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Health PEI: Summary of Benefits

Prince Edward Island offers residents the Health PEI provincial healthcare plan which covers basic hospital and medical treatment as well as other benefits.

The following summarizes Health PEI coverage.

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Medical Services

The following services are insured under Health PEI:

  • To be eligible all insured services MUST BE medically necessary.
  • Most physician services in a doctor's office, clinic or hospital.
  • Homecare services such as:
    • Nursing care (IV therapy, injections, wound care, etc.).
    • Home support assistance with daily living activities such as dressing and bathing.
    • Palliative care (numerous types of support such as medical services, nursing services, emotional/spiritual support and more).
    • Dietician (e.g. diet) assistance.
    • Physiotherapy.
    • Occupational therapy (includes help modifying the home with special devices that assist with daily living).
    • Home dialysis (peritoneal).
    • Long-term care assessment.
  • Surgical services if necessary.
  • Obstetrical services (e.g. pre-natal care).
  • Certain oral surgery when performed by an oral surgeon in a hospital when medically required.
  • Male and female sterilizations; reversals are not insured.
  • Certain insured specialist services when referred by an attending physician.
  • Coverage for home care, palliative care, long-term care, addiction services and mental health services.

Services that are not insured by Health PEI include:

  • Third-party examinations.
  • Routine dental services such as examinations, fillings, cleanings and extractions (unless medically necessary and done in hospital).
  • Prescription drugs if not administered in a hospital.
  • Any cosmetic surgery that is not medically required.
  • Vision care such as eye glasses and hearing aids (the exception is children in kindergarten who are eligible for one eye exam and a set of glasses via the "Eye See ... Eye Learn" program).
  • Durable medical equipment such as artificial limbs and other devices.
  • Acupuncturists, audiologists, chiropodists, chiropractors, dieticians, homeopaths, naturopaths, optometrists, physiotherapists, podiatrists, osteopaths and psychologists.
  • Vaccinations for travel purposes are not covered. The flu vaccine is covered although residents must still pay a $7 administration fee.
  • Ambulance services are not covered, unless an ambulance is considered "urgent" and the resident is a senior (65+ years old). For more information go here.

Hospital Services

These services are insured (some are available for out-patient services):

  • Meals and accommodations at the standard ward rates (semi-private and private rooms are covered at the standard ward rate).
  • Nursing services that are medically necessary.
  • Laboratory, x-rays and diagnostic procedures.
  • Radiotherapy and physiotherapy.
  • Operating room, routine surgical supplies, and anesthetic facilities.

These services are not covered:

  • Ambulance user fees within the province; all ambulance fees outside of the province.
  • Some prosthetic devices, crutches.
  • Dental extractions, unless patient is medically required to be in hospital or unless there is prior approval.

Drug Programs

Generally, prescription drugs are not covered by Health PEI. However, you may be eligible for full or partial coverage of prescription drug costs if you are a senior, meet some financial criteria, and/or have a specific disease. Just some of the drug programs available are:

  • AIDS/HIV Drug Program
  • Catastrophic Drug Program
  • Children in Care Drug Program
  • Community Mental Health Drug Program
  • Cystic Fibrosis Drug Program
  • Diabetes Drug Program
  • Erythropoietin Drug Program
  • Family Health Benefit Drug Program
  • Financial Assistance Drug Program
  • Generic Drug Program
  • Growth Hormone Drug Program
  • Hepatitis Drug Program
  • High Cost Drug Program
  • Home Oxygen Program
  • Immunization Program
  • Institutional Pharmacy Program
  • Insulin Pump Program
  • Meningitis Drug Program
  • Nursing Home Drug Program
  • Nutrition Services Program
  • Phenylketonuria (PKU) Supplement Program
  • Quit Smoking Drug Program
  • Rabies Vaccine Program
  • Seniors Drug Program
  • Sexually Transmitted Disease Drug Program
  • Transplant Anti-Rejection Drug Program
  • Tuberculosis Drug Program

Please notify Health PEI if you are traveling out-of-province for more than one month. This will help to avoid any delay in payment for an out-of-province service. In addition, know that for out-of-country medical costs Health PEI may not pay the full costs you incur (for this reason private travel insurance is recommended when traveling).

- for full details about Health PEI coverage click here -

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Last updated February 2017