Medical and Health Care Benefits
» Medical Benefits
» Supplementary Health Care Benefits
» Services Not Covered by MSP
» Extra Billing
» Reimbursement for Medical Care
» Medical Care Outside B.C.
Medical Benefits
The Medical Services Plan (MSP) provides the following benefits:
- medically required services provided by a physician enrolled with MSP;
- maternity care provided by a physician or a midwife (see the BC Midwifery Program);
- medically required eye examinations provided by an ophthalmologist or optometrist;
- diagnostic services, including x-rays and laboratory services, provided at approved diagnostic facilities, when ordered by a registered physician, midwife, podiatrist, dental surgeon or oral surgeon;
- dental and oral surgery, when medically required to be performed in hospital*;
- orthodontic services related to severe congenital facial abnormalities.
* Surgical removal of an impacted third molar (wisdom tooth) is an MSP insured service only when hospitalization is medically required, due to the extreme complexity of the extraction and where there is associated pathology. The removal of healthy wisdom teeth, even if impacted, is not a benefit.
Supplementary Health Care Benefits
Eye Exams - Medically required eye examinations are a benefit for all MSP beneficiaries when there is a medical necessity (for example, eye disease, trauma or injury, or health conditions associated with significant risk to the eyes, such as diabetes). Routine eye examinations are a benefit only for those 18 years of age and under and 65 years of age and over.
Surgical Podiatry - Surgical podiatry services are a benefit for all beneficiaries.
For MSP beneficiaries receiving premium assistance, MSP pays $23 per visit for a combined annual limit of 10 visits each calendar year for the following services: chiropractic, massage therapy, naturopathy, physical therapy and non-surgical podiatry. Effective April 1, 2008, acupuncture services will be included among the choice of services within the ten visit limit. Those who may be eligible for these supplementary benefit services include:
- Income Assistance recipients
- Convention refugees
- Inmates of B.C. Correctional Facilities
- Individuals enrolled with MSP through the At Home Program
- Residents of long term care facilities receiving the Guaranteed Income Supplement (GIS)
- Individuals enrolled with MSP as Mental Health Clients
- First Nations individuals with valid B.C. Medical Plan coverage through the First Nations and Inuit Health Branch of Health Canada.
Children in low and moderate income families may be eligible for basic dental and vision care coverage through the Ministry of Employment and Income Assistance - see the Healthy Kids Program for more information.
Services Not Covered by MSP
MSP does not provide coverage for the following:
- services that are deemed to be not medically required, such as cosmetic surgery;
- dental services, except as outlined under benefits;
- routine eye examinations for persons 19 to 64 years of age;
- eyeglasses, hearing aids, and other equipment or appliances;
- prescription drugs (see PharmaCare);
- chiropractic, massage therapy, naturopathy, physical therapy and non-surgical podiatry services (except for MSP beneficiaries with premium assistance status);
- preventive services and screening tests not supported by evidence of medical effectiveness (for example, routine annual "complete" physical examinations, whole body CT scans, prostate specific antigen (PSA) tests);
- services of counsellors or psychologists;
- medical examinations, certificates or tests required for:
- driving a motor vehicle
- employment
- life insurance
- school or university
- recreational and sporting activities
- immigration purposes
Note: The Ministry of Health provides funding through regional Health Authorities for hospital programs, mental health and addictions services, and residential/assisted living. For information about ambulance services, see B.C. Ambulance Service. For information about assistance with prescription drug costs, go to PharmaCare.
Extra Billing - Information for Patients
Prohibition Against Extra-Billing for Medical Services
The Medicare Protection Act protects patients from being charged an extra amount for physicians' services that are benefits of MSP. Moreover, a person acting on behalf of a patient must not be charged for any benefit or billed any additional cost in place of the patient for medical services that are benefits of MSP.
The prohibition against extra-billing for medical services does not apply to uninsured services, such as cosmetic surgery, or services that are not medically required, such as exams for a driver's licence, employment, camp, etc. The charges for these uninsured services, including related pre-operative and post-operative visits, are the responsibility of the patient.
