Medicare - Submitting a Claim for Out-of-Country Services
New Brunswick Medicare only covers emergency out-of-country physician and hospital services or services for which you have received prior approval.
Any New Brunswick resident with a valid New Brunswick Medicare card.
Emergency services - An emergency is related to a specific incident that occurs while outside Canada where a delay in the provision of treatment would threaten life, such as fractures, sutures and cardiac arrests. Emergency services do not include:
- services related to a pre-existing condition which requires ongoing monitoring
- follow-up visits resulting from an out-of-country emergency; these visits should be sought in Canada.
New Brunswick Medicare pays:
- $50.00 a day for out-patient emergency services, and
- $100.00 a day for in-patient services resulting from an emergency admission.
Prior approval - New Brunswick Medicare covers out-of-country services not available in Canada on a prior approval basis only. This involves having a written request submitted to New Brunswick Medicare by a New Brunswick specialist who identifies a specific, medically necessary and scientifically acceptable service unavailable in New Brunswick or elsewhere in Canada. Please contact New Brunswick Medicare for more details.
To claim for out-of-country services, original signed invoices or receipts (no faxes, photocopies or carbon copies) must be submitted to New Brunswick Medicare within one year of the date of service along with a completed Application for Reimbursement form (see Forms). If an original document is not provided, the patient must ensure that the service provider certifies that the document is an original and the only one provided to the patient and that the document has an original signature. If payments have been made on bills, a receipt showing the amount paid is required. If a claim is not in one of the official languages (English or French) a translation must be provided.
Payment for out-of-country emergency physician fees and hospital care is made out to the patient in Canadian funds. The patient is then responsible for settling the account with each out-of-country physician or hospital. However, if a patient requires emergency hospital care in an approved hospital facility in the United States, New Brunswick Medicare will make direct payments in Canadian funds to the facility, unless a patient provides proof of payment.
The costs of most out-of-country physician and hospital services are considerably higher than rates paid by New Brunswick Medicare and the difference between the two is your responsibility. That is why out-of-country travelers are strongly advised to obtain additional insurance from private insurers to cover the portion of charges not paid by New Brunswick Medicare.
Residents may choose to seek non-emergency out-of- country services, however, those who receive such services will assume responsibility for the total cost.
Travel and accommodation fees are not covered by New Brunswick Medicare for out-of-country services.