3.5 - Health Card

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:

• Mobility and Adaptive Equipment Loan Program
• Dental Program
• Enhanced Dental Program
• Hearing Aid Program
• Medical Supplies / Services Program
• Therapeutic Nutrients Program
• Orthopedic Program
• Respiratory Program
• Ostomy / Incontinence Program
• Prosthetic Program
• Vision Program

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

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.

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 will be approved for a period of 12 months, unless circumstances require a shorter duration. Prescription Drug Plan Coverage may be approved up to a maximum of 60 months.

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.  When several items are requested, each individual coverage must be calculates separately.  If a deficit still exists, each coverage can be added.

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.

A person 21 years of age or older living in the parental home who do not have a Household Income Policy exemption that allows them to qualify for social assistance may apply for a Health Card Only with their parents.

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.

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.

SD does not cover the cost of a monthly health plan subscription. However, if the 4(4) calculation indicates a deficit for the monthly subscription fee, a health card may be issued.

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.

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.

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.