Thank you, Mr. Speaker. Mr. Speaker, I have a Return to Oral Question asked by the Member for Kam Lake on October 27, 2022, regarding Infertility Treatment.
To answer the Member’s question as to who decides what conditions are covered as a medically necessary insured health service, it is not unfortunately a simple answer.
There are multiple factors that come together to determine what is deemed a medically necessary insured service. While the Canada Health Act sets out the principles of its Medicare system, specifically the principles of universality, portability and accessibility, it is the provincial and territorial healthcare insurance plan administrators who work with their respective physician groups, and across jurisdictions, to identify a set of services that each jurisdiction accepts as medically necessary insured service provided by physicians and in hospitals. This common set of services allows Canadians to have access to the same suite of services no matter where they live in the country.
Of course, each province and territory can cover additional services that are not universally insured across Canada. These services are only available as an insured service to the residents of that jurisdiction. In the NWT, we cover additional services such as eye examinations and rehab services, which are not services covered in other jurisdictions.
In cases of infertility, when an underlying medical condition is identified as the probable cause of the infertility, treatment of that underlying condition is covered under the NWT Healthcare Plan as an insured health service.
Where the cause of infertility is not readily known, these cases may be submitted to the Medical Advisor for review of the specifics of the case and decision. This process, referred to as 'prior approval,' is used in situations where detection and treatment of a potential underlying condition may be outside the Health and Social Services system's usual referral pathway or in circumstances that warrant further examination. Thank you, Mr. Speaker.
