3(1)Subject to section 4, a person shall be eligible to become a beneficiary on the first day of the third month following the month of arrival in the Province.

3(2)Except as otherwise provided in the Act and this Regulation, a beneficiary is eligible to have payment made on his or her behalf or to receive an amount computed in accordance with this Regulation for entitled services received

3(3)Notwithstanding subsection (2), no beneficiary is eligible to receive reimbursement or have payment made on his or her behalf for the cost of any entitled service where that person has had payment made on his or her behalf for such entitled service under any contract of insurance.

3(4)For the purposes of this section, a person is “temporarily absent from the Province” where that person is absent from New Brunswick

3(5)The Director may, with respect to a person meeting the requirements of paragraph (4)(a), (a.1) or (b) and any dependents, upon such terms, as it is considered to be in accordance with the intention of the Medicare Branch and this section, enlarge the time during which that person shall be deemed to be temporarily absent from the Province.

3(6)Notwithstanding the definition of “dependent” a newborn child is deemed, during the first three months following its birth, to have the status of its mother or, if the mother has no status, the status of its father under Medicare.

3(7)A beneficiary who leaves the Province ceases to be a beneficiary for purposes of coverage by the Medicare Branch,

3(8)For the purposes of this Regulation, the spouse of a beneficiary who ceases to be a resident and moves outside the Province is deemed to be a beneficiary during such time, if any, the spouse remains in the Province after the beneficiary ceases to be a resident and during this time the dependents of the beneficiary are deemed to be dependents of that person’s spouse.

4(1)The following persons, whether residents or not, are not beneficiaries:

4(2)Where a person described in paragraph (1)(a) or (c) has dependents residing in the Province, the spouse of that person or other person standing in the place of a parent to the dependents, is deemed to be the beneficiary and is eligible to receive reimbursement or have payment made on his or her behalf for or with respect to entitled services received by the beneficiary or the dependents.

4(3)Where a person described in paragraph (1)(a) or (c) has no spouse, the Director may designate that person a beneficiary for purposes of receiving reimbursement or have payment made on his or her behalf for or with respect to entitled services received by any dependents.

4(4)A person mentioned in paragraph (1)(a) or (c) shall, upon ceasing to be a person as therein mentioned and upon discharge within the province, become a beneficiary.

4(5)Immigrants who, in the opinion of the Director, are or will become permanent residents under the Immigration Act (Canada) and Canadian citizens as defined in the Citizenship Act (Canada) who have entered the Province from another country shall be entitled to become beneficiaries on the first day of arrival in the Province if they will, in the opinion of the Director, establish residence in the Province.

4(6)Notwithstanding the definition of “dependent”, the dependents of persons mentioned in subsection (5) shall be entitled to become beneficiaries in accordance with the provisions of subsection (5).

4(7)Any person who is a full-time student enrolled at a designated learning institution and who holds a valid study permit under the Immigration and Refugee Protection Act (Canada) entitling the person to be in Canada for a period of at least six consecutive months shall be entitled to become a beneficiary on the first day of classes or on the commencement date specified in the study permit, whichever is later, if the person will, in the opinion of the Director, establish residence in the Province.

4(8)A spouse or child of a person mentioned in subsection (7) shall be entitled to become a dependent and eligible to receive entitled services on the first day of classes or on the commencement date specified in the study permit, whichever is later, if the spouse or child will, in the opinion of the Director, establish residence in the Province.

5(1)A beneficiary who wishes to become eligible to receive entitled services shall register, together with any dependents, with the Medicare Branch on a registration form provided by the Medicare Branch for the purpose, or be registered by a person acting on his behalf.

5(2.01)The Director may at any time re-issue a New Brunswick Medicare Card to a beneficiary and the New Brunswick Medicare Card held by the beneficiary immediately before receiving the re-issued card ceases to be a valid card upon receipt of the re-issued card.

5(2)After a beneficiary registers himself and his dependents in accordance with this section, the Director shall issue a New Brunswick Medicare Card for the beneficiary and for each dependent, which card shall bear the person’s name, birth date and Medicare number.

5(2.1)A New Brunswick Medicare Card issued under subsection (2) or re-issued under subsection (2.01) shall bear an expiry date, such expiry date to be determined by the Director.

5(2.2)A New Brunswick Medicare Card that was issued before September 1, 1992 and that does not bear an expiry date ceases to be a valid card as of September 1, 1992.

