Types of Eating Disorders

​​​​​​​

In the Canadian health system, feeding and eating disorders are diagnosed by medical doctors or psychologists. These diagnoses are guided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The manual is revised periodically with input from professionals in Canada and the United States. The most recent version (DSM-5) was published in 2013, with revisions to the feeding and eating disorders section intended to be inclusive of a wider range of disordered eating, to aid in the identification of males affected, and to facilitate earlier identification of eating disorders. 



These formal categories of eating disorders and their definitions are summarized in the linked pages.  In addition we include a few categories which are only informally used but which represent real distress related to troubled eating or disturbances about weight and shape. 




For clarification or additional information, connect with our helpline by phone at 416-340-4156 or toll free at 1-866-NEDIC-20 (1-866-633-4220), or by email at nedic@uhn.ca, or by our instant chat service. You may also find these Tips for Choosing a Provider (PDF) helpful. 

Clinical eating disorders

Anorexia Nervosa

Anorexia nervosa is a serious mental illness characterised by behaviours that interfere with maintaining an adequate weight. 

Biological, social, genetic, and psychological factors play a role in increasing the risk of its onset.

learn more

Bulimia Nervosa

Bulimia nervosa is a serious mental illness characterised by periods of food restriction followed by binge eating, with recurrent compensating behaviours to “purge” the body of the food.

Biological, social, genetic, and psychological factors play a role in increasing the risk of its onset.

learn more

Avoidant and Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID) involves limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness. 

ARFID is a mental illness which can severely compromise growth, development, and health. 

learn more

Binge Eating Disorder

Binge eating disorder is a mental illness that can seriously affect psychological and physical health. It is characterized by recurrent episodes of eating large quantities of food then experiencing shame, distress or guilt afterwards.

learn more

Other Specified Feeding or Eating Disorder

Other Specified Feeding and Eating Disorders refers to atypical presentations of anorexia nervosa, bulimia nervosa, and binge eating disorder, among other eating disorders. 

These eating disorders are equally serious and as potentially life-threatening as the more typical presentations. 

learn more

Other Eating Disorders

Including pica, rumination disorder and unspecified feeding or eating disorder

learn more
  • Informal Definitions

    • Compulsive exercising (sometimes called “anorexia athletica”)

      This is an informal definition which is not a diagnosable eating disorder included in the DSM. You will not have insurance-covered treatment for it unless you also have another diagnosable ED. It is a colloquial term referring to problematic eating behaviours that can seriously impact someone’s life.

      Anorexia athletica is a condition where people over-exercise to the point that fulfilling their exercise goals takes on more importance than almost anything else. Exercise is used to control body shape and weight and to provide a sense of power, control and self-respect. It is not a clinically recognized diagnosis in the same way that anorexia nervosa and bulimia nervosa are, but compulsive exercising can have serious health consequences.

      Symptoms of anorexia athletica include:

      • Being unwilling to miss a single workout
      • Taking time off work, school and relationships to exercise
      • Focusing on the challenge exercise poses while sacrificing enjoyment
      • Believing that one’s self-worth depends on our physical performance
      • Rarely being satisfied with one’s physical achievements
    • Nocturnal sleep-related eating disorder

      This is an informal definition which is not a diagnosable eating disorder included in the DSM.  You will not have insurance-covered treatment for it unless you also have another diagnosable ED. It is a colloquial term referring to problematic eating behaviours that can seriously impact someone’s life.

      People with nocturnal sleep-related eating disorder may binge eat, or consume strange combinations of food, raw foods and even non-food items in the period between sleep and wakefulness. Upon waking up, the person has little or no memory of doing this.

      Nocturnal sleep-related eating disorder is found across ages and in both males and females. Because it occurs while the person is unconscious (as in sleep-walking), it may be best to consider it a sleep disorder rather than an eating disorder.

    • Orthorexia

      This is an informal definition which is not a diagnosable eating disorder included in the DSM.   You will not have insurance-covered treatment for it unless you also have another diagnosable ED. It is a colloquial term referring to problematic eating behaviours that can seriously impact someone’s life.

      Orthorexia is a cluster of food- and weight-related symptoms, including: 

      • Eating only foods regarded as healthy.
      • Relying only on "natural" products to treat an illness.
      • Finding more pleasure in eating "correctly" rather than enjoying the tastes and textures of a variety of foods.
      • Although orthorexia is not a recognized diagnosis, it does - like other forms of disordered eating - lead to an obsessive focus on food. People with orthorexia experience emotional satisfaction when they stick to their goals, but intense despair when they fail to do so. Weight is commonly used as a measure of their success. Their behaviours and beliefs can lead to social isolation and ill health. If weight loss compromises health and body dissatisfaction plays a part, orthorexia may become anorexia nervosa.
  • Additional Definitions

    • Body Mass Index (BMI)

      The Body Mass Index (BMI) was originally designed in the 1800s as a way to show the various proportions of the human build. By the 1970s, the BMI evolved into a quick and inexpensive way for epidemiologists to classify participants based on body mass in public health studies. In 1986, the National Institute of Health started encouraging its use for defining “obesity”

      The BMI is calculated by dividing an individual’s body weight in kilograms by their height in squared meters. It is a measure of total body mass. It does not calculate a person's body fat, nor does it take into consideration a person's natural set point range. The assumption that obesity directly causes disability and death has led to the belief that the higher your BMI, the higher your health risk. However, there is no consistent or reliable data to show that losing weight and lowering one’s BMI actually decreases risk of disease or increases life expectancy.

      The current guidelines that define a "normal" BMI were lowered based on recommendations set by the Obesity Task Force in 1998; however these recommendations were not supported by research evidence. It is important to note that weight gain, or increases in BMI, over time may be normal and healthy. Not everyone labeled "overweight" or "obese" is unhealthy and needs to lose weight, and not everyone labeled "normal" is healthy. Since this tool does not reveal the individual's level of fitness, their quality of life, or the quality of their dietary habits, it is not effective at measuring an individual’s health.

    • Obesity

      The label of “obesity” is problematically defined and can be stigmatizing for the individuals it is associated with. The World Health Organization defines "obesity" as a BMI of 30 and above. Please see Body Mass Index (BMI) for information on its limitations. It is assumed that all people who are “obese”, as per BMI standards, have a higher risk of death. However, an association between obesity and increased mortality is actually clustered in the extreme obesity range (BMI 35 and above), which is higher than where most people's BMI falls. In addition, government statistics have indicated that obesity rates have stabilized and leveled off between 1999 and 2003, while life expectancy continues to increase. Therefore, we can conclude that "obesity crises" may be exaggerated.

