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Alberta Provincial Health Insurance Plan

 

The Alberta Health Care Insurance Plan (AHCIP) provides eligible Alberta residents with full coverage for medically necessary physician services and some dental and oral surgical health services.

 

Residents must be physically present in Alberta for 183 days or longer in a 12 months period to remain eligible for continued Alberta Health Care Insurance Plan (AHCIP).

 

DENTAL
- What is covered: The Alberta Health Care Insurance Plan (AHCIP) covers some specific dental, oral, and maxillofacial surgical services. Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program (limited to $5,000 every five years for eligible procedures).
- What is NOT covered: Dental services that are NOT covered by Alberta Health include dentures; routine dental care services, such as cleaning, fillings, and extraction of wisdom teeth.

DRUGS
- What is covered:
Alberta Health covers medications administered in a hospital. Seniors with low-income can get financial assistance to help with monthly living expenses. Alberta residents eligible for Non-group coverage (under age 65) pay 30% to a maximum of $25 for prescription drugs. The current monthly premium for Non-Group health insurance coverage is $63.50 for single and $118.00 for family.
- What is NOT covered
: Alberta Health Care Insurance Plan (AHCIP) does not cover prescription drugs provided in non-hospital settings and vaccinations for travel purposes and some immunizations.

TRAVEL INSURANCE
- What is covered: 
Physician services: If you get insured services from a physician outside Canada you will be reimbursed either the amount you claimed for the physician’s services or the rate an Alberta physician is paid for that service, whichever amount is less. Hospital services: The rate for in-patient hospital services is $100 (Canadian) per day, not including the day of discharge. The rate for outpatient services is $50 (Canadian) per day, with a limit of one visit per day.
- What is NOT covered:
Effective April 1, 2020, only the cost of insured emergency physician and/or hospital services received outside of Canada will be eligible for reimbursement under the Alberta Health Care Insurance Plan. Travel medical insurance is strongly recommended for travellers leaving the country.

VISION
- What is covered:
Children 18 years old and under, and seniors 65 years and older are eligible for one complete eye exam, one partial exam, and one diagnostic procedure per benefit year (July 1 to June 30). Full coverage, if you are 19 to 65 years old, for an eye exam your optometrist deems is medically necessary as a result of trauma, a medical condition, or an episode of illness. Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program.
- What is NOT covered:
Alberta Health Care Insurance Plan (AHCIP) does not cover eyeglasses and contact lenses, refractive laser eye surgery, vision care such as routine eye exams for residents 19 to 64 years of age.

PARAMEDICAL
- What is covered
: Alberta Health Care Insurance Plan (AHCIP) provide partial coverage for some podiatry services (foot care) under the basic podiatry program, to a maximum of $250 per benefit year (July 1 to June 30). Podiatrists can charge additional fees for these services. The Coverage for Seniors program covers low-income seniors for chiropractic services (up to $25 per visit to a maximum of $200 per person each benefit year) and psychologist services (up to $60 per visit, to a maximum of $300 per family each benefit year) for treatment of mental or emotional illness.
- What is NOT covered:
Alberta Health does NOT cover services provided by a provider other than a physician (for example chiropractor, acupuncturist, massage therapist, homeopath, nutritionist, psychologist, physician assistant, or nurse practitioner)  Note: services such as physiotherapy may be covered if performed in a hospital and deemed medically necessary.

HOSPITAL ROOM
- What is covered:
The following hospital services are covered by Alberta Health Care Insurance Plan: medically necessary nursing services; medically required laboratory, x-ray, and diagnostic procedures; accommodations at a standard level and meals; medications administered in a hospital; use of the operating room, care room, radiotherapy, physiotherapy and anesthetic facilities; routine surgical equipment and supplies; inter-facility transfer in Alberta by ambulance.
- What is NOT covered
:  Hospital services NOT covered under Alberta Health Care Insurance Plan (AHCIP) include private and semi-private hospital rooms (unless medically necessary); ambulance services (except inter-facility transfers); anesthetic charges for services not covered by the AHCIP; for dental service exceptions, contact your dentist; procedures that are experimental or undergoing clinical trials; hearing aids, medical and surgical appliances, prosthetics, supplies, mobility devices, etc. Alberta Aids to Daily Living may provide some of these services.

PRIVATE DUTY NURSING AND MEDICAL EQUIPMENT
- What is covered:
Alberta residents eligible for Non-group health insurance covers up to $600 per eligible person (insulin-treated diabetics only) each benefit year for diabetic supplies including needles, syringes, lancets, and urine- and blood-glucose testing strips. Home nursing care (up to $200 per family each benefit year) and prosthetic & orthotic (up to 25% of the maximum allowable amount for items listed by Alberta Health). The current monthly premium for Non-Group health insurance coverage is $63.50 for single and $118.00 for family.
- What is NOT covered:
Alberta Health does NOT cover surgical and medical appliances, prosthetics, wheelchairs, and other mobility devices. Note: the Alberta Aids to Daily Living program provides partial coverage to eligible residents for basic medical equipment. Patients may be required to pay some of the costs of community-based home care services, based on assessed needs.

HEARING AIDS
- What is covered:
Alberta Aids to Daily Living may provide some of these services.
- What is NOT covered: 
Hospital services not covered under the AHCIP include: hearing aids, medical and surgical appliances, prosthetics, supplies, mobility devices, etc. Alberta Aids to Daily Living may provide some of these services.

AMBULANCE
- What is covered:
The Alberta Non-group health insurance covers ambulance services to the maximum rate established by the Alberta government for treatment, and transportation to and from a general, active treatment hospital in the event of illness or injury. The current monthly premium for Non-Group health insurance coverage is $63.50 for single and $118.00 for family.
- What is NOT covered:  Hospital services not covered under the AHCIP include ambulance services (except inter-facility transfers).

 

Helpful links:

- Alberta Health

- Alberta Health Care Insurance Plan (AHCIP)

 

Visit www.ExtendedHealth.ca or call toll free 1-877-838-0020 to get a quote or apply for Extended Health care insurance.

 

get a free quote

 

IMPORTANT NOTE: The information on this web page is for illustration purposes only. Every effort has been made to ensure the accuracy of the information. Coverage details are subject to change. For complete benefits, terms, conditions, limitations, and exclusions, please contact Alberta Health and Wellness.

 

Last revised in September 2020.

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