5(2.21)Every New Brunswick Medicare Card that is not made of plastic and that does not possess an electromagnetic strip on the back of the card ceases to be a valid card as of February 28, 1995.

5(2.3)A beneficiary who wishes to remain eligible to receive entitled services shall, before the expiry date on a card issued under subsection (2) or re-issued under subsection (2.01), as the case may be, re-register, together with any dependents, with the Medicare Branch on a form provided by the Medicare Branch, or be re-registered by a person acting on the beneficiary’s behalf.

5(3)A beneficiary or a dependent requesting entitled services shall produce and show to the medical practitioner or oral and maxillofacial surgeon to whom the request is made, a valid unexpired card issued under this section identifying the beneficiary or dependent to whom it was issued and signed by the person or, if the person is unable to sign, by the person’s legal representative.

5(4)The Director may, in cases where the beneficiary and spouse do maintain the same household, deem both parties to be beneficiaries for purposes of the Act and this Regulation.

5(5)Notwithstanding subsection (1), where the Director is satisfied that a person would have been eligible to receive entitled services as a beneficiary or dependent if that person had been registered with the Medicare Branch, he may deem the person to have been registered as a beneficiary or dependent for the purposes of the Act and this Regulation as of the date the person was eligible to be registered or re-registered as a beneficiary.

5(6)Where the Director is not satisfied that a person is eligible to become or continue as a beneficiary, he may require the person to complete and file with him a declaration of residency form provided by the Minister.

5.1(1)The fee to be paid by a beneficiary to replace a New Brunswick Medicare Card as a result of loss, damage, destruction or theft of the card is ten dollars.

5.1(2)The Minister may waive a fee to be paid by a beneficiary under subsection (1) where, in the Minister’s opinion, the payment of the fee would constitute a hardship.

8(1)There is established in the Province a plan to be known as Medicare which shall provide, in accordance with the Act and this Regulation, payment to or on behalf of any beneficiary for or with respect to all entitled services received by that person or any dependents.

8(2)Medicare shall be administered and operated by the Medicare Branch composed of the Director and such other persons as are, in the opinion of the Minister, required.

11(1)A medical practitioner or an oral and maxillofacial surgeon who wishes to practise within the provisions of the Act and the regulations shall apply to the Director for a practitioner number and, subject to this section, the Director shall issue a practitioner number to the medical practitioner or oral and maxillofacial surgeon.

11(1.1)The Director shall not issue a practitioner number to a medical practitioner or an oral and maxillofacial surgeon unless the medical practitioner or oral and maxillofacial surgeon holds privileges granted by a regional health authority and signs an agreement with the Minister on the form prescribed in Schedule 3.

11(1.2)Notwithstanding subsection (1.1), the Director shall issue a practitioner number to a medical practitioner described in subsection 5.2(2) or (3) of the Act whether or not the medical practitioner holds privileges granted by a regional health authority.

11(1.3)A practitioner number issued by the Director before the commencement of this subsection to a medical practitioner described in subsection 5.2(2) or (3) of the Act shall be deemed to be a practitioner number issued under subsection (1.2).

11(1.4)A medical practitioner or an oral and maxillofacial surgeon may use a practitioner number only for so long as the medical practitioner or the oral and maxillofacial surgeon holds privileges granted by a regional health authority, unless the practitioner number is sooner revoked, suspended or cancelled by the Director.

11(1.5)Subject to subsection (1.6), a medical practitioner who is issued a practitioner number under this section and who does not hold privileges granted by a regional health authority may use the practitioner number until it is revoked, suspended or cancelled by the Director.

11(1.6)A medical practitioner referred to in subsection (1.5) who subsequently obtains privileges granted by a regional health authority is subject to the requirements of subsection (1.4).

11(1.7)Notwithstanding subsection (1.4), a practitioner number may be used where the privileges granted by a regional health authority to the medical practitioner or the oral and maxillofacial surgeon are temporarily suspended, unless the practitioner number is revoked, suspended or cancelled by the Director.

11(1.8)The Director

11(1.9)Where a medical practitioner or an oral and maxillofacial surgeon is being replaced on a locum tenens basis, the Director shall suspend the practitioner number issued to the medical practitioner or the oral and maxillofacial surgeon being replaced for the duration of the replacement.