      One of the more harmful effects of people being labeled "obese" is often the prescribed recommendation to lose weight. Attempts to lose weight have been associated with lean tissue loss, a higher risk of preoccupation with food and eating disorders, and other psychological consequences. Often people use “diets” in an effort to lose weight despite newer research showing dieting can predict weight gain; in fact, two-thirds of those who lose weight through dieting often regain all the weight, if not more, within 1 to 5 years.

      A person's weight may be influenced by numerous contributors beyond diet, physical activity, and genetics. Therefore it should not be assumed a person labeled "obese" is necessarily unhealthy. Most health indicators can actually be improved by changing health behaviours, regardless of weight loss. Therefore, one’s health cannot be assessed by whether or not they meet the BMI’s criteria for obesity. A more accurate measure of one’s health is to look at their health behaviors, including enjoyable exercise habits, intuitive eating habits, and whether they smoke cigarettes or consume alcohol.

    • Overweight

      The World Health Organization defines "overweight" as a BMI 25-30. Please see Body Mass Index (BMI) for information on its limitations. It’s assumed that people above a certain BMI have a higher risk of death. However, increased mortality is actually clustered in the more extreme obesity range (BMI 35 and above), which is higher than where most people's BMI falls. A BMI in the "overweight" category actually shows a protective affect against risk of death.

      The use of the label “overweight” as a health indicator rouses similar concerns to that of the “obesity”. Please see Obesity for more information on its limitations.

  • Types of Provider

    • Counsellor

      Counsellors are mental health clinicians who perform counselling, including advising, educating, and coaching. This is sometimes called “talk therapy”. Many counsellors hold master’s degrees, and may be registered with a professional association like the Canadian Counselling and Psychotherapy Association.

    • Dietitian

      A dietitian has comprehensive training in food and nutrition, and helps individuals translate the science of nutrition into terms and ideas that the individual can apply to one’s own life and dietary habits. In Canada, dietitians are regulated by provincial colleges.

    • Family doctor (general practitioner or GP)

      A family doctor is usually your first point of contact in the health care system. They are medical doctors who work with individuals and their families. If you do not have a family doctor, a walk-in clinic can sometimes offer similar services. 

    • Occupational therapist

      Occupational therapists are registered health care professionals who have been trained to offer interventions if a barrier is preventing an individual from participating in activities or life. They work in a variety of clinical settings.

    • Nurse

      A nurse is a health practitioner who has undergone rigorous training and is registered by their provincial regulatory body. They provide health care in a variety of settings.  

    • Nurse Practitioner

      A nurse practitioner is a registered nurse who has completed additional advanced university education. Nurse practitioners work in a variety of settings. 

    • Nutritionist

      Nutritionists offer advice on food and nutrition to individuals. Their qualifications may vary because, in Canada, they are not regulated by a provincial body. Some registered dietitans may also use the term nutritionist. 

    • Psychiatrist

      A psychiatrist is a medical doctor who has had further training in the diagnosis and treatment of mental illnesses. They can prescribe medication to individuals living with mental illnesses.

    • Psychologist

      A psychologist has undergone extensive training, and often has a master’s degree or PhD. They can offer counselling and a variety of specialized treatments and interventions for mental illnesses. In Canada, psychologists are regulated by provincial bodies. Psychologists work in a variety of settings, including hospitals, community-based care settings, and private practice.

    • Psychotherapist

      A psychotherapist is a mental health practitioner who uses one or a variety of techniques of the various branches of psychotherapy. Psychotherapists help individuals to understand and process their problems, and are usually registered by a regulatory college.

    • Social worker

      Social workers usually have master’s degrees, and are regulated at the provincial level in Canada. Their focus is on helping people to develop their skills and ability to resolve problems using the individual’s own skills or community resources. 

  • Types of Therapy

    • Cognitive Behavioural Therapy (CBT) 

      CBT is based on the assumption that thoughts, emotions, and behaviours are interconnected and can be restructured to support new, healthier thoughts and actions. 

    • Dialectical Behavioural Therapy (DBT) 

      DBT is based on the assumption that self-destructive behaviours are caused by the inability to manage and regulate intense emotion. DBT combines cognitive behavioural techniques with mindfulness and acceptance strategies. 

    • Emotion-Focused Therapy (EFT)

      In EFT, individuals learn how to manage their maladaptive emotions, as opposed to controlling what they eat as an outlet for the emotions

    • Family-Based Treatment (FBT) or the Maudsley Model

      In FBT, parents of children and younger teens are empowered to take responsibility for managing their child’s eating disorder symptoms, with the goal of restoring their child’s health.

      There are three phases.

             o Phase one: parents are supported to re-establish normal eating patterns, deciding what their child will eat for meals and snacks, ensuring adequate nourishment, and interrupting problematic behaviours like exercising to control weight or purging. 
             o Phase two: control of eating is carefully handed back to the child or teen (age-appropriately). 
             o Phase three: treatment focuses working through underlying issues and helping the child establish a healthy, non eating-disordered, identity. 

      • FBT includes child and parents (and siblings or other important family members) together in the sessions most of the time. Everyone hears what the others say, so confidentiality is not an issue. When a child or parent is seen individually, as happens sometimes, the therapist discusses what will be shared with the family with the person affected.
      • Current evidence points to FBT as the best available therapy for a child or adolescent who has been ill for less than three years.


      Emotion-Focused Family Therapy (EFFT)

      In EFFT, emotion coaching is integrated into a Maudsley model. A parent or caregiver helps their child to identify and process emotions that come up in the process of eating disorder recovery, allowing the young person to feel the compassion and understanding of their parent. The parent also learns to recognize when their own actions are being controlled by maladaptive emotions. New and healthier choices and directions can then be taken.

    • Peer Support Group

      Group members are all going through similar struggles and come together to support and empower each other.

  • Types of Treatment

    • Day Treatment

      Day treatment programs are a form of outpatient care. The patient usually spends a number of hours at the program, and eats meals there while continuing to live at home. In Canada, these are often hospital-based programs. Day programs are staffed by multidisclipinary teams that generally include psychiatrists, nurse practitioners/ nurses, psychologists, dietitians, social workers, child/youth counsellors, and educators.


