Essential Information for

Albertans from Alberta

Health and Wellness

1
 Alberta Health Care
Insurance Plan
The Alberta Health Care Insurance Plan
provides eligible residents of Alberta and their
dependants with:
• coverage for medically required
services provided by physicians;
• coverage for medically required oral
and maxillofacial surgery and
medically required dental services;
• coverage for medically required stays
and services in Alberta hospitals; and
• some coverage for services provided
by optometrists, chiropractors and
podiatrists (services must be provided
in Alberta).

The Schedule of Benefits, which list services

and rates paid for these services, are
available on the Alberta Health and Wellness
website at www.health.alberta.ca.

Alberta Personal Health Card

Please protect this card.
Personal Health Number

12345-0000 p le
Jane Lisa Doe S am
Gender F Birthdate 1960/11/16
Year Mo Day

You are eligible for health insurance coverage provided you are a resident of Alberta.

2
 Table of
Contents
Eligibility 4-5
Registration 6
Changes to Coverage 7-8
Benefits 9-12
Exclusions 13-14
Programs and Benefits for Seniors 15
Supplementary Coverage
(Alberta Blue Cross) 16-18
Travel and Temporary Absence 19-23

Moving 24-25

Other Health Care Services 26-27

Contact Alberta Health back

and Wellness cover

3
 Eligibility
All permanent residents
of Alberta must register
themselves and their
dependants (if applicable) with the
Alberta Health Care Insurance Plan.
Members of the Canadian Armed Forces,
the Royal Canadian Mounted Police, and
federal penitentiary inmates are not eligible
for coverage, but their dependants who
reside
in Alberta are.

An Alberta resident is defined as a

person who is:
• legally entitled to be or to remain in
Canada and makes his/her permanent
home in Alberta;
• committed to being physically present
in Alberta for at least 183 days in a
12-month period. (Note: Alberta Health
and Wellness considers temporary
absences as periods of physical presence);
• not claiming residency or obtaining
benefits under a claim of residency in
another province, territory or country;
• any other person deemed by the
regulations to be a resident but not
including a tourist, transient or visitor to
Alberta.

For the purpose of Alberta Health Care

Insurance Plan coverage, a dependant is
defined as:
• a spouse (married couples that reside
together must register together;
4
 separated couples may register together
or separately; divorced couples must
register separately);
• an adult interdependent partner*
(may register together or separately)
• a single child and/or an adopted child,
under 21 years of age and wholly
dependent on his/her parent(s). In cases
of separation or divorce, the custodial
parent should register the child. In cases
of joint custody, the child is registered on
the account agreed to by both parents,
generally with the parent the child resides
with the most;
• a foster child and/or ward of the court,
if an income tax deduction was claimed;
• a single child 21 years of age or older
and wholly dependent on the parent(s)
because of a physical or mental disability;
and
• a single child under 25 years of age and
enrolled in three or more courses at an
accredited educational institute. Proof of
enrolment may be required.
*An adult interdependent partner is a person
who lives with another person in a relationship of
interdependence:
• for a continuous period of not less than
three years; or
• of some permanence, if as a result of the
relationship the partners have a child by
birth or adoption; or
• if the partners have entered into an adult
interdependent partner agreement as
provided for in the Adult Interdependent
Relationships Act. The Adult
Interdependent Relationships Act may be
viewed at www.qp.gov.ab.ca. 5 5
 Registration
All residents of Alberta must register
themselves and their eligible dependants with
the Alberta Health Care Insurance Plan.
New and returning residents are required to
provide documents that prove their identity,
legal entitlement to be in Canada and Alberta
residency with their registration forms.
Registration forms are available from
employers, associations, unions, an Alberta
Health and Wellness office, or from the
Alberta Health and Wellness website at www.
health.alberta.ca.

Registration is required by law, however,

Albertans may choose to formally opt out
of the Alberta Health Care Insurance Plan.
Please contact an Alberta Health and
Wellness office for details.

Following registration, Alberta Health and

Wellness sends each person their Alberta
Personal Health Card with their personal
health number. Your Alberta personal health
care number and card are your personal
key to publicly-funded health services, and
they are a link to your health information. No
one else has the right to use them. To report
cases of suspected misuse of a health care
card or number call toll-free:
1-866-278 5104

Please note: You may be asked to show

picture identification as well as your personal
health card when you obtain health services.