11(2)Subject to section 13, where a participating medical practitioner or a participating oral and maxillofacial surgeon provides an entitled service to a beneficiary or dependent, he shall within three months after rendering that service submit an account for service to the Medicare Branch

11(2.1)Where a participating medical practitioner or a participating oral and maxillofacial surgeon submits an account for service under paragraph (2)(a), he shall provide the following information:

11(2.2)Where a participating medical practitioner or participating oral and maxillofacial surgeon submits an account for service under paragraph (2)(b), he shall provide the following information:

11(2.3)A participating medical practitioner or a participating oral and maxillofacial surgeon who submits an account for service under paragraph (2)(b) shall

11(3)Notwithstanding subsection (2), the Director may require the medical practitioner or oral and maxillofacial surgeon to supply such additional information concerning the services rendered and within such time as in the opinion of the Director is necessary to enable the Director to make an assessment.

11(4)If an account is not submitted for payment within the time limit prescribed under subsection (2), an account shall not be accepted for payment unless the time limit is waived by the Director in respect of that account.

11(5)The requirement to submit accounts within three months after the services are rendered does not apply in respect of entitled services rendered before April 1, 1997.

13(1)Where a participating medical practitioner or participating oral and maxillofacial surgeon provides an entitled service to a person who is a beneficiary or dependent and wishes to charge the person for the service and not submit an account for service to Medicare, the medical practitioner or oral and maxillofacial surgeon shall inform the person that he or she may charge the person for the service directly and shall provide the person with such information as is prescribed in subsections 11(2.1) and (3) on a form provided by the Medicare Branch so as to enable the person to make a claim for reimbursement.

13(1.1)Before providing a service under paragraph (n.1) of Schedule 2 to a person who is a beneficiary or a dependent, a participating medical practitioner or a participating oral and maxillofacial surgeon shall

13(2)Where an entitled service is provided in accordance with subsection (1), the amount that is payable for the service by the Medicare Branch shall be paid

13(3)Notwithstanding any other section of this Regulation, the Director may, make payments directly to persons acting on behalf of patients, and such payments to be made in accordance with this Regulation and are not to exceed the amounts provided hereunder.

13(4)Where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from the beneficiary a claim for reimbursement notwithstanding that all the information set out in subsection 11(2.1) has not been provided.

13(5)Notwithstanding the provisions of this section, where a non-participating medical practitioner or non-participating oral and maxillofacial surgeon resident and practising outside the Province provides an entitled service to a beneficiary or dependent, the Director may, in his discretion, accept from that medical practitioner or oral and maxillofacial surgeon an account for service rendered to the beneficiary or dependent and make payment in the amounts permitted by this Regulation directly to the medical practitioner or oral and maxillofacial surgeon notwithstanding that all the information set out in subsection 11(2.1) has not been provided.

13(6)Any payment made pursuant to subsection (5) shall be in lieu of making payment to the beneficiary.

14(4)The amounts payable by the Medicare Branch shall be

14(4.1)Despite paragraph (4)(a), the amounts payable by the Medicare Branch for gender confirming surgeries that are entitled services and that are rendered in Canada outside the Province shall be at the negotiated rate.

14(5)Where a participating medical practitioner or a participating oral and maxillofacial surgeon

14(6)Travelling expenses incurred by a medical practitioner are deemed to be entitled services where the medical practitioner is providing entitled services under the extra-mural service delivered by a regional health authority or by a person under an agreement with the Minister entered into under the Regional Health Authorities Act.

14(8)Notwithstanding any other provision of this Regulation, the Minister, on the advice of the Insured Services Appeal Committee established under section 33.01, may authorize payments in excess of the prescribed rates for entitled services if such payments do not exceed the amounts actually incurred or paid by or on behalf of an entitled person.

14.01(1)Notwithstanding sections 13, 13.1 and 14, no payment shall be made for entitled services unless the account or claim for reimbursement is received by the Medicare Branch

14.01(2)Notwithstanding subsection (1), an account or claim for reimbursement that is received after the applicable period may be paid if the Director so directs.

14.4(1)For the twelve month period beginning on April 1 of any year, the Lieutenant-Governor in Council may determine the sum that is available to the Medicare Branch for payments for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons.

14.4(2)A determination under subsection (1) may be made at any time before or during the twelve month period to which it relates.