      Youth

      Adolescents who are medically stable but for whom outpatient treatment is insufficient to reduce their eating disorder symptoms may require a day program. This typically involves attending a clinic 5 days per week from breakfast through dinner time.

    • Inpatient care

      Inpatient care is, in Canada, a form of hospital-based care for individuals whose eating disorder symptoms require intensive medical interventions or monitoring. It is intended to be relatively short-term with the goal of stabilizing the person’s physical health so that they can continue treatment.


      Inpatient eating disorder treatment includes medical monitoring, re-feeding/nutrition restoration, and/or symptom interruption. A typical week’s schedule will consist of staff-supervised meals and snacks. In addition, an inpatient program may offer academic programming; increasingly, family-based meal support is being integrated into inpatient programs. 


      Inpatient eating disorder units are staffed by multidisclipinary teams that generally include psychiatrists, nurse practitioners/ nurses, psychologists, dietitians, social workers, child/youth counsellors, and educators. 


      Youth

      Children who are experiencing or at high risk of medical complications need to be hospitalized so they can receive 24-hour care. They may be placed in a general hospital setting for medical stabilization or, where available, in a specialized eating disorder unit. 

    • Outpatient treatment

      Individuals who are medically stable may be treated on an outpatient basis (e.g., attending weekly therapy appointments). 


      Youth

      Most families, with professional help, are able to restore their children’s health at this level of care. The recommended firstline treatment for youth with eating disorders is an outpatient approach known as Maudsley/Family-Based Therapy (see Types of Therapy). 


    • Residential Treatment

      For individuals who are medically stable but for whom outpatient or day treatment has been unsuccessful, residential treatment may be indicated. 24-hour care is provided, with aspects of inpatient care incorporated into some sites.

  • Out of Province/Country Care

    • General Information

      In all provinces, to obtain provincial health insurance coverage for out-of-province and out-of-country eating disorder treatment, a similar process must be followed.  Note that government-funded treatment facilities are relatively scarce in Canada and they are often unable to accommodate to out-of-province clients.


      The process across Canada usually involves the following steps:


      1. The client must be assessed and referred in writing by an appropriate eating disorders specialist.


      2. A letter of request and/or the necessary application forms from a physician specializing in eating disorders must be sent to the Ministry of Health in the client’s home province.


      The letter of request/application must include the following: 

      • Evidence that the client has explored the resources available within her/his province (and Canada) and that there are no services that will be available within a reasonable amount of time
      • Contact information for the proposed out-of-country treatment centre to which the individual wishes to go must also be included in the letter with verification that it is an accredited facility. 
      • Pertinent medical records, clinical information or health and treatment history in support of the application should be appended if appropriate.


      3. 

      The request will receive approval or denial by the corresponding provincial government panelIf denied there are appeal processes that can be followed in each province. 

    • Alberta

      Source:https://www.alberta.ca/ahcip-out-of-country-health-funding.aspx



      For More Information:

      Alberta Health Care Insurance Plan

      Telephone Edmonton area: 780-415-8744

      Toll Free (elsewhere in Alberta): dial 310-0000, then 780-415-8744

      Fax 780-415-0963

      E-mail (for general information or non-personal questions about insurance coverage ONLY) health.ahcipmail@gov.ab.ca

      Mail

      Chair, Out-of-Country Health Services Committee 

      PO Box 1360, Station Main

      Edmonton AB  T5J 2N3



      Out-of-Province



      Under the Alberta Health Care Insurance Plan (AHCIP) and the Hospitals Act, eligible Alberta residents are provided coverage for insured physician and hospital services in Alberta and elsewhere in Canada. Alberta Health limits some coverage outside the province and covers only limited physician and hospital expenses outside Canada.



      Out-of-Province Claim Form: https://cfr.forms.gov.ab.ca/form/ahc0934.pdf



      Out-of-Country 



      1. The Out-of-Country Health Services Committee (OOCHSC) considers applications for funding of insured medical, oral surgical and/or hospital services that are not available in Canada. Applications must be made by Alberta physicians or dentists on behalf of eligible Alberta residents.
      2. The OOCHSC is made up of four Alberta physicians and one non-voting chair who is an employee of Alberta Health.
      3. Applications can be made only by an Alberta physician/dentist on behalf of an Alberta resident.





      Applicant Conditions



      1. The application must be made on behalf of an Alberta resident who is registered with the Alberta Health Care Insurance Plan (AHCIP). The services must be medical, oral surgical, and/or hospital services and insured under the AHCIP and/or the Hospitalization Benefits Plan.
      2. There must be documentation that the requested services are not available in Canada and the health services available in Canada have been fully utilized.
      3. The services must be medically necessary, according to an Alberta physician or dentist.
      4. Applications to the OOCHSC for funding of health services that are non-emergent in nature must be declared complete prior to receiving the services.
      5. OOCHSC applications are considered complete when all the required information has been submitted, the OOCHSC Chair has notified the applicant in writing, and the application has been scheduled for review at an upcoming meeting.



      Application Process



      Online Application: https://cfr.forms.gov.ab.ca/Form/AHC2176.pdf



      Applications must include the following documents/information:



      a) A letter of referral/support, or a completed Application Form, including the following information: 

      1. The health services/treatment for which funding is requested.
      2. Expected duration of the initial out-of-country health services and the dates on which the health services will be provided.
      3. The number and frequency of expected out-of-country follow-up visits, if any.
      4. Address of the out-of-country facility where the health services are to be obtained.
      5. Name and specialty of the out-of-country physician who will provide and/or coordinate the health services.
      6. The arrangements that have been made for follow-up care in Alberta or elsewhere in Canada.



      b) The reason for seeking funding for out-of-country health services and a minimum of one of the following to support that reason: 

      1. Documentation confirming that relevant health services in Alberta and elsewhere in Canada have been fully utilized.
      2. Documentation confirming that the health service is not available in Alberta or elsewhere in Canada.
      3. If the health service is available in Alberta or elsewhere in Canada, an explanation as to why it is not being utilized.



      c) A recent health history/summary of the patient that is relevant to the health service for which funding is requested, prepared by an Alberta physician or dentist and which must include: 

      1. The clinical diagnosis relevant to the application.
      2. Any health services previously provided for the condition, when and where they were provided, and the outcome.
      3. Copies of existing relevant findings and/or reports from specialists and/or consultants
      4. Copies of relevant diagnostic and laboratory reports.
      5. If applicable, additional health services considered or explored but not pursued and the reason(s) why.



