SOCIAL DEVELOPMENT

1-833-SDDStel (733-7835)

Health Services

There is no cost to eligible clients for entitled services.

These programs are available to:

  • Clients of this department and their dependents
  • Individuals who have special health needs and who qualify for assisted health care under Section 4.4 of the Family Income Security Act and Regulations

Additional benefit-specific eligibility criteria may apply.

Convalescent/Rehabilitation Program
This program assists clients of this department with the provision and maintenance of specific convalescent and rehabilitation items and services which are not covered by other agencies or private health insurance plans.

Hearing Aid Program
This program assists clients of this department with coverage for the purchase and maintenance of hearing aids services which are not covered by other agencies or private health insurance plans.

Hearing Aids are payable once every 5 years. Repairs are eligible as required once the manufacturer’s warranty expires. Ear molds are paid once a year for adults and twice a year for children

Orthopedic Program
This program assists clients of this department with the coverage of orthopedic items which are not covered by other agencies or private health insurance plans.

Most items are eligible once every 2 years for adults and once a year for children. Modifications and repairs are paid as required but quantities and frequencies are monitored.

Prosthetic Program
This program assists clients of this department with coverage for specific prosthetic services that are not covered by other agencies or private health insurance plans.

Prosthetic limbs are payable once every 5 years. Artificial larynxes and artificial eyes are eligible every 3 years. Breast prostheses and bras are Medical Funding Assistance and Rehabilitation Equipment Programs eligible once every 2 years. Modifications and repairs are considered as required.

Wheelchair/Seating Program
This program assists clients of this department with coverage for specific wheelchair and seating related benefits which are not covered by other agencies or private health insurance plans.

Equipment may be provided from the Recycling Program, or provided new, when recycled equipment is not available.

Wheelchairs are considered once every 5 years. Seating and accessories are eligible every 2 years. Repairs and modifications can be considered as required.

Vision Program
This program assists clients of this department who are over the age of 19 with coverage for specific vision benefits which are not covered by other agencies or private health insurance plans. Vision services are negotiated with the New Brunswick Association of Optometrists and the New Brunswick Guild of Dispensing Opticians

Adults (19 and Over) are eligible once every 2 years.

There is a 30 percent participation fee on dispensing services, frames and some diagnostic services. Once a treatment plan has been determined, the optical professional will advise of the amount payable. The participation fee is paid directly to the optical professional and may be required before services are provided.

The department cannot reimburse a client for any vision services paid for by the client.

Dental Program
This program assists clients of this department who are over the age of 19 with coverage for specific dental benefits that are not covered by other agencies or private health insurance plans. Benefits are negotiated with the New Brunswick Dental Society and the New Brunswick Denturists Society.

This program is only available to clients who have no other dental coverage.

Note: Coverage for children 18 years of age and under now falls under the Healthy Smiles, Clear Vision Program administered by Medavie Blue Cross effective September 1, 2012.

Clients are eligible for a maximum of $1000 per year, excluding emergency and prosthetic services.

Clients will be charged a 30 per cent participation fee for dentures and denture repairs. Once a treatment plan has been determined the dental professional will advise of the amount payable. The participation fee is paid directly to the dental professional and may be required before dental services are provided.

With the exception of certain types of fillings, there is no cost to eligible clients for (all) other dental services.

This program cannot reimburse you for any dental services you pay for yourself.

Enhanced Dental Program
Assists eligible clients of this department with additional coverage for specific dental services which are not covered by other agencies or private health insurance plans. These services are negotiated with the New Brunswick Dental Society.

To be eligible, clients of this department must be:

  • Between the ages of 20 and 63,
  • Participating in Career Development Options programming,
  • In need of additional treatment to support employment or educational goals

Clients are eligible for a maximum of $1000 per year, excluding emergency treatment and prosthetic services

Clients are eligible for this program for one year with the option to renew annually for a maximum of three years. Time restrictions for services covered under the regular Dental Program would also apply.

Adults will be charged a 30% participation fee for services covered under this program. Once a treatment plan has been determined, the dental professional can advise of the amount payable. The participation fee will be paid directly to the dental professional and may be required before any denture related services are provided.

Therapeutic Neutrients Program
This program assists clients of this department with coverage for feeding supplies and formulas which are not covered by NB Medicare or private health insurance plans.

Eligible services are paid monthly but quantities and frequencies are monitored.

