plan services

If you bought a prescription drug from a pharmacy in another province or territory, you may submit the original receipt to the Saskatchewan Drug Plan and Extended Benefits Branch.

We reimburse prescription drugs normally covered in Saskatchewan according to Saskatchewan prices and our policies. Include your health services card number with the original receipt.

Physical therapy

We only cover physical therapy provided as part of an acute hospital stay in other provinces and territories. We don't cover private physical therapy or rehabilitative physical therapy out-of-province.

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Costs for hospital services outside of Canada may be much higher than in Saskatchewan. You will be responsible for paying the difference between the full amount charged and the amount Saskatchewan Health covers. We recommend you obtain additional health insurance when travelling outside the country.

This Information Sheet for Patient health coverage outside Canada, can be downloaded or printed for your reference before travelling.

Emergency hospital services

Saskatchewan Health provides limited coverage for emergency medical care from approved hospitals outside Canada if the same services would be covered in the province.

Saskatchewan Health will pay:

• Up to $100 CAD per day for inpatient services;
• Up to $50 CAD for an outpatient hospital visit. Your Saskatchewan health coverage will not pay for more than two visits in one day.

If applicable, please submit your bill to Saskatchewan Ministry of Health, Claims Unit using the Out of Country Claim Form.

Emergency psychiatric services

Your Saskatchewan health coverage provides coverage for a brief period of stabilization (about five to seven days), both out-of-province and out-of-Canada.

Your Saskatchewan health coverage does not cover cancer treatment provided outside of Canada unless the services have been pre-approved by the Saskatchewan Cancer Agency.

Elective hospital services

Your Saskatchewan health coverage does not normally cover elective hospital services.

Prior approval is required.

For more information, see Treatment not available in Canada below.

Emergency services

Your Saskatchewan health coverage pays for eligible services at Saskatchewan rates. Prior approval is not required.

Non-emergency services

Your Saskatchewan health coverage does not normally cover elective services received outside Canada.

Prior approval is required.

For more information, refer to Treatment not available in Canada below.

Drug Plan

Your Saskatchewan health coverage does not cover prescriptions filled outside of Canada. For more information, call 306-787-3317 or 1-800-667-7581.

If your specialist refers you outside Canada to receive treatment not available in Saskatchewan or other provinces, your Saskatchewan health coverage may cover the full cost of the treatment.

Prior approval is required. Your specialist must ask for prior approval from the Medical Services Branch of Saskatchewan Health or from the Saskatchewan Cancer Agency. Important details are outlined on the Information Sheet for Patient Health Coverage outside Canada that can be downloaded or printed for when you and your specialist meet to discuss the details of your care plan.

If the treatment is approved, we will pay the full cost of treatment at a rate that the Saskatchewan Ministry of Health considers fair and reasonable after taking into account the location where the insured service is provided.

If you are charged directly for physician and/or hospital services outside of Saskatchewan, or emergency services outside of Canada, you can submit your itemized statement/receipt(s) to the Saskatchewan Ministry of Health for consideration of reimbursement.

We pay all approved reimbursements for physician services at Saskatchewan rates in Canadian funds.

How to Submit a Medical Claim

Step 1 - Obtain an itemized statement/receipt which includes:

A. Physician statement/receipt(s):

• Full name of referring practitioner (if applicable);
• Full name and address of the treating practitioner;
• Diagnosis (i.e. medical reason for seeing the physician);
• Dates of service;
• Location of the service (i.e. office, hospital, emergency room, home, etc.);
• Proof of payment;
• Itemized list of service(s) that were provided and a description of each service;
• Fees charged for each service; and
• Original receipt.

B. Hospital statement/receipt(s):

• Diagnosis (i.e. medical reason for admission);
• Date of discharge;
• Description of each service;
• Your name if your child or ward received the service; and
• Original receipt.

Step 2 - Ensure the statement/receipt(s) include the following information from your health services card or your dependent's card:

• Patient's name;
• Name and address of the parent or guardian if the patient is a dependent;
• Patient's health services number (9-digit number);
• Patient's month and year of birth; and
• Gender of the patient.

Please mail this information to:
Medical Services Branch
Claims Analysis Unit
Saskatchewan Ministry of Health
3475 Albert Street
Regina, SK S4S 6X6

This committee reviews government decisions made on requests for out-of-province and out-of-country medical coverage, ensuring legislation, policy, and guidelines are followed appropriately.

Services and programs may be reviewed

The Ministry of Health informs eligible applicants of their right to request a review by the Health Services Review Committee (HSRC) upon denial of their out-of-province or out-of-country coverage request.

You can request a review by HSRC only if your coverage request was for:

• Out-of-province medical health services;
• Elective out-of-country medical services (physician and hospital care); or
• Community care programs (mental health, alcohol and drug, problem gambling, and rehabilitative services).