      Approval



      Once the OOCHSC chair has determined that an application is complete, the OOCHSC has 60 days to assess the application and make a decision. If the application is urgent for medical reasons, the physician or dentist must state this on the application, along with the reasons for the urgency and the timeframe within which it is recommended that the health services/ treatment be initiated. 

      The OOCHSC will send a written copy of its decision with reasons to the applicant and the patient on whose behalf the application was made, within 10 days of making its decision.



      Appeal Process



      Decisions made by the OOCHSC can be appealed. Appeals may be submitted by the Alberta physician or dentist who submitted the application for the Alberta resident, or by the Alberta resident. All appeals must be submitted in writing to the Out-of-Country Health Services Appeal Panel within 60 days of the appellant receiving the OOCHSC decision letter. The appeal letter must be sent either:


      By mail to:

      Out-of-Country Health Services Appeal Panel 

      PO Box 1360, Station Main

      Edmonton, AB  T5J 2N3



      Or by fax to: 

      780-644-1445 

      Attention: Chair, Out-of-Country Health Services Appeal Panel 

    • British Columbia

      Source: https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/ooc_funding_guidelines.pdf


      For More Information:

      Health InsuranceBC Authorization Coordinator – Out of Country Programs
      Telephone

      Toll Free BC:  866-456-6950 

      Vancouver:  604-456-6950 

      Fax250-405-3588 
      MailMedical Services Plan 
      PO Box 9480 Stn Prov Govt 
      Victoria, BC  V8W 9E7
      Ministry of Health – General Inquiries
      Mail

      Ministry of Health

      1515 Blanshard Street

      Victoria, BCV8W 3C8

      E-mailhlth.health@gov.bc.ca
      Minister of Health
      Telephone250-953-3547
      Fax250-356-9587
      Mail

      Minister of Health

      Room 337, Parliament Buildings

      Victoria, BC   V8V 1X4

      E-mailhlth.minister@gov.bc.ca


      Out-of-Province


      BC will fund the cost of physician and acute care hospital services in other Canadian provinces and territories (except Quebec) provided the service meets the following criteria: 

      a) It is medically required;

      b) It is provided by a medical practitioner or oral surgeon entitled to practice in the province or territory where the service is rendered; and

      c) It would be a benefit if performed in BC unless otherwise stipulated by the terms of the reciprocal agreement. 


      Out-of-Country


      a) Generally, eating disorder treatment services are not eligible for out of country funding because treatment services are available in BC. Exceptions may be funded pursuant to these Guidelines.

      b) Applications for out of country funding for treatment of eating disorders outside of Canada require the following information to be submitted by the appropriate specialist involved in the beneficiary's care: 

      (i) a written recommendation based on an assessment by the Director of the St. Paul’s Hospital Eating Disorders Program (located at St. Paul's Hospital in Vancouver) following assessment and referral from a BC tertiary eating disorder program (for adults, St. Paul's Hospital Eating Disorders Program, for children, B.C. Children's Hospital Eating Disorders Program);

      (ii) Details of the referring physician’s attempts to locate appropriate medical care within Canada;

      (iii) A written treatment plan and transfer protocol (a written plan detailing date and manner of return of the beneficiary to BC following the provision of out of country medical care)

      (iv) Proof of accreditation of the proposed facility; and

      (v) Approximate length of stay for the treatment plan and an undertaking by the out of country treating physician to provide MSP and the referring specialist with monthly follow-up reports on the outcomes of the treatment program.

      c) If funding is approved under this provision, payment will be at the negotiated U&C* or 

      contract rate.

      * "usual and customary rate" (U&C) is the preferred customer rate that MSB will negotiate in advance ofthe provision of out of country medical services during the pre-approval process. It is a preferred rate received by large insurance providers.


      Application and Review Process for Funding of Out of Country Medical Care

      Printable Application Form:https://www2.gov.bc.ca/assets/gov/health/forms/2810fil.pdf


      In relation to an application for elective out of country medical care, MSB may consider:

      a) Whether the treatment is recommended by the medical profession in BC and/or elsewhere in Canada;

      b) If the treatment is experimental or developmental, Health Canada's position with respect to the efficacy of the treatment including if a drug or device has been approved by Health Canada for the proposed use; 

      c) If a procedure offered in the United States is beyond Phase III clinical trials and approved by the Centers for Medicare & Medicaid Services; and

      d) Whether all avenues for treatment within the Canadian healthcare system have been exhausted.


      The Application and Approval Process 


      INTRODUCTION

      Prior approval of provincial coverage for elective out of country medical care is the responsibility of Out of Country Claims Branch, HIBC, and the Medical Services Branch, Ministry of Health Services. In order to consider provincial coverage for elective out of country medical care, an application for prior approval must be received by HIBC. In cases where out of country funding is appropriate, the preapproval process enables the province to negotiate a reasonable and fair compensation rate from out of country service providers prior to the provision of the service. 


      APPLICATION BY APPROPRIATE SPECIALIST

      Applications for prior approval of funding for medically necessary out of country services must be submitted to HIBC by an appropriate specialist actively involved in the beneficiary's care in BC.  An appropriate specialist is one with the most knowledge in the proposed service and/or specialty that will be provided out of country. 


      DOCUMENTATION 

      It is the responsibility of the appropriate medical specialist making application on behalf of the beneficiary to submit all supporting documentation, including, when appropriate or required, a written recommendation from the tertiary care centre or appropriate agency responsible for standards of care in BC regarding the proposed out of country medical care. 


      APPLICATIONS

      Only complete applications will be considered. Incomplete or abandoned applications are not eligible for review by an authority delegated by the MSC. An incomplete application is one that does not include a recommendation from the appropriate attending medical specialist and/or does not include the required documentation or written recommendation from a tertiary care centre or the appropriate agency responsible for the medical standard of care in BC.

      If additional information is requested during the course of reviewing an application, the information must be received within 45 days of the request, or on an agreed date. If the information is not received, the application for out of country funding will be considered abandoned. 


      SUMMARY OF THE DECISION PROCESS 


      Stage 1 - Consideration and decision by Medical Services Branch

      The completed application for funding approval and any supporting documentation is considered by MSB or its designate, Health Insurance BC, and a decision is made as to whether or not funding for out of country care will be provided. 


      Stage 2 - Administrative Review by Medical Services Branch

      If the decision made by MSB is to deny the application for funding, the beneficiary may request an administrative review of the denial.  To request the administrative review, the beneficiary must supply MSB with additional relevant information from the appropriate specialist. 