6
 Changes to Coverage
To ensure that registration information stays
current, please notify Alberta Health and
Wellness of any changes that may affect your
coverage. This includes adding or removing a
dependant from your account and changes of
name or address.

Adding a dependant (Refer back to

pages 4 and 5 for a list of who qualifies
as a dependant.)
If Alberta Health and Wellness receives
notification within one month of the event
(e.g. marriage, adult interdependent partner
relationship), the dependant is added to the
account the date of the event. Otherwise, the
dependant is added the first day of the month
following notification.

Deleting a dependant
If Alberta Health and Wellness receives
notification within one month of the event
(e.g. divorce, child leaves home), the
dependant is deleted from the account
the day before the event. Otherwise, the
dependant is deleted the last day of the
month in which notification is received.

7
Newborn baby
Most babies born in
Alberta hospitals are
registered by the hospital
and coverage is effective
the date of birth. If the
hospital did not register the baby, coverage
can still be effective the date of birth if
notification is received within three months
from the date of birth. Otherwise, the effective
date is determined at the time of notification.
If the baby’s Alberta Personal Health Card is
not received within a month of registration, or
if the information on the card is not correct or
complete, please contact an Alberta Health
and Wellness office.

Name and address changes

It is important to notify Alberta Health and
Wellness of changes as soon as possible.
Changes can be made by filling out a Notice
of Change form available from employers,
associations or unions, or an Alberta Health
and Wellness office. Changes can also be
made at any Alberta Registry Agent or from
the Alberta Health and Wellness website at
www.health.alberta.ca.

8
 Benefits
Albertans who are registered with the Alberta
Health Care Insurance Plan are entitled to
a number of health care benefits. These
benefits may be paid directly by the Alberta
Health Care Insurance Plan or they may be
provided by a health region or the Alberta
Cancer Board. Benefits for health services
covered directly by the Alberta Health Care
Insurance Plan are payable whether they
are obtained within Alberta or elsewhere in
Canada, with the exception of private facility
fees. The Alberta Health Care Insurance
Plan pays medical benefits according to the
rates established by other provincial/territorial
health plans.

Physician services
The Alberta Health Care
Insurance Plan provides full
coverage for medically required
services provided by physicians.
Physicians are in the best position to advise
which health care services are covered.
Alternatively, this information is in the
Schedule of Medical Benefits, which are
available on the Alberta Health and Wellness
website at www.health.alberta.ca.

Oral and maxillofacial surgery and

dental services
Some specific dental/oral and maxillofacial
surgery services performed by a dentist are
fully covered. Examples of insured services
include cyst removal, joint and jaw surgery
and bone grafts. Tooth related treatments are

9
 Benefits
Continued ...
not an insured service. Dentists cannot
charge their patients for insured services
covered by the Alberta Health Care
Insurance Plan. However, dentists can
charge for uninsured services (such as
x-rays) they perform in association with an
insured service. Ask your dentist for more
details.

Chiropractic services
Benefits for chiropractic visits and x-rays
are payable at specific rates per service to
a maximum of $200 per person in a benefit
year if the services are provided in Alberta.
Chiropractors can charge more than what the
Alberta Health Care Insurance Plan pays.
The patient or their secondary insurer is
responsible for paying these additional costs.
Ask your chiropractor for more details.

Podiatry services (foot care)

Benefits for some services
provided by a podiatrist are
payable at specific rates per
service to a maximum of $250
per person in a benefit year if the
services are provided in Alberta.
Podiatrists can charge more than
what the Alberta Health Care Insurance Plan
pays. The patient or their secondary insurer
is responsible for paying these additional
costs. Ask your podiatrist for more details.

10
Optometric services (vision)
Benefits are payable if the
services are received in
Alberta. Benefits are limited
to one complete exam, one
partial exam and one diagnostic
procedure per benefit year for children
under 19 years of age and seniors 65
years of age and over. There are additional
benefits for some conditions. Optometrists
cannot charge their patients for services
covered by the Alberta Health Care
Insurance Plan. Ask your optometrist for
more details.

