Canada Health Act (R.S.C., 1985, c. C-6)

Short Title

Marginal note:Short title

1 This Act may be cited as the Canada Health Act.

Interpretation

Marginal note:Definitions

2 In this Act,

Act of 1977

Act of 1977[Repealed, 1995, c. 17, s. 34]

cash contribution

cash contribution means the cash contribution in respect of the Canada Health Transfer that may be provided to a province under sections 24.2 and 24.21 of the Federal-Provincial Fiscal Arrangements Act; (contribution pécuniaire)

contribution

contribution[Repealed, 1995, c. 17, s. 34]

dentist

dentist means a person lawfully entitled to practise dentistry in the place in which the practice is carried on by that person; (dentiste)

extended health care services

extended health care services means the following services, as more particularly defined in the regulations, provided for residents of a province, namely,

• (a) nursing home intermediate care service,

• (b) adult residential care service,

• (c) home care service, and

• (d) ambulatory health care service; (services complémentaires de santé)

extra-billing

extra-billing means the billing for an insured health service rendered to an insured person by a medical practitioner or a dentist in an amount in addition to any amount paid or to be paid for that service by the health care insurance plan of a province; (surfacturation)

health care insurance plan

health care insurance plan means, in relation to a province, a plan or plans established by the law of the province to provide for insured health services; (régime d’assurance-santé)

health care practitioner

health care practitioner means a person lawfully entitled under the law of a province to provide health services in the place in which the services are provided by that person; (professionnel de la santé)

hospital

hospital includes any facility or portion thereof that provides hospital care, including acute, rehabilitative or chronic care, but does not include

• (a) a hospital or institution primarily for the mentally disordered, or

• (b) a facility or portion thereof that provides nursing home intermediate care service or adult residential care service, or comparable services for children; (hôpital)

hospital services

hospital services means any of the following services provided to in-patients or out-patients at a hospital, if the services are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness or disability, namely,

• (a) accommodation and meals at the standard or public ward level and preferred accommodation if medically required,

• (b) nursing service,

• (c) laboratory, radiological and other diagnostic procedures, together with the necessary interpretations,

• (d) drugs, biologicals and related preparations when administered in the hospital,

• (e) use of operating room, case room and anaesthetic facilities, including necessary equipment and supplies,

• (f) medical and surgical equipment and supplies,

• (g) use of radiotherapy facilities,

• (h) use of physiotherapy facilities, and

• (i) services provided by persons who receive remuneration therefor from the hospital,

but does not include services that are excluded by the regulations; (services hospitaliers)

insured health services

insured health services means hospital services, physician services and surgical-dental services provided to insured persons, but does not include any health services that a person is entitled to and eligible for under any other Act of Parliament or under any Act of the legislature of a province that relates to workers’ or workmen’s compensation; (services de santé assurés)

insured person

insured person means, in relation to a province, a resident of the province other than

• (a) a member of the Canadian Forces,

• (b) [Repealed, 2012, c. 19, s. 377]

• (c) a person serving a term of imprisonment in a penitentiary as defined in Part I of the Corrections and Conditional Release Act, or

• (d) a resident of the province who has not completed such minimum period of residence or waiting period, not exceeding three months, as may be required by the province for eligibility for or entitlement to insured health services; (assuré)

medical practitioner

medical practitioner means a person lawfully entitled to practise medicine in the place in which the practice is carried on by that person; (médecin)

Minister

Minister means the Minister of Health; (ministre)

physician services

physician services means any medically required services rendered by medical practitioners; (services médicaux)

resident

resident means, in relation to a province, a person lawfully entitled to be or to remain in Canada who makes his home and is ordinarily present in the province, but does not include a tourist, a transient or a visitor to the province; (habitant)

surgical-dental services

surgical-dental services means any medically or dentally required surgical-dental procedures performed by a dentist in a hospital, where a hospital is required for the proper performance of the procedures; (services de chirurgie dentaire)

user charge

user charge means any charge for an insured health service that is authorized or permitted by a provincial health care insurance plan that is not payable, directly or indirectly, by a provincial health care insurance plan, but does not include any charge imposed by extra-billing. (frais modérateurs)

Canadian Health Care Policy

Marginal note:Primary objective of Canadian health care policy

3 It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.

Purpose

Marginal note:Purpose of this Act

4 The purpose of this Act is to establish criteria and conditions in respect of insured health services and extended health care services provided under provincial law that must be met before a full cash contribution may be made.