      The request for an administrative review must be made by the beneficiary within six months after the date of the initial determination made by MSB. 


      Stage 3 - Formal Review by Medical Services Commission 

      If, after the administrative review is concluded, the application for funding is denied again, the beneficiary may request that the MSC formally review the decision of MSB.  The question for the MSC to determine in the formal review is whether MSB properly applied the Out of Province and Out of Country Medical Care Guidelines for Funding Approval.

      The formal review is conducted by an MSC Review Panel, which consists of three members -- one representative from each of the Ministry of Health Services, the British Columbia Medical Association and the general public.

    • Manitoba

      Source:https://www.gov.mb.ca/health/mhsip/oop.html


      For More Information:

      Manitoba Health – Insured Benefits Branch
      Telephone204-786-7303
      Toll-free: 1-800-392-1207 x 7303
      TDD/TTY:  204-774-8618
      E-mailinsuredben@gov.mb.ca
      MailOut-of-Province Claims
      Manitoba Health
      300 Carlton Street
      Winnipeg MB R3B 3M9


      Out-of-Province


      You may be eligible for help with costs related to getting medical care in another province when an appropriate physician (specialist) recommends that you need a necessary, specific medical service (i.e., care or treatment) and that it is not available in Manitoba.


      Application Form: http://www.gov.mb.ca/health/mhsip/forms.html


      Approval process


      If treatment is not available in Manitoba, documentation from a specialist is needed to obtain coverage for out-of-province care:

      1. the specialist must write a letter to Manitoba Health, and provide certain information about your case;
      2. Manitoba Health will review the letter from the specialist, and seek an opinion from a medical consultant if necessary;
      3. After reviewing your case, Manitoba Health will write back to the specialist to approve or deny coverage for out-of-province treatment.  You will also receive a copy of this letter.


      Out-of-Country


      Manitoba Health will pay for care or treatment in the United States only if all Canadian medical resources have been exhausted.  In some cases, documentation that you have seen other Canadian specialists may be required before your request for referral outside the country will be considered.


      Costs covered outside of Canada


      For medical and hospital services provided in the U.S., Manitoba Health will cover:

      1. Doctor bills, at the same rate a Manitoba doctor would receive for similar services; 
      2. Hospital bills, up to 75 per cent of insured hospital services.


      If your costs for medical and hospital services exceed these coverage limits, it is your responsibility to pay the difference, unless you qualify for special assistance based on financial hardship.  


      Travel Costs


      If your out-of-province referral is approved, you may be reimbursed for reasonable transportation costs.  Accommodations, meals, taxis, ambulance and other expenses are not covered.


      More Information on Travel Subsidies for Out-of-Province Medical Referrals:

      https://www.gov.mb.ca/health/mhsip/travel.html


      Escorts


      Travel costs for an escort may also be reimbursed if the escort is required for your well-being and safety during travel.  If an escort is required, your specialist must notify Manitoba Health by including that information in his or her initial letter of request.


      Billing


      1. Doctor and hospital bills – In most cases, the original doctor bills and hospital bills will be sent directly to Manitoba Health for processing.
      2. Transportation costs – You must send your original receipts for transportation costs, or a letter requesting mileage reimbursement, to the Out-of-Province Claims Section at Manitoba Health.


      If you have already paid a doctor or hospital bill, you must include in your request for reimbursement the original receipt showing the amount you paid.  If you do not include a receipt, Manitoba Health will pay the doctor or hospital directly.


    • New Brunswick

      Source:https://www2.gnb.ca/content/gnb/en/departments/health/MedicarePrescriptionDrugPlan.html


      For More Information:

      New Brunswick Medicare
      Telephone

      Eligibility and Claims Branch Reception:  506-684-7901

      Toll-free Information:  1-888-762-8600

      E-mailmedicare@gnb.ca
      Mail

      New Brunswick Medicare

      Department of Health

      PO Box 5100

      Fredericton, NB   E3B 5G8


      Out-of-Province


      If you require insured physician services anywhere in Canada, except Quebec, simply present your valid New Brunswick Medicare card to the physician. New Brunswick has agreements with all Canadian provinces and territories, except Quebec, which allow physicians to bill their own health plan for providing insured physician services to New Brunswickers.


      However, physicians in other provinces or territories may bill a New Brunswick resident for services excluded from the agreements, such as genetic screening and procedures still in the experimental or developmental phase. These claims can be submitted to New Brunswick Medicare for consideration, but reimbursement is not guaranteed.


      In the province of Quebec, the physician may bill the patient directly or choose to bill New Brunswick Medicare. If you receive a bill from a physician in Quebec, submit a claim to New Brunswick Medicare for consideration. If reimbursement applies, it will be calculated at the Quebec rate only, which could be less than the amount billed by the physician.


      If you require insured hospital services elsewhere in Canada, New Brunswick Medicare will pay the standard rate. However, certain insured hospital services may be billed directly to you. These claims can be submitted to New Brunswick Medicare for consideration, but reimbursement is not guaranteed.


      It is mandatory for physicians to request prior approval from New Brunswick Medicare before referring a patient out-of-province for addiction or psychiatric treatment, unless the treatment is provided in a general hospital. The approval must be sought through the province’s Addiction Services or Mental Health Services.

      Please note that you must present a valid New Brunswick Medicare card to receive insured physician and hospital services in other Canadian provinces or territories.


      Travel and accommodation fees are not covered by New Brunswick Medicare for out-of-province services.


      Out-of-Country


      Prior approval


      New Brunswick Medicare covers out-of-country services not available in Canada on a prior approval basis only. This involves having a written request submitted to New Brunswick Medicare by a New Brunswick specialist which identifies a specific, medically necessary and scientifically acceptable service unavailable in New Brunswick or elsewhere in Canada.


      Appeals


      You may appeal to the Insured Services Appeal Committee if you do not agree with a decision made by New Brunswick Medicare about your case or the case of an immediate family member. This includes decisions about eligibility, refusal of a claim for entitled services or the amount paid on a claim. The Committee is made up of three members from the general public. It meets three to four times a year based on the number of cases it receives. It then reviews each case and presents recommendations to the Minister of Health and Wellness who makes the final decision regarding an appeal.