Hospital services
Alberta Health and Wellness provides
funding to health regions for medically
required inpatient and outpatient hospital
services. There is no additional charge to
Albertans for insured hospital services.
However, a hospital can charge for non-
insured services (e.g. private/semi private
room).
Insured hospital services include:
• medically required diagnostic, clinical
laboratory and nursing services;
• medications given to hospital inpatients
(patients may have to pay for
prescription medications provided in
hospital outpatient departments); and
• accommodation at a standard ward
rate (semi-private or private
accommodation and some other
services are not covered).
11
 Services covered by the Alberta Health
Care Insurance Plan and the amounts
paid for health services are subject to
change. Discuss coverage with a doctor
or other health care provider, refer to
the Alberta Health and Wellness website
at www.health.alberta.ca, or contact
an Alberta Health and Wellness office
about coverage for a treatment before
proceeding.

Statement of Benefits Paid is a list of

practitioner services a person received
during a specified period. A statement can
be obtained free of charge for the most
recent complete benefit period (July 1 to
June 30), plus the current year to date by
calling the Alberta Health and Wellness
automated request system at 780-427-0845
within Edmonton. To call toll-free from within
Alberta dial 310-0000, then 780-427-0845
when prompted. Statements can also be
requested for up to seven benefit years at
a charge of $63.60 per request. Requests
for statements that cover more than
the free period must be in writing and
accompanied by a cheque or money
order.

Please note: The Statement of Benefits Paid

does not include hospital services. The cost
of these services can be obtained from the
hospital that provided them.

12
 Exclusions
Some services are NOT covered by the
Alberta Health Care Insurance Plan. These
include, but are not limited to:
• cosmetic surgery,
• experimental procedures,
• research program procedures,
• transportation costs (contact your
health region),
• medical advice by telephone (unless
otherwise stated in the Schedule of
Medical Benefits or Schedule of Oral and
Maxillofacial Surgery Benefits),
• medical-legal services,
• anesthetic charges for services not
covered by the Alberta Health Care
Insurance Plan (for dental service
exceptions, please contact the dentist
performing the services),
• routine eye exams for residents 19 to 64
years of age,
• routine dental care, dentures,
• eyeglasses,
• hearing aids (contact 780-427-0731
in Edmonton or toll-free within Alberta at
310-0000, then 780-427-0731 when
prompted to determine if coverage for
these services is available through the
Alberta Aids to Daily Living program),

13
 Exclusions
Continued...

• medical and surgical appliances/supplies

(contact 780-427-0731 in Edmonton
or toll-free within Alberta at 310-0000,
then 780-427-0731 when prompted to
determine if coverage for these services
is available through the Alberta Aids to
Daily Living program),
• clinical psychologist services,
• prescription drugs (government
sponsored supplementary coverage is
available from Alberta Blue Cross – see
pages 16 and 18),
• third-party medical services (e.g. for
employment, insurance or sports
purposes; and for driver’s licenses for
individuals under 74.5 years of age),
• immunizations (contact your local health
region for exceptions),
• services provided by an acupuncturist,
licensed massage therapist, midwife,
homeopath, social worker or nutritionist,
• chiropractic services provided under
the Diagnostic and Treatment Protocols
Regulation for the diagnosis and
treatment of minor injuries resulting from
motor vehicle accidents,
• some hospital services, such as a private
or semi-private room,
• chiropractic, podiatry and optometric
services obtained outside Alberta.

14
 Programs and Benefits
for Seniors
Alberta Blue Cross Coverage for
Seniors
Alberta Health and Wellness provides
seniors and the dependants covered on their
accounts with Alberta Blue Cross coverage at
no cost. This is supplementary coverage for
prescription drugs and other services. Seniors
must provide proof of their age to receive this
benefit.

Optical and Dental Assistance for Seniors

Programs are available through Seniors and
Community Supports. For more information
on these two programs, contact the Seniors
Information Line in Edmonton at
780-427-7876, toll-free for the rest of Alberta
at 1-800-642-3853, or visit the website at
www.seniors.gov.ab.ca.