14.4(3)Notwithstanding any other provision of this Regulation, where a determination has been made under subsection (1) and the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons exceeds

14.4(4)Where during part or all of any period referred to in subsection (2) the amounts payable for ordinary entitled services have been set under that subsection, and at the end of that period the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners and oral and maxillofacial surgeons has not reached the level set by subsection (2) for the end of that period, the amount payable during the three months that immediately follow for ordinary entitled services rendered by any medical practitioner or oral and maxillofacial surgeon shall be, if the Director so directs, a percentage above the amount that would be payable apart from this section.

14.4(5)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections the Director shall have regard to the following principles:

14.4(6)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections in relation to payments to be made in the three months immediately following the end of the twelve month period to which a determination under subsection (1) relates, the Director may assume, unless a further determination has already been made under subsection (1), that for the twelve month period that is about to begin a determination will be made under subsection (1) in the same terms as the determination that was made for the twelve month period that is ending.

15(1)In this section and section 5.4 of the Act, “assess”, with respect to accounts submitted for payment under the medical services plan means

15(2)The provincial authority may, in the provincial authority’s sole discretion, require any person who has submitted an account for payment by the Medicare Branch to supply such additional information within such time as in the opinion of the provincial authority is necessary to enable an assessment to be made.

15(3)The provincial authority may

17(3)A person, being a beneficiary who has submitted an account for payment by the Medicare Branch and who has any complaint concerning eligibility to receive payment for entitled services or the assessment of accounts with respect to entitled services rendered or received, may make a request to the provincial authority that the matter complained of be reviewed by the Insured Services Appeal Committee as established under section 33.01.

22(1)Subject to section 10, entitled services shall be deemed to include the health services listed in Schedule 4 when rendered by a qualified dental practitioner in a hospital facility if the condition of the patient is such that the services are medically required to be rendered in a hospital facility.

22(2)The dental practitioner rendering the entitled services mentioned in subsection (1) may make application for payment in the same manner as a medical practitioner and the provisions in this Regulation respecting payment for entitled services shall apply mutatis mutandis to a dental practitioner.

22(2.1)Except where otherwise provided in this Regulation, payment for entitled services rendered by a dental practitioner on or after April 1, 1998, shall be at the rate of ninety-eight cents per unit for the unit values listed for such services in Schedule 4 or the amount billed, whichever is the lesser.

22(3)Subsection 13(1) applies with the necessary modifications to a dental practitioner rendering an entitled service.

22(4)Subsection 13(1.1) applies with the necessary modifications to a dental practitioner rendering a service under paragraph (n.1) of Schedule 2.

24(1)The members appointed to the Professional Review Committee shall be appointed from persons nominated by the New Brunswick Medical Society and shall be medical practitioners duly registered and licensed in accordance with the terms of the Medical Act.

24(2)The members appointed under subsection (1) shall appoint one of their number as chairman at the first meeting of the committee.

25(1)Any member appointed to the Professional Review Committee shall be appointed for an initial term of one to three years at the discretion of the Minister.

25(2)A member may be reappointed any number of times for a term of three years.

25(3)If a member is unable or unwilling to perform the duties properly due to incapacity, incompetence, absence or for any other reason whatsoever, that person shall be removed as a member and another shall be appointed.

25(4)Notwithstanding the expiration of the term, a member shall continue to be a member until replaced.

25(5)The provisions of this Regulation shall apply to the appointment of any person who is appointed to replace another member, provided however, that where a new member is appointed to replace another member whose term has not expired the new member shall be appointed initially for the remainder of the unexpired term only.

33.003(1)Where a medical practitioner or an oral and maxillofacial surgeon is not satisfied with the assessment of accounts with respect to entitled services rendered or with respect to audit findings, the medical practitioner or oral and maxillofacial surgeon may appeal the assessment or the audit findings to an adjudicator.

33.003(2)An adjudicator shall be appointed by mutual agreement between the Department of Health and the New Brunswick Medical Society.

33.003(3)An adjudicator shall be appointed for a term of one year which may be renewed and his or her name shall be placed on a list maintained by the provincial authority.

33.004(1)A medical practitioner or an oral and maxillofacial surgeon who wishes to make an appeal under subsection 33.003(1) shall file with the provincial authority a notice of appeal within 60 days after receipt of the final notice of assessment issued by the provincial authority.

33.004(2)The notice of appeal shall include the reasons for the appeal and the official language chosen by the appellant.