      Appeals, with all background information, should be addressed to:


      Insured Services Appeal Committee

      c/o New Brunswick Medicare

      Department of Health and Wellness

      PO Box 5100

      Fredericton, NB   E3B 5G8


      Client Advocate Services


      Client Advocate Services was established to: inform patients of their rights when dealing with New Brunswick Medicare; provide help and guidance on matters of dispute or disagreement; ensure the Medical Services Payment Act is appropriately applied; and ensure the process of the different sections of the Act is respected. Examples of issues that can be brought to the attention of the Client Advocate Services include: non-payment of services and eligibility issues.


      Contact Client Advocate Services at:


      Client Advocate Services

      New Brunswick Medicare

      Department of Health and Wellness

      P.O. Box 5100

      Fredericton, NB   E3B 5G8

      Phone: (506) 453-4227

      Fax: (506) 453-2726

    • Newfoundland and Labrador

      Source: http://www.health.gov.nl.ca/health/mcp/outofprovincecoverage.html


      For More Information:

      Newfoundland and Labrador Medical Care Plan 
      Telephone

      Avalon / St. John’s:  709-758-1500 or 1-866-449-4449

      All other areas:  709-292-4027 or 1-866-563-1557

      E-mail  mcpregistration@gov.nl.ca
      Mail or in-person

      PO Box 8700

      57 Margaret's Place

      St. John's, NL  A1B 4J6


      PO Box 5000

      22 High Street

      Grand Falls-Windsor, NL  A2A 2Y4


      Out-of-Province / Out-of-Country


      Application Form:http://www.health.gov.nl.ca/health/mcp/forms/out_of_province_claim.pdf


      With certain exceptions, claims for insured medical services obtained outside Newfoundland or Canada are paid at Medical Care Plan (MCP) rates, which are the rates paid to Newfoundland and Labrador physicians


      A) Rates Payable - Services Available in Newfoundland and Labrador


      Claims for insured medical services obtained outside Canada, that are available in Newfoundland and Labrador, are paid at Medical Care Plan (MCP) rates, which are the rates paid to Newfoundland and Labrador physicians. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.


      B) Rates Payable - Services Available in Canada but not in Newfoundland and Labrador


      Insured medical services obtained outside of Canada which are not available in Newfoundland and Labrador but are available in another province are payable at the rates established by the medical care plan in that province. When the amount billed exceeds the amount payable, payment of the difference is the patient’s responsibility.


      C) Rates Payable - Services Not Available in Canada


      If you are planning to have insured medical treatment which you think may not be available in Canada, and if you wish to claim reimbursement of related medical costs through Medical Care Plan (MCP), you must ask your physician to request prior approval from Medical Care Plan (MCP) before obtaining such treatment in another country. By doing so you will be made aware in advance of the rate at which your medical bills will be reimbursed.


      If you are granted prior approval based on the unavailability of the services in Canada, the Medical Care Plan will provide coverage for medically necessary physician services. Payment will be in the currency of the country where the services are received provided the rates are deemed to be fair and reasonable as determined by the Department of Health and Community Services. Prior approval is mandatory to receive payment at rates higher than those published in the Medical Care Plan (MCP) or other provincial physician fee schedules. If a patient opts to travel outside the country for medical service/treatment and prior approval has not been granted, payment will be in accordance with the established rates outlined in A) or B) above, and any balance remaining is the responsibility of the patient.


      Claim Submission Requirements


      If you have been treated by a physician in Canada who is not participating in the interprovincial arrangement, or have obtained services which are excluded firm the agreement, it will be necessary for you to submit an Out-of-Province Claim Form. This claim may be submitted on your behalf by the physician, in which case you will be asked to sign the form.


      If the physician elects not to submit a claim on your behalf or you obtain medical services outside Canada, you should obtain letterhead billing which contains an itemized statement of the charges and services. This information is required so that we may substantiate and assess your claim. You will then be required to submit an Out-of-Province Claim Form, accompanied by the letterhead billing.


      Medical Travel Assistance


      The Medical Transportation Assistance Program provides financial assistance to beneficiaries of the Medical Care Plan (MCP) who incur substantial out-of-pocket travel costs to access specialized insured medical services which are not available in their immediate area of residence and/or within the Province.


      Claimable expenses include airfare, accommodations purchased from a registered accommodations provider, such as a hostel, hotel, motel and/or registered apartment, scheduled busing services, and taxis when used in conjunction with commercial air travel. When a patient/family is out of pocket for the cost of registered accommodations, there is a provision for claiming a meal allowance for each night of medically required purchased accommodations. Accommodations and/or meals provided by family/friends are not claimable expenses under the Program.


      Claims can be made for Economy Airfare, Private Vehicle Usage and Registered Accommodations 


      For forms and detailed information on criteria: 

      https://www.health.gov.nl.ca/health/mcp/travelassistance.html#medical

    • Nova Scotia

      Source: http://novascotia.ca/DHW 


      For More Information:

      Nova Scotia Health – Medical Service Insurance
      Telephone

      1-902-496-7008

      1-800-563-8880 (toll-free in Nova Scotia)

      1-800-670-8888 (TTY/TDD)

      E-mailMSI@medavie.ca
      Mail

      Medical Services Insurance Programs

      PO Box 500, Halifax NS B3J 2S1



      Out-of-Province:


      Nova Scotians who are referred outside the province to receive medical or clinical treatment are eligible for coverage under the province’s out-of-province services plan.


      This type of funding can apply to a breadth of treatments, including eating disorders.


      The province has a process in place to consider funding out-of-province treatments:


      • Consideration for out-of-province treatment is given to patients who meet the need for treatment that cannot be met within Nova Scotia (wait times do not apply).
      • Coverage in other provinces is given for any provincially insured service. Uninsured services, as outlined under the provincial plan, are not funded outside of the province.
      • Requests are assessed on an individual basis by medical experts, and are evaluated to determine whether all reasonable treatment within Nova Scotia has been accessed.
      • The request for referral must come from the treating Nova Scotia specialist to the MSI medical consultant. Most physicians are aware of the process to follow.
      • The out-of-province treatment must be done in an accredited medical facility.
      • The referral must come to the MSI medical consultant for approval from a Nova Scotia specialist. Most physicians are aware of the process to follow.


      Out-of-Country:


      If you are a Nova Scotia resident and require medically necessary treatment unavailable in Canada, your referring Nova Scotia specialist must submit a request to the MSI Medical Consultant for prior approval. For travel and accommodation assistance, prior approval is required from the Nova Scotia Department of Health and Wellness before accessing out-of-country treatment.


