Applicants, including seniors, who have access to another health plan must take advantage of it first. Some application forms for seniors plans can be found here.
Those who have coverage under other medical plans may be considered for specific health card coverage, or diabetic supplies benefits, and will be assessed on a case-by-case basis.
The health card coverage may be provided only if a 4(4) calculation shows a deficit, and one of these conditions apply:
- the item is not at all covered under their plan,
- the yearly maximum has been exceeded under their plan, or
- there is a probation period for their plan to become active, and the coverage is needed immediately.
Applicants, including seniors, who have coverage under other medical plans and seek assistance with their remaining costs (such as co-pays or cost-sharing) do not qualify for a SD Health Card coverage or benefits, even if the 4(4) calculation indicates a deficit. Exceptions to this include:
- Mobility and Adaptive Equipment (e.g. wheelchair, power lift, etc.)
- Prosthetics
- Hearing Aids
- Respiratory Equipment (e.g. CPAP)
- NB Drug Plan co-pay per prescription.
Issuing the Health Card Coverage does not guarantee approval by Health Services or Prescription Drug Program for specific items. For more information on what is covered you can verify with Health Services.
When several items are requested, each individual coverage must be calculated separately. If a deficit still exists, each coverage can be added.
When an applicant has access to a health plan but can’t afford to subscribe to the health plan, a 4(4) calculation can be done with the estimated price of the health plan and if in a deficit, then coverage for the item requested can be evaluated. The price of co-pay per prescription can also be included in the 4(4) calculations in the case of NBDrug plan.
