Medicare - Submitting a Claim for Out-of-Country Services
For out-of-country services, New Brunswick Medicare only covers:
- emergency hospital services (see Payment for out-of-country emergency hospital care);
- emergency physician services at New Brunswick rates; and
- services for which you have received prior approval.
Any New Brunswick resident with a valid New Brunswick Medicare card.
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 (but not limited to) fractures, sutures, strokes and cardiac arrests. Emergency services do not include:
- services related to a pre-existing condition which requires ongoing monitoring, or
- follow-up visits resulting from an out-of-country emergency; these visits should be sought in Canada.
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, an original signed proof of payment must be submitted to New Brunswick Medicare within one year of the date of service along with a completed “Application for Reimbursement” form. If an original proof of payment cannot be provided, the patient must ensure the service provider certifies the document provided is the only original proof of payment. Travel and accommodation fees are not covered by New Brunswick Medicare for out-of-country services.
Payment for out-of-country emergency hospital care:
Upon approval of the application for reimbursement New Brunswick Medicare will make payment:
- To the resident, if the resident submits the original proof of payment, or
- To an approved hospital facility in the United States.
New Brunswick Medicare’s out-of-country hospital rates are as follows:
- $50.00 CAD for out-patient emergency services, and
- $100.00 CAD a day for in-patient services resulting from an emergency admission.
Payment for out-of-country emergency physician fees:
Upon approval of the application for reimbursement New Brunswick Medicare will make payment(s) to the resident. To avoid delays in approval, you must include the original proof of payment with your “Application for Reimbursement” form.
New Brunswick Medicare does not make payment directly to any service provider for medical services.
If the proof of payment is not in one of the official languages (English or French) a translation may be requested. The costs of most out-of-country services are considerably higher than rates paid by New Brunswick Medicare and the difference between the two is your responsibility. 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.