What is covered
Know what is covered. Before choosing to have elective (non-emergency) surgery outside Canada, contact the Alberta Health Care Insurance Plan (AHCIP) Out-of-Country unit at [email protected].
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.
Emergency services consist of insured services rendered in relation to an illness, disease or condition that is acute and unexpected, arose outside of Canada, and requires treatment without delay outside Canada.
The AHCIP covers only limited physician and hospital costs outside of Canada.
If you get medical or hospital care when outside of Canada, you will be responsible for paying the difference between the amount charged and the amount the AHCIP reimburses you.
If you claim coverage under the AHCIP, it is your responsibility to pay the health service provider. Submit a claim to the AHCIP office to request reimbursement for eligible out-of-country health expenses. Reimbursement is issued in Canadian funds only.
Emergency medical care and transportation can be expensive. You should have additional travel medical insurance when you travel outside Alberta.
Physician services outside Canada
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.
Services and rates paid to Alberta physicians are listed in the Schedule of Medical Benefits.
Hospital services outside Canada
Hospital services must be services that would normally be covered by the AHCIP and must be provided in a general or auxiliary hospital. Payment for hospital services provided in a private health facility will not be reimbursed.
A hospital is defined as a place that provides diagnostic services and facilities for medical and surgical treatment for urgent medical conditions and short-term treatment for a severe injury or episode of illness.
Hospital-services rates are the maximum that is reimbursed for all services provided to a patient, such as room and board, nursing, laboratory and X-ray services, medical supplies, and prescription drugs.
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.
Out-of-country health services funding
The Out-of-Country Health Services Committee considers applications for funding of insured medical, oral surgical and/or hospital services that are not available in Canada.
What is not covered
Services and expenses that the AHCIP does not cover include (but are not limited to):
- elective (non-emergency) treatment and surgery
- routine lab services received outside a hospital
- food, lodging, transportation, or other costs related to obtaining health services outside Alberta
- health services provided by health care providers other than physicians including:
- massage therapist
- physician assistant
- nurse practitioner
- air or ground ambulance services
- mental health services not provided in a general hospital
- publicly funded services (services in Alberta funded by Alberta Health Services) such as:
- home care
- behavioural disorders
- addiction treatment
- prescription medication
- medical/surgical appliances, prosthetics
- experimental or research procedures, for example, clinical trials
Submit a claim
Learn how to submit a claim for insured health services.
Connect with the Alberta Health Care Insurance Plan office.
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