A comprehensive list of services for seniors

is in the Seniors Programs and Services
Information Guide. To obtain a copy, contact
the Seniors Information Line in Edmonton at
780-427-7876, toll-free for the rest of Alberta
at 1-800-642-3853, or visit the website at
www.seniors.gov.ab.ca.

15
 Supplementary Coverage
(Alberta Blue Cross)
Alberta Health and Wellness funds the
following Alberta Blue Cross non-group
supplementary health care plans.

Alberta Blue Cross Non-Group

Coverage
Coverage is available to residents under
the age of 65 years subject to the payment
of premiums. This coverage provides the
following benefits with some restrictions
and/or maximum limits: prescription drugs;
ambulance services; clinical psychological
services; home nursing care; prosthetic and
orthotic benefits; mastectomy prosthesis and
hospital accommodation in a private or semi-
private room.

Multiple Sclerosis (MS) drug coverage is also

available under the Alberta Blue Cross
Non-Group plan subject to prior approval
from the MS Drug Review Panel. Coverage
is provided for specific drugs used in
the treatment of relapsing/remitting MS.
Applications and more information are
available by contacting an Alberta Health and
Wellness office or from the Alberta Health
and Wellness website at www.health.alberta.
ca.

Alberta Blue Cross Coverage for

Seniors
See page 15 for information about this
coverage.

16
 Payment Options
Pre-Authorized Payment Plan
The Pre-Authorized Payment Plan provides a
convenient and reliable way to pay premiums
monthly. Applications are available by
contacting an Alberta Health and Wellness
office or from the Alberta Health and
Wellness website at www.health.alberta.ca.

Premium Subsidy Program

Non-senior Albertans with lower incomes
are encouraged to apply for the Premium
Subsidy Program, which may reduce your
non-group Blue Cross Premiums. Eligibility
for this program is based on the account
holder’s (and, if applicable, their spouse’s
or partner’s) taxable income for the taxation
year immediately before the subsidy period
(April 1 to March 31).

Applications for this program may be

submitted for the current subsidy period, plus
two previous periods immediately before
the current subsidy period. Applications and
information regarding qualifying taxable
income levels are available by contacting an
Alberta Health and Wellness office or from
the Alberta Health and Wellness website
at www.health.alberta.ca. Information
and applications are also available from
employers.

17
 Supplementary Coverage
Continued ...
Alberta Blue Cross Palliative Care
Drug Coverage
Alberta Health and Wellness offers premium-
free Alberta Blue Cross coverage for drugs
required by residents who are diagnosed
as palliative; whose physicians or nurse
practitioner have applied for the coverage on
their behalf; and who are receiving treatment
at home. Applications and more information
are available by contacting an Alberta Health
and Wellness office or from the Alberta
Health and Wellness website at www.health.
alberta.ca.

Please note: Claims for any of the

government sponsored Alberta Blue
Cross Plans must be received by
Alberta Blue Cross within 12 months of
the service date to be considered for
payment.

Private health care insurance

Albertans can purchase supplementary
health insurance coverage from private
insurers to help with costs for services that
are only partially covered or not covered
by the Alberta Health Care Insurance Plan.
Individuals interested in purchasing additional
health insurance coverage should speak
with their employer or contact a private
insurer directly to determine what coverage
is available. Supplementary health
insurance coverage cannot be purchased
through the Alberta Health Care Insurance
Plan.

18
 Travel and Temporary
Absence
When traveling, Albertans should always carry
their Alberta Personal Health Card and show it
when they obtain health services.

When traveling outside Alberta, it is important

to note that the Alberta Health Care Insurance
Plan does not cover some health services and
there are maximum benefits on some services
that are covered. Hospital services must be
provided in a general or auxiliary hospital to be
eligible for coverage.

To be eligible for treatment of drug and/

or alcohol abuse, eating disorders or other
behavior disorders outside Alberta, prior
approval must be obtained from Alberta Health
and Wellness.

Residents who will be absent from Alberta

for more than six months, are required to
contact an Alberta Health and Wellness office
before leaving to ensure Alberta Health Care
Insurance Plan coverage is maintained.

