Alberta Health Care Insurance Plan (AHCIP)

Under the Alberta Health Care Insurance Plan (AHCIP), residents are covered for standard accommodations and meals during hospital stays. This includes basic ward rooms and medically necessary services. Private or semi-private rooms are not covered, but may be available for an additional fee.

The Alberta Health Care Insurance Plan (AHCIP) provides coverage for eligible prescription drugs listed on the Alberta Drug Benefit List for low-income residents, including seniors aged 65 and older. Depending on the drug, you may be required to pay premiums and a percentage of the drug cost, up to a maximum per prescription. For those without group insurance, the Non-Group Coverage program offers coverage for supplementary health benefits, including prescription drugs. Alberta’s Biosimilars Initiative mandates that only biosimilar versions of eligible drugs are covered under AHCIP.

Alberta Health Care Insurance Plan (AHCIP) covers one complete eye exam, one partial eye exam, and one diagnostic procedure per benefit year for residents aged 18 and under, or 65 and older. For adults aged 19 to 64, routine eye exams are not covered unless deemed medically necessary. The plan does not cover prescription glasses or contact lenses.

Routine dental services, such as cleanings, fillings, and extractions, are not covered under the Alberta Health Care Insurance Plan (AHCIP). However, partial coverage is available for specific dental, oral, or maxillofacial surgeries when they are medically required, such as for severe oral health conditions or trauma.

Alberta Health Care Insurance Plan (AHCIP) does not provide coverage for services offered by chiropractors, acupuncturists, massage therapists, homeopaths, nutritionists, psychologists, physician assistants, or nurse practitioners. However, Alberta seniors enrolled in the Coverage for Seniors health benefit may be eligible for chiropractic and psychological services. Coverage for podiatric services and appliances is available, up to a set rate per person, per benefit year. Private insurers cannot cover paramedical services until the Alberta government’s yearly maximum has been reached.

The Alberta Aids to Daily Living (AADL) Program provides limited coverage for hearing aids, medical supplies and other necessary equipment for residents who are disabled, chronically ill, or terminally ill. Eligibility is based on medical need, and additional assistance may be available depending on the individual’s circumstances. Continuous Glucose Monitors (CGMs) are covered for individuals aged 18 and under who meet specific eligibility requirements. Coverage for other medical supplies, such as ostomy supplies or orthoses, may also be available depending on medical need and eligibility criteria.

Ground ambulance services are generally not covered under the Alberta Health Care Insurance Plan (AHCIP) unless you meet specific criteria. You may be eligible for coverage if you are a senior citizen (65+), receiving income support, or belong to a low-income household. Ambulance services are covered for hospital-to-hospital transfers. In other cases, residents are typically responsible for the full cost.

Continuing care services and home care in Alberta are based on individual needs. If you qualify, the Alberta government provides coverage for various services delivered in your home or community, including personal care, nursing, and support services. Coverage is determined by an assessment of your healthcare requirements.

The Alberta Health Care Insurance Plan (AHCIP) provides limited coverage for physician services outside of Canada, reimbursing up to Alberta rates only. Hospital services are covered if they are medically necessary and performed in a hospital setting. However, ambulance services outside of Alberta are not covered, and services provided in private healthcare facilities are also excluded. The cost of any services beyond Alberta's rates is the responsibility of the resident.

The Alberta Health Care Insurance Plan (AHCIP) does not provide any coverage for accidental death and dismemberment. Residents seeking this type of coverage will need to explore private insurance options.