The Health and Dental Services Cost Assistance Regulations have been amended under the Health and Dental Services Cost Assistance Act. These changes introduce a series of modifications aimed at improving the administration of health and dental services in the province. The amendments focus on the submission and processing of claims, the introduction of new programs for eye care, and the clarification of eligibility criteria.

One of the key changes includes a revision of Section 5, which requires that if an eligible person is covered by third-party insurance or a prescribed benefit plan, they must first submit claims to those third-party insurers or plan administrators before submitting claims under these regulations. This ensures that the provincial assistance program acts as a secondary payer for health and dental services. Additionally, Sections 6 and 9 have been updated to extend the time allowed for submitting claims in cases where benefits are also covered by a prescribed third-party plan or program. Under the new amendments, claims must be submitted within one year of receiving or providing the benefit, giving more time for both healthcare professionals and eligible individuals to file claims.

Further amendments affect the provisions regarding the Canadian Dental Care Plan. The regulations now clarify that this plan, established by the Government of Canada, is considered a payor of last resort when benefits are covered by both this plan and the provincial program. Sections 14 and 18 have been updated to reflect this, ensuring that any reimbursement from the Canadian Dental Care Plan is deducted when claims are made under the provincial regulations.

In addition to these updates, two new programs have been introduced: the Eye See…Eye Learn Program and the Program for Elementary Eye Care. The Eye See…Eye Learn Program provides financial assistance for one oculo-visual assessment conducted by a participating optometrist, with a maximum benefit amount of $150 for the period from April 1, 2025, to March 31, 2026, which will increase gradually in subsequent years. To be eligible, residents must be enrolled in pre-kindergarten or kindergarten and entitled to basic health services. The Program for Elementary Eye Care offers similar benefits but targets children enrolled in elementary school grades one through six. Both programs are designed to make eye care more accessible to young residents by covering the costs of eye exams, with eligibility criteria including residence requirements and enrollment in the respective educational levels.

Overall, the amendments to the Health and Dental Services Cost Assistance Regulations serve to align the provincial program more effectively with federal initiatives, expand coverage for essential services, and provide greater clarity and flexibility for both service providers and recipients. The introduction of the Eye See…Eye Learn Program and the Program for Elementary Eye Care represents a targeted effort to address the eye care needs of young residents, ensuring that children have access to necessary health assessments as part of a comprehensive approach to healthcare.

Prince Edward Island (2025-260) March 29, 2025
Disclaimer: Insights are for informational purposes only and do not reflect RRI’s official position or constitute legal opinion.