Enrolled Physicians
Physicians enrolled with MSP may choose to be "opted-in" or
"opted-out".
Opted-in physicians are paid directly by MSP for their services. A physician who is opted-in to MSP may not charge a patient for an insured benefit.
Opted-out physicians bill patients directly for their services, then the patients may claim reimbursement from MSP. By law, an opted-out physician may not charge a patient more for an insured benefit than the prescribed MSP amount.
In some cases, certain additional costs can be charged to the patient. See Permitted Patient Charges.
Physicians Who Are Not Enrolled
Services provided by a physician who is not enrolled with MSP or whose enrollment has been cancelled by MSP are not insured and will not be reimbursed by MSP. However, unenrolled physicians in B.C. may not charge patients more than the MSP amount that would otherwise be payable for an insured benefit, unless the service is provided at a facility other than a hospital or community care facility, as defined by legislation.
Prohibition of Extra-Billing for Facilities and Materials
A patient or a person acting on behalf of a patient must not be charged fees in connection with the delivery of medical services funded by MSP (except as expressly permitted by regulation or by the Medical Services Commission). The prohibition of extra-billing for facilities and materials does not apply to uninsured services such as cosmetic surgery or services that are not medically required (e.g. exams, tests or services for driver's licence, employment, etc.). Charges associated with these services are the responsibility of the patient.
Annual Fees
Some physicians elect to charge their patients an annual, enrollment, or registration fee. Patients cannot be denied service for choosing not to pay these fees. An annual fee is generally meant to cover uninsured services over the course of a year. Patients should be given the option to pay for these uninsured services through an annual fee or individually as they occur. If a physician charges an annual fee, a record detailing what the fee includes must be provided to the patient. The College of Physicians and Surgeons of B.C. has issued rules to physicians governing annual fees. Patients of physicians charging these fees may request a copy of the rules from their physician.
Patient Charges that Are Not Permitted
Patient charges are not permitted in the following categories:
- Consumables, such as examining gowns, tongue depressors, chemstrips, and dipsticks for urinalysis
- Rental charges for instruments or equipment used by the physician in rendering the service
- Tray fees
- Facility fees
Permitted Patient Charges
Patient charges are permitted in the following categories:
- Therapeutic drugs, such as those used for allergy injections and cortisone injections
- Devices, such as pessaries, IUDs, crutches, splints, braces, and tensor bandages
- Material upgrades where the cost of the upgrade is significant relative to the cost of the standard item, such as fibreglass instead of plaster casts
- Extensive dressings and special bandages, such as dressing for a major burn
Notifying Patients of Permitted Charges
When direct charges are permitted, the physician must inform the patient of the charge before the service is provided. The charge to the patient can only be made on a cost-recovery basis, which means that a direct sale must be a not-for-profit transaction.
Medical Services Branch Extra Billing Review Process
The Medical Services Branch investigates reports from patients about charges they believe contravene the Medicare Protection Act. If you wish to have charges in connection with insured MSP benefits investigated, submit the details in writing to the address below. Be sure to include your Personal Health Number and any documentation and receipts.
Administrator - Extra Billing
Medical Services Branch
Ministry of Health
3rd Floor, 1515 Blanshard St.
Victoria, B.C. V8W 3C8
Email: MEDSERVE@gov.bc.ca
Fax: 250 952-3133
Reimbursement for Medical Care
Opted-Out Services
You may be required to pay an opted-out practitioner directly, then request reimbursement from MSP. The practitioner will provide you with a claim card, including the date(s) of your visits, that you can mail to MSP. Cheques are mailed to the address indicated on the claim card. Costs will be reimbursed in accordance with the amount insured by MSP. For more information contact MSP.
Medical Care Outside B.C.
For information on your eligibility for MSP coverage and how to submit a claim for medical care received while you are temporarily away from B.C., see Leaving B.C.
Last Revised: March 13, 2008