There is no cost to eligible clients for entitled hyperalimentation supplies. However, if you obtain services that you are not eligible for, you may be required to reimburse the department for the amount paid on your behalf.

Out of Province Medical Program
This program assists clients with coverage for the balance of the cost of eligible medical or hospital services that were received outside of New Brunswick that were not completely covered by Medicare or a private health insurance plan.

Requests will be assessed on an individual basis when they occur.

There is no cost to eligible clients for approved out of province services.

Oxygen & Breathing Aids Program
This program assists clients of this department with coverage of respiratory equipment and supplies which are not covered by other agencies or private health insurance.

The period of eligibility for purchased equipment varies.

Eligible supplies and rentals may be (services are) paid monthly but quantities and frequencies are monitored. There is no cost to eligible clients for entitled oxygen and breathing aid services and equipment.

Ostomy / Incontinence Program
This program assists clients of this department with coverage for ostomy, catheterization and incontinence supplies which are not covered by other agencies or private health insurance plans.

Eligible services are paid monthly but quantities and frequencies are monitored. There is no cost to eligible clients for entitled ostomy, catheterization or incontinence supplies

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.

All programs are subject to benefit guidelines and limitations and have specific eligibility criteria.

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 under Section 4(4)

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.

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 Counter Items
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; a 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.

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 20 to 63 years of age inclusive.

Only services performed during the eligibility period on the card will be paid.

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

Medical Transportation

Private Vehicle
This special benefit may be available to clients who require transportation for medical reasons and who travel by private vehicle, whether their own or another’s. May be paid:

  • in an emergency situation.
  • if frequent medical attention is required creating financial hardship.
  • if medical service is not available within 25 km.

If service is available within 25 km, only to be paid outside area if:

  • the client is referred outside region with documentation from physician indicating why the client cannot obtain service in region or
  • the client has had surgery outside region and is returning for checkup.

The most economical method of transportation must be paid if medical condition of client will permit. Regardless of the number of clients in a vehicle, payment is only made for one.

Payment is limited to 25 cents per km for all vehicles.

Required Documents:

  • For ongoing benefits – a report from physician stating diagnosis, transportation required, number of trips, and length of time needed.
  • If going outside the area for services available within area, documentation as to why client cannot obtain service in region.
  • Proof that the appointment was kept.

Public Transportation
This special benefit may be available to clients who require transportation for medical reasons and who use public transportation.

Medical Funding Assistance and Rehabilitation Equipment Programs

NOTE: This special benefit may also be selected to pay the Medical Transportation – Taxi benefit within a municipality according to the criteria etc. for that benefit. This is necessary as the regular taxi rate may not be based on a per km. amount.

May be paid:

  • in emergency situations.
  • if frequent medical attention is required, creating financial hardship.
  • medical service is not available within 25 km. If service is available within 25 km, only to be paid outside area if:
    • client is referred outside region with documentation from the physician as to why client cannot obtain service in region or
    • client has had surgery outside region and is returning for checkup.

The most economical method of transportation must be paid if medical condition of client will permit.
Guidelines to these payments:

  • Bus/train: cover cost of fare.
  • Air transportation: use Hope Air (www.hopeair.org) or Air Canada’s Medical fare (if available in your region); full fare paid only if no other options are available.

Required Documents:

  • Medical report completed by physician, stating diagnosis, transportation required, number of trips, and length of time needed
  • If going outside the area for services available within area, documentation as to why client cannot obtain service in region
  • Proof that the appointment was kept
  • Confirmation of cost – i.e. estimate, invoice or receipt

Taxi
This special benefit may be available to clients who require transportation for medical reasons and who use taxi. May be paid:

  • in emergency situations.
  • if frequent medical attention is required, creating financial hardship.
  • if medical service is not available within 25 km.

If service is available within 25 km, only to be paid outside area if:

  • the client is referred outside region with documentation from the physician indicating why the client cannot obtain service in region.
  • the client had surgery outside region and is returning for checkup.

The most economical method of transportation must be paid if medical condition of the client will permit. Regardless of the number of clients in a vehicle, payment is only made for one.

Payment is to a maximum of 43 cents per km (HST included) outside municipality. If within municipality where municipal taxi rates must be paid, choose Public Transportation.