      Travel and Accommodation Assistance Policy


      Nova Scotians who are approved to travel out-of-province for medical care are eligible for some financial support under the province's travel and accommodation assistance policy.


      Patients will need to have their specialist seek approval from MSI. It needs to be a medically insured treatment and it has to be a service that is not available in Nova Scotia.


      Insured services are generally those determined by experts to have proven medical benefits for patients. This does not include cosmetic procedures, procedures still being researched, or drug therapy.


      Travel and Accommodation Assistance forms and information:

      https://novascotia.ca/dhw/Travel-and-Accommodation-Assistance

    • Ontario

      Source: 

      http://www.health.gov.on.ca/en/public/programs/ohip/outofcountry/prior_approval.aspx


      For More Information:

      Ministry of Health and Long-Term Care
      Telephone1-888-359-8807
      Fax1-866-221-3536 or 1-613-536-3184
      E-mailOOCPRIORAPPROVALINQ.MOH@ontario.ca
      Mail

      Health Services Branch, 

      Provider Facility Payment Unit – Out of Country Prior Approval Program

      Ontario Health Insurance Plan

      Ministry of Health and Long-Term Care

      1055 Princess Street, PO Box 168

      Kingston, ON K7L 5V1


      Out-of-Province / Out-of-Country


      Prior approval from the Ministry of Health and Long-Term Care is required in order for patients to receive funding for OHIP-insured hospital and medical services out-of-country (OOC). Written approval must be received from the ministry before OOC health services are rendered.


      Physicians seeking out-of-country treatment on behalf of patients must complete and submit a Prior Approval Application to the ministry before funding will be considered.


      Application Form: http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetFileAttach/014-4520-84~1/$File/4520-84E.pdf


      Completed application forms may be mailed to the ministry at the address provided at the top of the form, or sent by fax to: 1-866-221-3536 or 613-536-3181.


      Specialist Confirmation


      Requests for prior approval for funding of out-of-country health services require written confirmation from an Ontario physician who is a specialist in the type of service for which funding is requested. The specialist must confirm that the service is:

      1. Generally accepted by the medical profession in Ontario as appropriate for a person in the same medical circumstances as the insured person, and
      2. Medically necessary, and EITHER
      3. An identical or equivalent service is not performed in Ontario, OR
      4. An identical or equivalent service is performed in Ontario, but it is necessary for the insured person to travel out of Canada to avoid death or medically significant irreversible tissue damage.

      General practitioners (GPs) may submit applications that include confirmation from a specialist.


      Approval


      When a patient's application for OOC Prior Approval has been processed by the ministry a decision letter will be sent to you and a copy sent to your physician. The ministry's decision letter will clearly outline what service(s) have been approved, the facility where the service(s) are to be provided and the approved cost of the service(s).


      The decision letter is based on the medical documentation that was provided with the application. If a patient's circumstances change, the physician may submit a new prior approval application to the ministry requesting new treatment and/or services as well as the proposed OOC physician/facility for consideration.


      Services Not Eligible for Out-of-Country Funding


      In the case of prior approvals, the ministry only covers costs for prior approved medical services. Expenses incurred for non-medical services such as travel, accommodation and meals (except where included as part of insured hospital services) are not insured services of OHIP.

    • Prince Edward Island

      Prince Edward Island

      Source: https://www.princeedwardisland.ca/en/information/health-pei/out-of-province-medical-services-non-emergency


      For More Information:

      Health PEI – Out-of-Province Coordinator
      Telephone902-368-6516
      Fax902-620-3072
      Mail

      Out-of-Province Coordinator

      Medical Affairs

      PO Box 2000

      16 Garfield Street

      Charlottetown, PE   C1A 7N8


      Out-of-Province / Out-of-Country


      Residents seeking government funding for non-emergency (that is, not for sudden illness) out-of-province medical or hospital services are required to obtain prior approval from Health PEI.  The cost of such out-of-province services may be fully covered providing that your physician submits an application on your behalf to Health PEI. 


      Applications may be approved in the following circumstances:

      • The insured medical service is not available in the province
      • Only one (1) medical practitioner in the required specialty area exists on the Island
      • The provincial medical consultant deems that adequate service is not available within the

      province

      • Extenuating circumstances exist and are documented that permit services to be provided in another province or territory


      Approval for a service will cover a period of no more than 12 consecutive months.


      If you do not receive prior approval from Health PEI for a non-emergency medical and/or hospital service to be obtained out-of-province, you will be held responsible for the total cost of the services rendered.


      Out-of-Province Travel Support Programs


      If you are a PEI Resident with a valid PEI Health card and have received prior approval from Health PEI for out-of-province medical services, you may be eligible for travel assistance. 


      Travel Support forms and information: https://www.princeedwardisland.ca/en/information/health-pei/out-province-travel-support-programs


      Appealing a Medical Insurance Decision


      For information/questions about a decision or other matter relating to the administration of Health PEI, residents need to contact Health PEI, Appeals Division. 


      Contact Information

      Medicare Office

      Appeals Division

      126 Douses Road

      Montague, PE C0A 1R0

      Toll Free:  1-800-321-5492

      Fax:  902-838-0940 

    • Quebec

      Source:http://www.ramq.gouv.qc.ca/en/Pages/home.aspx


      For More Information:

      Régie de l’assurance maladie Québec
      Telephone

      Québec:  418-646-4636 

      Montréal:  514-864-3411 

      Toll-free:  1-800-561-9749

      E-mailLink to e-mail form available at http://www.ramq.gouv.qc.ca/en/contact-us/citizens/Pages/contact-us.aspx
      Mail or in-person

      1125, Grande Allée Ouest

      Québec, QC   G1S 1E7


      Case postale 6600

      Québec, QC   G1K 7T3


      425, boulevard de Maisonneuve Ouest

      3e étage, bureau 300

      Montréal, QC   H3A 3G5


      Out-of-Province / Out-of-Country


      The Health Insurance Plan covers a wide range of essential medical services. However, in exceptional cases, some services may not be available in Québec. In such cases, and as a last resort, it is possible to request the Régie's authorization to receive healthcare outside Québec.


      How to proceed


      The Régie must be provided with the following:

      • a brief description of the medical care required
      • a written request, signed by 2 Québec medical specialists having recognized expertise in the disease that affects the insured person suffers, that attests that the services required are not available in Québec
      • the name and address of the hospital recommended for the hospitalization
      • a summary of the person's medical record. 


