Prince Edward Island Health Insurance: Coverage Summary

Prince Edward Island Health Insurance: Coverage Summary

Nearly all residents of Prince Edward Island have access to the territory’s government health care plan, Health PEI. The program pays for medical care on behalf of the Prince Edward Island Department of Health and Wellness.

As publicly funded health services, the benefits of Health PEI only cover essential medical treatments and hospital services. Residents that require additional care, treatment, or medical supplies beyond the scope of the provincial plan will be responsible for paying for expenses that are not part of the insurance plan. 

Supplemental insurance from a group benefits plan can reduce out-of-pocket expenses.

What Does Prince Edward Island Health Insurance Cover?

Prince Edward Island residents must apply for a PEI health card to receive benefits. Each household member will have a card as long as they are legal Canadian citizens and physically reside in their primary residence in the province for a minimum of six months and a day every year.

Members must present their card each time to the doctor, hospital, or medical facility to receive benefits. To apply for a PEI card, residents can submit a form online. A valid PEI health card can be used for five years before requiring renewal.

After receiving a card, some of the medical services the plan will pay for include:

  • All essential medical services
  • Most doctor services in a doctor’s office, at home, or in a hospital
  • Medically required surgeries
  • General obstetrical services, such as prenatal and postnatal care
  • Treatment for broken bones and dislocations
  • Some referrals to an insured specialist from an attending physician
  • Male and female sterilization
  • Standard meals and accommodations in a hospital
  • Operating room, anesthesia, and surgical supplies
  • Laboratory and diagnostic tests
  • Essential nursing services

Health PEI also provides payment for select home care services, including:

  • Nurse services
  • Home support for daily activities like grooming and dressing
  • Adult protection
  • Occupational therapy
  • Adult daycare
  • Long-term care
  • Physiotherapy to improve mobility

What Exclusions Does Prince Edward Island Health Insurance Have?

Like government health care in provinces like Nova Scotia and British Columbia, Prince Edward Island health insurance has restrictions on the services it provides at no expense to residents. PEI Health does not cover the following services:

  • Third-party examinations for employment, life insurance, etc.
  • Cosmetic surgeries and procedures that are not medically necessary
  • Routine dental services, such as teeth cleaning and fillings
  • Paramedical services, including treatment from acupuncturists, chiropractors, podiatrists, and audiologists
  • Hearing aids, eyeglasses, contact lenses, and prosthetic limbs

Health PEI doesn’t typically cover ambulatory services either. Unless the ambulance is for a medical emergency and the person involved is over 65, ambulance transport will incur a fee billable to the resident.

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Health PEI Drug Programs

As a general rule, Health PEI does not cover prescription drugs. However, seniors over 65 and people who have financial difficulty or specific diseases can be eligible for financial assistance in acquiring necessary medications. 

Prince Edward Island drug programs include:

  • Diabetes Drug Program
  • Generic Drug Program
  • AIDS/HIV Drug Program
  • Children in Care Drug Program
  • Family Health Benefit Drug Program

Benefits of Supplementing Public Health Care With Private Health Insurance

Though the Prince Edward Island government has some resources to help pay for its residents’ medical expenses, it’s not always enough. People who have severe financial difficulties, injuries, and chronic medical conditions may require treatments and supplies that the program will not cover.

Many people turn to their employer’s group benefits to help manage health, dental, and vision care expenses. Group benefits plans are fully customizable, helping businesses select comprehensive insurance products to cover the costs of health, medical, and hospital services that provincial plans don’t cover. 

Extended health care benefits for group plans are an example of supplementary insurance. They make the business’s benefits package more comprehensive as it covers the upfront costs for various services, including:

  • Hospital service
  • Dental care
  • Optometry service
  • Ambulance transport
  • Prescription medication
  • Out-of-province medical services

Reduce Medical Costs With Supplementary Group Benefits

At Group Enroll, we help you find customizable insurance solutions from Canada’s leading insurance companies across Prince Edward Island and other provinces. We understand that provincial insurance is not all-inclusive, leaving residents to pay for high medical bills. 

We make it simple to receive multiple quotes and compare insurance products from various providers. Our professional representatives can help you select the best group benefits package and supplement government health care for your employees. Submit a quick quote request form to start comparing insurance prices today. 

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