Required Documents:

  • For ongoing – Medical Report, completed by the physician, stating diagnosis, transportation required, number of trips, and length of time needed.
  • If going outside the area for services available within area, documentation as to why the client cannot obtain service in region.
  • Proof that the appointment was kept.

Food and Shelter
This special benefit may be available to all clients who require food and shelter when making medical trips outside the region or province. The standard rate is $ 7 per meal up to a maximum of $21 per day per person, unless meals are provided by hospital. Where daily rates established by service providers (i.e., IWK) are higher, the service providers rate would be covered. If the client is staying in a housekeeping unit, the standard rate will be $8 per day per person for groceries instead of a meal allowance. Provision can be made for meals, at the same rate, for a person required to accompany the client and also for lodging (usually at a hostel) for the person accompanying the client.

Required Documents:

  • Written confirmation from the physician, stating diagnosis, transportation required, length of time needed
  • For accompaniment – a letter from the physician stating client cannot travel alone for medical reasons
  • Verbal confirmation from the supplier of accommodations including estimate of cost, followed up by invoice for payment
  • Proof that the appointment was kept

Treatment Program Transportation

Private vehicle
This special benefit may be available to clients who require daily transportation to a pharmacy or clinic in order to receive a prescribed medication within a treatment program (i.e., Methadone Program) and who travel by private vehicle, whether their own or another’s. When the vehicle being used is not the client’s, the special benefit is still paid to the client as opposed to the owner of the vehicle.

Treatment Program Transportation Guidelines include:

  • Daily transportation benefits will be offered to clients for a maximum total of 18 months.
  • A maximum of $200 per month may be issued for this benefit.
  • The most economical means of available transportation must be used.
  • This benefit may only be provided if the dispensing pharmacy or clinic is greater than 2.4 kilometres from the client’s residence.
  • If monthly bus passes are being issued for the daily transportation, no extra coverage is to be issued.
  • Daily transportation benefits will be calculated based on the distance to the dispensing pharmacy that is closest to the client’s place of residence.

Guidelines to these payments:

  • Payment is limited to 20 cents per km for all vehicles.
  • Regardless of the number of clients in a vehicle, payment is only made for one.

Required documents:

  • Proof of daily attendance from the pharmacy or clinic every month.

Public transportation
This special benefit may be available to clients who require daily transportation to a pharmacy or clinic in order to receive a prescribed medication within a treatment program (i.e., Methadone Program) and who use public transportation.

NOTE: This special benefit may also be selected to pay the Treatment Program Transportation – Taxi benefit within a municipality according to the criteria for that benefit. This is necessary as the regular taxi rate may not be based on a per km amount.

Treatment Program Transportation Guidelines include:

  • Daily transportation benefits will be offered to clients for a maximum of 18 months.
  • A maximum of $200 per month may be issued for this benefit.
  • The most economical means of available transportation must be used.
  • This benefit may only be provided if the dispensing pharmacy or clinic is greater than 2.4 kilometres from the client’s residence.
  • If monthly bus passes are being issued for the daily transportation, no extra coverage is to be issued.
  • Daily transportation benefits will be calculated based on the distance sto the dispensing pharmacy that is closest to the client’s place of residence.

Guidelines to these payments:

  • Bus: cover cost of fare.

Required documents:

  • Proof of daily attendance from the pharmacy or clinic every month.

Taxi
This special benefit may be available to clients who require daily transportation to a pharmacy or clinic in order to receive a prescribed medication within a treatment program (i.e., Methadone Program) and who use public transportation.

Treatment Program Transportation Guidelines include:

  • Daily transportation benefits will be offered to clients for a maximum of 18 months.
  • A maximum of $200 per month may be issued for this benefit.
  • The most economical means of available transportation must be sused.
  • This benefit may only be provided if the dispensing pharmacy or clinic is greater than 2.4 kilometres from the client’s residence.
  • If monthly bus passes are being issued for the daily transportation, no extra coverage is to be issued.
  • Daily transportation benefits will be calculated based on the distance to the dispensing pharmacy that is closest to the client’s place of residence.

Guidelines to these payments:

  • Payment is to a maximum of 33 cents per km outside a municipality. If within a municipality where municipal taxi rates must be paid, choose Public Transportation.
  • Regardless of the number of clients in a vehicle, payment is only made for one.

Required documents:

  • Proof of daily attendance from the pharmacy or clinic every month.
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