      The Régie's decision


      The Régie will evaluate the request and inform the insured person and that person's medical specialists of its decision.


      If the Régie grants an authorization, it will pay the full cost of:

      • hospital services (services related to a hospital stay, such as nursing care and accommodation)
      • professional services rendered in a hospital setting (such as the services of a doctor).


      Application for Review


      If you disagree with the decision of the Regie you can apply for a review. You have six months, from the date the Régie’s letter of decision is deposited in your mailbox or handed to you in person, to apply for a review of your file. Under the Health Insurance Act, the Régie has 90 days to render its decision following an application for review. If, after you’ve filed your application, you wish to provide supporting documents or comments, the 90-day time limit will run from the date the Régie receives the documents. Moreover, if the Régie deems that it needs additional documents or information, it may extend the time limit by another 90 days.Finally, if the Régie does not meet the deadlines, you may wait for its new decision, or contest the previous decision before the Tribunal administratif du Québec (TAQ).


      If you believe that the decision rendered in follow-up to your application for review does not respect your rights, you have 60 days (from the date the decision is delivered to your address) to contest it before the Tribunal administratif du Québec.


      For more information on the review process:

      http://www.ramq.gouv.qc.ca/en/regie/Pages/application-for-review.aspx


      Online application for review form: 

      http://www.ramq.gouv.qc.ca/SiteCollectionDocuments/citoyens/en/formulaires/form-demande-revision-4185-en.pdf

    • Saskatchewan

      Source:https://www.saskatchewan.ca/residents/health/prescription-drug-plans-and-health-coverage/health-benefits-coverage/out-of-province-and-out-of-canada-coverage


      For More Information:

      Ministry of Health – Medical Services Branch
      Telephone

      Regina: 306-787-3475

      Toll-free 1-800-667-7523

      Mail

      Saskatchewan Ministry of Health

      Medical Services Branch

      3475 Albert Street

      Regina, SK S4S 6X6




      Out-of-Province 


      Prior approval is required for services related to alcohol and drug, mental health, and problem gambling issues. Requests for out-of-province assessment and/or treatment are only accepted from Regional Health Authorities or the Physician Support Program of the Saskatchewan Medical Association. Once a request is submitted, it is reviewed by the Ministry of Health according to the out-of-province policy. If approved, the Ministry will pay the full cost of the assessment or treatment service. The cost of travel, accommodation, and meals are not eligible for coverage or

      reimbursement.


      Please note that you will not be reimbursed for the cost of services accessed without prior approval.


      Out-of-Country 


      If a specialist physician refers you outside Canada for treatment not available in Saskatchewan or another province, they must ask for prior approval, in writing, from the Medical Services Plan of Saskatchewan Health.  The request must:

      • Describe the circumstances of the case;
      • Clearly describe the service(s) being requested; and
      • State – to the best of the specialist’s knowledge – that the service(s) are not available anywhere in Canada.


      Referring specialists may call 306-787-3299 for further details about the prior approval process.


      If the treatment is approved, Saskatchewan Health will pay the full cost of treatment at a rate that the Ministry considers to be fair and reasonable after taking into account the locality in which the insured service is being provided


      Health Services Review Committee (HSRC)


      This committee reviews government decisions made on requests for out-of-province and out-of-country medical coverage, ensuring legislation, policy and guidelines are followed appropriately. 


      Reviews for denied coverage can be requested if the requested coverage is for insured out-of-province or out-of-country medical services (physician and hospital care) or community care programs (mental health, alcohol and drug, problem gambling, home care and rehabilitative services). 


      The Ministry will inform eligible applicants of their right to request a review by the HSRC. 


      Applications Process


      Eligible applicants must submit a written application to the HSRC within 90 days after the date the Ministry made its coverage decision. 


      Online application form:http://www.publications.gov.sk.ca/redirect.cfm?p=87716&i=104407 


      Send the completed application to: 


      Health Services Review Committee

      TC Douglas Building

      3475 Albert Street

      Regina, SK S4S 6X6

      Phone : 306-787-1910

      Fax:  306-787-3761


      You may submit to the HSRC additional information that was not previously provided to the Ministry in its coverage decision.This information will be forwarded to the Ministry to reconsider its decision.  If the additional information does not result in a change in the Ministry’s coverage decision, the HSRC will schedule a meeting to review your request.


      The Ministry has 30 days from receiving your application to inform you of the date that the HSRC will consider your application.In cases of clinical urgency, the committee may be convened to conduct a review with a quicker turnaround time.  The committee will consider whether the legislation, policies and guidelines governing out-of province and out-of country coverage were followed by the Ministry in making its coverage decision.Following the review, the committee will provide you with its recommendation as soon as possible.


      If the committee turns down your request you may contact the Provincial Ombudsman.  The Ombudsman not only reviews whether the Ministry followed policy appropriately, but also assesses the fairness and equity of the decision. Note: The Provincial Ombudsman is not able to review past Ministry decisions; it only has the authority to make recommendations. 

    • Territories

      Out-of-Territory / Out-of-Country 
      Specialized eating disorder services are not available in the territories. Residents should be referred to the nearest provincial centre where treatment is available by an appropriate physician. Those seeking funding for treatment at an out-of-country facility must obtain prior approval from their territory’s health and social services department. The process is similar to that of the provincial ones whereby the physician must submit an explanation as to why the procedure is required outside the country which is reviewed by a team. The criteria considered include the urgency, wait times at Canadian hospitals, and the type of treatment requested. 


      Yukon Territory 
      http://www.hss.gov.yk.ca/ 
      Telephone 
      Toll-free (in Yukon): 1-800-661-0408 + 4 digit extension 
      Email hss@gov.yk.ca 
      Mail 
      Health and Social Services 
      Government of Yukon 
      Box 2703 
      Whitehorse, YK Y1A 2C6 


      Northwest Territories 
      http://www.hlthss.gov.nt.ca/ 
      Telephone 867-777-7400 
      Toll-free: 1-800-661-0830 
      Fax 867-777-3197 
      E-mail hsa@gov.nt.ca 
      Mail 
      Health Services Administration 
      Department of Health and Social Services 
      Bag #9 
      Inuvik, NT X0E 0T0 


      Nunavut 
      http://www.hss.gov.nu.ca/en/Home.aspx 
      Telephone 867-975-5766 
      Fax 867-975-5705 
      Mail 
      Department of Health and Social Services 
      PO Box 1000, Station 1000 
      Iqaluit, NU X0A 0H0