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Seniors’ Pharmacare Program Regulations

made under subsections 6(2), 7(1) and 31(1) of the

Fair Drug Pricing Act

S.N.S. 2011, c. 7

O.I.C. 2011-234 (June 30, 2011, effective July 1, 2011), N.S. Reg. 224/2011


Citation

1     These regulations may be cited as the Seniors’ Pharmacare Program Regulations.


Definitions

2     In these regulations,

 

“Act” means the Fair Drug Pricing Act;

 

“benefit period” means April 1 to March 31 of the following year;

 

“common-law partner” of an individual means another individual who has cohabited with the individual in a conjugal relationship for a period of at least 1 year;

 

“CRA” means the Canada Revenue Agency;

 

“health card” means identification with a person’s health card number and issued by the Minister;

 

“health card number” means a unique identification number assigned by the Minister to individuals insured under the Health Services and Insurance Act;

 

“senior” means a resident who is 65 years old or older;

 

“Program” means the Seniors’ Pharmacare Program established under the Plan to provide coverage to seniors for benefits;

 

“spouse” means, with respect to any individual, an individual who is cohabiting with that individual in a conjugal relationship as married spouse, registered domestic partner or common-law partner.


Program coverage

3     (1)    Coverage under the Program is available to all seniors.

 

       (2)    Except as provided in subsection (2), coverage under the Program is insurance of last resort and no amount may be paid under these regulations for benefits supplied to any beneficiary if

 

                (a)    coverage in respect of the benefits has been paid under any contract or plan of insurance that applies to the beneficiary; or

                (b)    coverage in respect of the benefits would be payable if claimed in any jurisdiction under any contract or plan of insurance that applies to the beneficiary.

 

       (3)    A senior may apply to the Minister for coverage of expenses they incur to purchase benefits as described in subsection (2) if the expenses are greater than the expenses the senior would have incurred for payment of premiums and copayments under Section 4.


Funding of Program

4     (1)    The Seniors’ Pharmacare Program must be funded by all of the following:

 

                (a)    money appropriated by the House of Assembly;

 

                (b)    premiums paid by each beneficiary, other than those granted a waiver under Section 8;

 

                (c)    copayments paid by beneficiaries.

 

       (2)    The Minister must determine the maximum copayment payable per prescription and the maximum amount of copayments payable per beneficiary for a benefit period.

 

       (3)    Subject to any reductions or waivers under Section 8, the Minister must determine the maximum amount of premiums payable per beneficiary for a benefit period.

 

       (4)    The Minister must determine the available methods for payment of copayments and premiums.

 

       (5)    The aggregate amount of all copayments and premiums paid under the Program during any fiscal year of the Program must not be greater than 25%, plus or minus 3%, of the budgeted total cost of the Program for the fiscal year.


Application for enrolment and deadline

5     (1)    To enrol in the Program without penalty, a resident must apply to the Minister no later than 3 months after

 

                (a)    turning 65 years old; or

 

                (b)    for a senior who takes up residence in the Province, no later than 3 months after obtaining a health card number.

 

       (2)    A senior who fails to register for the Program within the time limits specified in subsection (1), may apply to the Minister for late enrolment.

 

       (3)    The Minister may approve or deny an application for late enrolment under subsection (2), and may consider the applicant’s health status when deciding whether to approve or deny the application.


Effect of late enrolment

6     (1)    A senior who is approved for late enrolment under subsection 5(3) must pay 1.5 times the premium that would apply if they were applying without penalty under subsection 5(1) for a total of 5 years, as follows:

 

                (a)    for the fiscal year in which enrolment begins; and

 

                (b)    for the 4 years of coverage after the first year in clause (a).

 

       (2)    There is a 90-day waiting period from the date a late enrolment is approved under subsection 5(3) to the date coverage begins.

 

       (3)    Despite subsections (1) and (2), a senior who provides proof of private prescription drug insurance since becoming a senior is exempt from subsections (1) and (2).


Benefits purchased before date of coverage

7     A beneficiary must not be reimbursed for benefits they purchased before the date their coverage under the Program begins.


Premium reductions and waivers

8     (1)    A beneficiary may apply, in the manner prescribed by the Minister, for a reduced premium or a waiver of the premium.

 

       (2)    If a beneficiary meets the criteria prescribed by the Minister for a reduced premium, the beneficiary’s reduced premium must be calculated in accordance with the following formulas:

 

                (a)    for a beneficiary who does not have a spouse

 

P = MPP - (($24 000 - I) ÷ 14.15%)

 

in which

 

                         P      is the premium payable by the beneficiary

 

                         MPP is the maximum premium payable under subsection 4(3)

 

                         I       is the beneficiary’s total annual income reported on line 150 of the beneficiary’s latest Notice of Assessment from the CRA;

 

                (b)    for a beneficiary who has a spouse

 

P = MPP - (($28 000 - I) ÷ 16.51%)

 

in which

 

                         P      is the premium payable by the beneficiary

 

                         MPP is the maximum premium payable under subsection 4(3)

 

                         I       is the beneficiary’s total annual family income reported on line 150 of the beneficiary’s latest Notice of Assessment from the CRA.

 

       (3)    For greater certainty, the premium payable under clause (2)(b) must be paid by each beneficiary, regardless of whether the beneficiary’s spouse is also enrolled.

 

       (4)    A beneficiary qualifies for a waiver of premiums if the beneficiary meets any of the following criteria:

 

                (a)    for a beneficiary who does not have a spouse, the total annual income reported on line 150 of the beneficiary’s latest Notice of Assessment from the CRA is $18 000 or less;

 

                (b)    for a beneficiary who has a spouse, the total annual family income reported on line 150 of the beneficiary’s latest Notice of Assessment form the CRA is $21 000 or less;

 

                (c)    the beneficiary is in receipt of the guaranteed income supplement under the Old Age Security Act (Canada).