More information on Alberta Health Care

Insurance Plan coverage while traveling
outside Alberta is available on the Alberta
Health and Wellness website at www.health.
alberta.ca, in the brochure
Travel Health Insurance Matters, or by
contacting an Alberta Health
and Wellness office.

19
 Travel and Temporary
Absence Continued ...
Travel within Canada
Claims for medically required physician
and hospital services received elsewhere
in Canada are usually billed automatically
to the Alberta Health Care Insurance Plan
(except physician services in Quebec). Travel
insurance is recommended to cover costs for
ambulance services, private and semi-private
room accommodations. Medical claims are
paid at the established rates of the province
or territory where the services were obtained.
A patient may be asked to pay directly for
oral surgical services received outside
Alberta. A claim may be submitted for these
service expenses to the Alberta Health Care
Insurance Plan for reimbursement at Alberta
rates.
Travel outside Canada
Costs for health care services obtained
outside Canada are high. Alberta Health
and Wellness recommends that everyone
purchase travel health care insurance,
even for short trips. To ensure travel
insurance is adequate, travelers should
consider all pre-existing conditions they may
have. This will greatly reduce the risk of any
unexpected medical costs for the traveler.
Travel health insurance is not available
through the Alberta Health Care Insurance
Plan. See private health insurance section
on page 18 for information.
More information on Alberta Health Care
Insurance Plan coverage while traveling
outside Alberta is available on the Alberta
Health and Wellness website at
20
www.health.alberta.ca, in the brochure
Travel Health Matters, or by contacting an
Alberta Health and Wellness office.
Out-of-country practitioner services
are payable at the same rate an Alberta
practitioner would receive for the same
or a similar service, or the amount paid,
whichever is less. The maximum amount
paid for inpatient hospital care provided
outside Canada is $100 per day (in Canadian
funds), and inpatient hospital benefits are not
payable for the day of discharge. A maximum
benefit of $50 (in Canadian funds) is payable
for one outpatient hospital visit per day.
Hospital benefits are inclusive of x-rays, lab
tests, room and board, etc.
Temporary absence
Residents must maintain their Alberta
Health Care Insurance Plan coverage if they
temporarily leave Alberta for another part of
Canada and intend to return to Alberta within
12 months, or temporarily leave Canada and
intend to return to Alberta within six months.
If they leave for a longer period of time, but
intend to return to Alberta to live permanently,
they may apply for the following extensions of
coverage:
• up to two years (24 months) for travel,
personal visits or educational leave
(sabbatical); or
• up to four years (48 months) for
absences due to work, business or
missionary service; or
• the duration of time the resident is
enrolled as a full-time student at an
accredited educational institute.
21
 Travel and Temporary
Absence Continued ...
Temporary absence continued ...
Residents normally in Alberta 183 days of
the year remain eligible for coverage. If they
are away longer, but Alberta is still their
permanent place of residence, they need to
contact an Alberta Health and Wellness
office to apply for continued coverage.

Submitting a claim
Claims for health services received outside
Alberta and paid directly by the individual,
must be submitted within 365 days of the
service date. This can be done by filling out
the Out-of-Province Claim for Physician/
Practitioner Services (AHC0693). This form is
available by contacting an Alberta Health and
Wellness office or from the Alberta Health
and Wellness website at www.health.alberta.
ca. Copies of paid bill(s) must be included to
be processed.

Please note: Separate bills are needed

for hospital services and for practitioner
services. If the bills are not in English, they
must be translated into English before they
are submitted.

Claim forms can be submitted by fax to

780-422-1958 or mailed to:
Alberta Health and Wellness
Out-of-Country/Out-of-Province
Claims
PO Box 1360, Stn Main
Edmonton AB T5J 2N3

22
Special out-of-country benefit
programs
The Out-of-Country Health Services
Committee may approve additional funding
for patients who require medically necessary
physician, oral surgery and hospital services
not available in Canada. Applicants
require a referral from their physician with
appropriate supporting documentation. All
insured elective health services require prior
approval by the Committee to be eligible
for payment. For more information on the
program visit the Alberta Health and Wellness
website at www.health.alberta.ca or call
780-422-0969 in Edmonton, or toll-free in
Alberta at 310-0000 then dial 780-422-0969
when prompted.

