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Part II .

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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

as amended to O.I.C. 2016-74 (March 29, 2016, effective April 1, 2016), N.S. Reg. 53/2016

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;

“total annual income” of a beneficiary or a beneficiary’s spouse means the

beneficiary's or spouse's total annual income reported on their latest notice of

assessment from the CRA, calculated by subtracting the amount in line 210 of the

notice from the amount in line 150 of the notice.

Definition of “total annual income” added: O.I.C. 2016-74, N.S. Reg. 53/2016.

Program coverage

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

(2) Except as provided in subsection (3), 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.

Subsection 3(2) amended: O.I.C. 2016-74, N.S. Reg. 53/2016.

(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

(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 premium reduction under

Section 8, the Minister must determine the

maximum amount of the premium payable per beneficiary for a benefit period.

Subsection 4(3) replaced: O.I.C. 2016-74, N.S. Reg. 53/2016.

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

premiums.

Subsection 4(5) repealed: O.I.C. 2015-17, N.S. Reg. 14/2015.

Application for enrolment and deadline

(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

(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

(1) In this Section, “maximum premium payable” by a beneficiary who qualifies for a

reduced premium under subsection (2) means the maximum premium payable as

determined by the Minister under subsection 4(3) for that beneficiary.

(2) A beneficiary who meets any of the following criteria qualifies for a reduced

premium:

(

a) the beneficiary does not have a spouse and their total annual income is at least

$22 986 but no more than $34 999.99;

(

b) the beneficiary has a spouse and the combined total annual income of the

beneficiary and their spouse is at least $26 817 but no more than $39 999.99.

(3) The reduced premium of a beneficiary who qualifies under subsection (2) must be

calculated in accordance with the following formulas:

(

a) for a beneficiary who does not have a spouse and whose total annual income is

at least $22 986 but no more than $34 999.99,

P = [(I – $22 986) ÷ $12 014]MPP

in which

Pis the premium payable by the beneficiary,

Iis the beneficiary’s total annual income,

MPPis the maximum premium payable by the beneficiary;

(

b) for a beneficiary who has a spouse and, with their spouse, a combined total

annual income of at least $26 817 but no more than $39 999.99,

P = [(I – $26 817) ÷ $13 183]MPP

in which

Pis the premium payable by the beneficiary,

Iis the combined total annual income of the beneficiary and their spouse,

MPPis the maximum premium payable by the beneficiary;

(4) For greater certainty, a premium calculated under clause (3)(

b) must be paid by each

beneficiary.

(5) A beneficiary who meets any of the following criteria qualifies for a waiver of

premium:

(

a) for a beneficiary who does not have a spouse, their total annual income is less

than $22 986;

(

b) for a beneficiary who has a spouse, the combined total annual income of the

beneficiary and their spouse is less than $26 817;

(

c) the beneficiary is in receipt of the guaranteed income supplement under the

Old Age Security Act (Canada).

Section 8 replaced: O.I.C. 2016-74, N.S. Reg. 53/2016.