33.004(3)If a medical practitioner or an oral and maxillofacial surgeon has made full payment of the amount specified in the final notice of assessment or has agreed to a repayment schedule, the provincial authority shall refer the notice of appeal to an adjudicator within 30 days after receipt of the notice of appeal.

33.004(4)Within 30 days after receiving the notice of appeal, the adjudicator shall set out the time and place for the hearing of the appeal, and shall advise the appellant and the provincial authority in writing of the time and place of the hearing.

33.004(5)With the consent of both parties, the adjudicator may determine the appeal based on the written representations of the parties without a hearing.

33.004(6)Only non-identifying medical information shall be contained in written or oral representations.

33.004(7)For the purposes of a hearing, an adjudicator has all the powers, privileges and immunities of a commissioner under the Inquiries Act.

33.004(8)Within 30 days after the hearing or the receipt of written representations, the adjudicator shall render a written decision in which he or she may affirm, vary or reverse the amount specified in the final notice of assessment.

33.004(9)The decision of the adjudicator is final and binding on both parties.

33.004(10)The decision of the adjudicator must be implemented within 30 days after the decision is rendered.

33.004(11)If the decision of the adjudicator affirms the amount specified in the final notice of assessment and the medical practitioner or the oral and maxillofacial surgeon has agreed to a repayment schedule with the provincial authority, the decision shall be deemed to have been implemented.

33.01(1)There shall be established a committee which shall be known as the Insured Services Appeal Committee and which shall consist of the following:

33.01(1.1)The members appointed to the Insured Services Appeal Committee by the Minister shall include

33.01(2)The function of the Insured Services Appeal Committee is to advise the Minister on appeals by persons on matters in dispute or disagreement with respect to

33.01(3)The term of appointment of members of the Insured Services Appeal Committee appointed under paragraph (1)(a) shall be for a term of three years and all members shall be eligible for reappointment for two additional terms.

33.01(4)The Minister may appoint in accordance with subsection (1) a person to fill a vacancy that occurs in the membership of the Insured Services Appeal Committee and such person so appointed shall hold office for the remainder of the term of office of the person in whose place that person is appointed.

33.01(5)The Minister shall appoint a chairperson from the members appointed in paragraph (1)(a).

33.01(6)A majority of voting members constitutes a quorum and is sufficient for the exercise of all functions of the Insured Services Appeal Committee.

33.01(7)The Minister shall supply secretarial and other assistance, as may be reasonably required by the Insured Services Appeal Committee.

33.01(8)The Insured Services Appeal Committee shall meet at the call of the chairperson as required.

33.01(9)Members of the Insured Services Appeal Committee shall serve without salary but may be reimbursed

33.01(10)The Insured Services Appeal Committee may adopt such procedures for conducting its business as it sees fit.

33.1(1)The following terms and conditions apply to the sharing of proceeds of any recovery under subsection 10(7) of the Act:

33.1(2)Where an injured person or a person paying the proceeds to the injured person is not represented by a barrister and solicitor, the payment of the proceeds under paragraph (1)(a) and an affidavit required under paragraph (1)(b) shall be made by the person making the claim, whether acting on his own behalf or on behalf of another person.

33.3(1)A medical practitioner who has been refused privileges by a regional health authority on any of the bases set out in subsection 4.01(2) of the Hospital Services Act may request the provincial authority to re-calculate the actual number of full time equivalents for the type of practice in which the medical practitioner proposes to become engaged in the area in which the medical practitioner proposes to practise, to ensure that the actual number of full time equivalents has been properly calculated and adjusted.

33.3(2)Subject to subsection (3), a request shall be made in writing within thirty days after privileges have been refused by a regional health authority.

33.3(3)A request under subsection (1) that relates to the period between July 1, 1993 and the commencement of this section shall be made within thirty days after the commencement of this section.

33.3(4)The provincial authority shall provide the medical practitioner making the request with relevant non-identifying information respecting the calculation and adjustment of the actual number of full time equivalents as it pertains to the medical practitioner making the request.

33.3(5)The provincial authority may, as a result of any representation made by the medical practitioner, adjust the actual number of full time equivalents previously calculated and adjusted if the calculation is shown to be erroneous.

33.3(6)The provincial authority shall inform the medical practitioner referred to in subsection (1) of any decision to adjust or not adjust the actual number of full time equivalents within ten days after the decision is made.