Government of New Brunswick

SD health cards are required by many financial institutions as identification. Health card PDP coverage is administered by the NB Prescription Drug Program (PDP). Health card ambulance coverage is administered by Ambulance Services, Department of Health.

Coverage for certain Health Card benefits is administered by the Health Services Program in the central office of SD. These programs include:

All programs are subject to benefit guidelines and limitations and have specific eligibility criteria. Further details can be found here.

 

Coverage - Exceptions

All active clients are eligible for the health card if they do not have coverage under another plan. In the following exceptions, a health card may only be required for identification purposes (i.e. with no coverage), or upon clarification with the respective plan, partial coverage may be issued:

  • client and/or dependents may have coverage from their spouse/parent as part of the terms of separation or divorce,
  • status Indians (Natives), or
  • post-secondary students with compulsory health insurance coverage.

Coverage of the client's dependents should be clarified, as dependents of a Native or a student may be covered by their respective health plans for some costs.

 

Coverage - Partial versus Full

Applicants/dependents aged 19 years or older are eligible for only PDP and Ambulance coverage until they have been in receipt of assistance for three (3) months. Exceptions to this are clients/dependents who are:

  • in provincial institutions,
  • certified Blind, Deaf or Disabled,
  • pregnant,
  • discharged from a psychiatric facility,
  • former wards of the province with expired guardianship,
  • former clients (who had full coverage) canceled less than 30 days,
  • former clients (who had full coverage) canceled within the last 6 months for reasons of employment, or
  • suffering from the following illnesses:

- cancer,
- lung disease,
- diabetes,
- heart condition, or
- HIV positive/AIDS.

The system will determine health card coverage and dates, based on information entered on the case when initially set up at Registration. The system will adjust coverage accordingly for adults after 3 months to full coverage. The system will also automatically extend the Health Card every 6 months if case is still active.

 

Health Card Only

Requests for a health card from those who are not eligible for assistance must be assessed under Section 4(4). Health cards issued under this Section may be for any period up to 12 months. Health cards issued under this section will be approved for a period of 12 months, unless circumstances require a shorter duration. Although the entire Household must be assessed for eligibility, the card should be issued to provide coverage only to the specific individual(s) requiring the card.

Prescription Drug Plan Coverage may be approved up to a maximum of 60 months.

Applicants who have the Long Term Needs, Designated Needs or Blind, Deaf or Disabled certification and who are not living with a legal or common-law spouse or child would be considered as a separate unit when applying for Health Card Only benefits.

All clients who have been diagnosed with diabetes and are insulin dependent will have coverage for their insulin and their diabetic supplies. Insulin pump and supplies for adults are not covered. There may be coverage  for children under the age 19 through the department of Health’s New Brunswick Pediatric Insulin Pump Program (PIPP).  

All clients who have been diagnosed with diabetes who are not insulin dependent but are treated by diet alone or taking oral medications may have coverage for a limited number of testing strips, and supplies such as lancets, alcohol and swabs. A medical form completed by a physician, nurse practitioner and /or certified diabetic educator will determined the quantity of test strips that are needed.

  • Seniors 65 years of age and over who qualify for coverage under the New Brunswick Prescription Drug Program would be eligible for their insulin under this program.
  • Seniors 65 years of age and over may purchase extended health benefits from the Medavie Blue Cross Seniors' Health Program.  Diabetic supplies is one of the benefits covered under this program.  Should a senior not apply for this coverage within 60 days following either their 65th birthday, the cancellation of other coverage or eligibility for NB Medicare as a new resident they will face a one-year waiting period for certain benefits which includes diabetic supplies.
  • Applicants, including seniors who have coverage under other medical plans may be put at a financial disadvantage, depending on their participation fees and/or benefit restrictions  under their plan. Depending on the amount of such disadvantage, consideration may be given to assisting these applicant with the additional costs incurred, or in issuing an SD health card.
  • Families requesting dental or optical services for children 0-18 years of age should first be referred to the Health Smiles, Clear Vision plan administered by Medavie Blue Cross.  If they have been found ineligible for this plan they may then be assessed under Section 4(4) for dental or optical coverage
Other Plans

Clients who have coverage under other medical plans may be put at a financial disadvantage, depending on participation fees required under their plan. Depending on the amount of such disadvantage, consideration may be given to assisting these clients with the additional costs incurred, or in issuing an SD health card.

 

Prescriptions Not covered by PDP

Special Authorization/Over the CounterItems

Clients must request that their doctor apply to PDP for approval of the drugs. PDP will send written documentation to the SD district office - bills may be paid based on need or monthly cost may be added as an ongoing Special Benefit, as over the counter drugs cannot be covered by the card.

 

Shared Dependent

When a dependent is shared on two separate cases NB Case will produce only one Health Card. The information on the Health Card will reflect the most recent (or second) case entered in the system.

 

Career Development Opportunities (CDO)

Extended Health Card

If the loss of the health card is a significant barrier to clients wishing to move from assistance to training and/or employment; an health card may be issued to assist them during this transitional period. For clients exiting social assistance for employment, the health card should be extended automatically where long term/permanent work has been obtained and no other coverage is available. The maximum period of the health card coverage in such instances is 12 months renewable to a maximum of 36 months.  The extended health card is to be reviewed annually.

Enhanced Dental Benefits

This extended coverage is for a range of dental services, and is issued to support CDO clients who are in active programming towards their goal of self-sufficiency. It is indicated by an "E" in the Dental section of the health card. The client needs only to present the card to the dentist. The dentist bills SD, Health Services directly for services provided.

Benefits

  • Client must pay a participation fee of 30% to the dentist or denturist.
  • Maximum of $1,000, not including emergency services and dentures already covered by regular dental coverage.
  • Period not to exceed 12 months.

Eligibility

  • Case Manager determines eligibility on individual basis.
  • Client must be in active CDO programming.
  • Case Manager must demonstrate in case plan that additional dental work is needed to support goal of self-sufficiency to access training or employment.
  • Client must be able to cover participation fee within own resources.
  • Client must be aged 19 to 64 years of age inclusive.
  • Only services performed during the eligibility period on the card will be paid.

 

4(2)(b) Clients

4(2)(b) clients are eligible for the same level of health card coverage as basic assistance clients.