Cash Contribution

Marginal note:Cash contribution

5 Subject to this Act, as part of the Canada Health Transfer, a full cash contribution is payable by Canada to each province for each fiscal year.

6 [Repealed, 1995, c. 17, s. 36]

Program Criteria

Marginal note:Program criteria

7 In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, the health care insurance plan of the province must, throughout the fiscal year, satisfy the criteria described in sections 8 to 12 respecting the following matters:

• (a) public administration;

• (b) comprehensiveness;

• (c) universality;

• (d) portability; and

• (e) accessibility.

Marginal note:Public administration

• 8 (1) In order to satisfy the criterion respecting public administration,

  • (a) the health care insurance plan of a province must be administered and operated on a non-profit basis by a public authority appointed or designated by the government of the province;

  • (b) the public authority must be responsible to the provincial government for that administration and operation; and

  • (c) the public authority must be subject to audit of its accounts and financial transactions by such authority as is charged by law with the audit of the accounts of the province.

• Marginal note:Designation of agency permitted

  (2) The criterion respecting public administration is not contravened by reason only that the public authority referred to in subsection (1) has the power to designate any agency

  • (a) to receive on its behalf any amounts payable under the provincial health care insurance plan; or

  • (b) to carry out on its behalf any responsibility in connection with the receipt or payment of accounts rendered for insured health services, if it is a condition of the designation that all those accounts are subject to assessment and approval by the public authority and that the public authority shall determine the amounts to be paid in respect thereof.

Marginal note:Comprehensiveness

9 In order to satisfy the criterion respecting comprehensiveness, the health care insurance plan of a province must insure all insured health services provided by hospitals, medical practitioners or dentists, and where the law of the province so permits, similar or additional services rendered by other health care practitioners.

Marginal note:Universality

10 In order to satisfy the criterion respecting universality, the health care insurance plan of a province must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan on uniform terms and conditions.

Marginal note:Portability

• 11 (1) In order to satisfy the criterion respecting portability, the health care insurance plan of a province

  • (a) must not impose any minimum period of residence in the province, or waiting period, in excess of three months before residents of the province are eligible for or entitled to insured health services;

  • (b) must provide for and be administered and operated so as to provide for the payment of amounts for the cost of insured health services provided to insured persons while temporarily absent from the province on the basis that

    • (i) where the insured health services are provided in Canada, payment for health services is at the rate that is approved by the health care insurance plan of the province in which the services are provided, unless the provinces concerned agree to apportion the cost between them in a different manner, or

    • (ii) where the insured health services are provided out of Canada, payment is made on the basis of the amount that would have been paid by the province for similar services rendered in the province, with due regard, in the case of hospital services, to the size of the hospital, standards of service and other relevant factors; and

  • (c) must provide for and be administered and operated so as to provide for the payment, during any minimum period of residence, or any waiting period, imposed by the health care insurance plan of another province, of the cost of insured health services provided to persons who have ceased to be insured persons by reason of having become residents of that other province, on the same basis as though they had not ceased to be residents of the province.

• Marginal note:Requirement for consent for elective insured health services permitted

  (2) The criterion respecting portability is not contravened by a requirement of a provincial health care insurance plan that the prior consent of the public authority that administers and operates the plan must be obtained for elective insured health services provided to a resident of the province while temporarily absent from the province if the services in question were available on a substantially similar basis in the province.

• Marginal note:Definition of elective insured health services

  (3) For the purpose of subsection (2), elective insured health services means insured health services other than services that are provided in an emergency or in any other circumstance in which medical care is required without delay.