HSRC does not review the following services:

• Emergency medical services provided outside of Canada;
• Other health programs such as prescription drug or ambulance coverage;
• Denial of coverage administered by another Ministry or agency of government, the Saskatchewan Health Authority, a community-based organization or other entity;
• Coverage or benefits unrelated to Medical Services Branch or Community Care Branch;
• A patient is concerned with the manner in which he or she was treated by Ministry officials; or
• Cost of travel, accommodations or meals.

HSRC does not recommend payment for the following services:

• Health services not covered by Saskatchewan legislation, policies, and guidelines;
• Services provided outside of Canada if the services are available in Canada; or
• Services considered experimental or applied research.

Apply for review

Eligible applicants must submit a completed Health Service Review Committee Request for Review Application to the HSRC within 90 days of the date of the Ministry of Health's letter advising of its coverage decision.

Send your completed application to:

Health Services Review Committee
TC Douglas Building
3475 Albert Street
Regina SK S4S 6X6
Phone: 306-787-1910
Fax: 306-787-3761
Email: HealthServices.ReviewCommittee@health.gov.sk.ca

You may wish to submit additional information to the HSRC for reconsideration of your coverage decision. The committee process indicates any additional information that is received with an application is required to be sent to Ministry of Health officials for their consideration. If the additional information does not result in a change in the coverage decision by the ministry, the HSRC will schedule a meeting to review your request.

Review timeline

HSRC meetings are scheduled as necessary and as soon as possible. The Ministry of Health has 30 days from receiving your application to inform you of the date that the HSRC will consider your application. In cases of clinical urgency, the committee may conduct a review with a quicker turnaround time.

HSRC will consider whether the Ministry of Health followed the legislation, policies and guidelines governing out-of-province and elective out-of-country coverage in making its decision.

Please note only committee member will be in attendance at your review. Review meetings are closed to outside participants and ministry staff, and you will not be asked to attend. Following the committee's initial meeting, a comprehensive review may take several weeks to complete. The committee will notify you with their recommendation as soon as the comprehensive review is complete.

Composition of HSRC

There are 22 members in total. Three members will review each request for coverage: a chair with legal or administrative expertise, a physician or other health professional, and a public representative. Several different members are appointed in each role to ensure availability and scheduling of timely reviews.

Another option for review

If your case is ineligible for HSRC or if HSRC upholds the Ministry's coverage decision, you may contact the Provincial Ombudsman for another review.

Differences between the HSRC and the Provincial Ombudsman

HSRC:

• Contact first to request a review of coverage for out-of-province health service;
• Provides a timely review based on information presented to them;
• Makes its decisions solely on whether the Ministry of Health followed legislation, policy, and guidelines appropriately; and
• Has the authority to make recommendations effective July 13, 2011.

Provincial Ombudsman:

• Contact the Ombudsman if you have a concern about a decision of the HSRC; and
• Reviews whether the Ministry of Health followed policy appropriately, and may also assess the fairness and equity of the decision.

Non-Emergency/Elective Services

If you're from outside of Canada and require health services while visiting Saskatchewan, you are responsible for services provided in a general practitioner's office.

• Physicians should not make a referral to a specialist for a visitor to Canada in a non-emergency situation.
• Hospitals should not provide elective services to visitors to Canada. Elective services in hospital may include all diagnostic tests for anything other than emergency care, requests for non-emergency surgeries (e.g. cataract surgery, joint replacement), and non-emergency requests for cancer services.

Emergency Services

Emergency services are defined as a condition involving the immediate possible loss of life, loss of limb or function, or significant risk of morbidity.

• Hospitals should provide emergency services for all visitors to Canada as medically required, and the costs of all services provided must be charged to the individual.
• All visitors to Canada are to be charged three times the reciprocal billing rate for hospital services. This is to ensure that the rate charged to a visitor to Canada covers the full cost of the procedure. For more information or to access the fee guide, please visit the Saskatchewan Medical Association.

Cancer Care

The Saskatchewan Cancer Agency accepts a physician referral to treat a visitor to Canada only in emergency situations (recognizing that not all cancer care is an emergency) which include:

• Superior vena cava obstruction;
• Spinal cord compression;
• Newly diagnosed acute lymphocytic leukemia or acute myeloid leukemia;
• Highly aggressive lymphoma (e.g. Burkitt's, lymphoblastic);
• Bulky aggressive lymphoma at risk for tumour lysis syndrome; and
• Raised intracranial pressure.

Eligibility for Saskatchewan Health Coverage

Physicians and the Saskatchewan Health Authority can check an individual's public coverage on the Person Health Registration System (PHRS) viewer. PHRS provides coverage information for Saskatchewan residents. Individuals within Canada should provide their health card from their province of residence to receive services.

For more information, visit Eligibility for Health Benefits.

Pediatric Out-of-Province Travel Assistance Program

Out-of-Province Breast Cancer Diagnostic Procedures Initiative