23
 Moving
Moving to Alberta
When moving to Alberta
from another province or
territory, Alberta Health
Care Insurance Plan
coverage is effective the first
day of the third month following the date of
arrival. Registration must occur before the
first day of the fourth month after the date of
arrival. If an application for registration is late,
Alberta Health and Wellness will determine
the date coverage becomes effective.
When moving to or returning to Alberta from
outside Canada, coverage may be effective
on the date of arrival if the application for
registration is submitted within three months
of arrival. If the application for registration
is late, Alberta Health and Wellness will
determine the date coverage becomes
effective. To determine eligibility requirements
for those holding temporary immigration
documents, please contact an Alberta Health
and Wellness office.
New and returning residents who are
applying for coverage with the Alberta Health
Care Insurance Plan are required to provide
documents that prove their identity, legal
entitlement to be in Canada and Alberta
residency. Coverage cannot be provided until
Alberta Health and Wellness receives these
documents.
Please Note: If a person moves to Alberta
prior to their family and the family plans to
move to Alberta within 12 months, coverage
must be maintained in the province

24
or territory the family is living in. Alberta
Health Care Insurance Plan coverage should
be applied for within three months of the
arrival of all family members. Coverage is
effective on the first day of the third month
after the family’s arrival. If the family will not
join the person in Alberta within 12 months,
the person’s coverage is effective the first
day of the 13th month following his/her arrival
in Alberta.

Moving from Alberta

Temporary move
See temporary absence section on page 22
and 23 for information.
Permanent move
When moving from Alberta to another
province or territory, Alberta Health Care
Insurance Plan coverage remains effective
for the balance of the month of departure,
plus the two months immediately following
departure. This ensures continuous health
care coverage until coverage in the new
province/territory begins. An extra month of
coverage for travel time can be requested if
required.
When moving permanently from Alberta
to another country, arrangements can
be made to extend Alberta Health Care
Insurance Plan coverage for up to three
months from the date of departure.

25
 Other Health Care Services
Public health services such as home
care, speech-language pathology, early
intervention, nutrition, immunization,
community health nursing and environmental
health are available through your health
region. Some charges may apply. Contact
your health region for details.

Mental health services provided by

psychiatrists and other physicians within
Alberta at government-funded mental health
clinics, community agencies or hospitals and
are usually available at no cost. There may
be an accommodation charge for long-term
treatment. Contact your health region for
more information.

Physical therapy services received

in Alberta may be covered by your health
regions’ Community Rehabilitation Program.

Please contact your health region for more

details. Physical therapy services provided
outside Alberta are only payable in a hospital
and paid in accordance with the out-patient
rate only.

26
Questions about hospital, clinical laboratory
or physical therapy benefits
should be directed to your
health region. Information on
how to determine the health
region you live in or how to
contact your health region, is
available on the Alberta Health
and Wellness website at www.
health.alberta.ca or in your local telephone
book.

Coverage for services provided out-of-

province/out-of-country are subject to
rate maximums. See the sections in this
brochure on Travel and Temporary Absence
on pages 21 to 25, as well as the prior
approval requirements for treatments relating
to alcohol abuse, drug abuse, and eating
disorders on page 21.

27
 Notes

28
Notes

29
 Notes

30
Notes

31
 Contact Alberta
Health and Wellness
When applicable, please quote your Alberta
personal health number when making an inquiry.
Inquiries can be made through one
of the following methods:

Mail
Alberta Health and Wellness
PO Box 1360, Station Main
Edmonton AB, T5J 2N3

In person
To locate the office nearest you, please telephone
our office or visit our website.

Phone
780-427-1432 in Edmonton

Toll-free from other areas of Alberta

310-0000, then dial 780-427-1432 when prompted

Deaf/hearing impaired callers with a TDD/TTY

In the Edmonton area please call 780-427-9999.
To call toll-free from other areas of Alberta, dial
1-800-232-7215. This is not a voice line.

Fax
780-422-0102 Edmonton

Website
www.health.alberta.ca

E-mail
health.ahcipmail@gov.ab.ca

For your protection, please do not transmit

your personal health number or other
personal information by e-mail.

NCN0009 (2009/04)
32