Overview

The Out-of-Country Health Services Committee and Appeal Panel are regulatory/adjudicative agencies established under Sections 3 and 11 of the Out-of-County Health Services Regulation.

Governance

Search the list of public agencies for the Out-of-Country Health Services Committee and Appeal Panel:

  • mandate and roles
  • code of conduct

Membership

View the current membership of the Out-of-Country Health Services Committee and Appeal Panel.

Application eligibility

Applications to the Out-of-Country Health Services Committee must be submitted by an Alberta physician or dentist.

To apply for funding, your application must meet the following conditions:

  • The services must be medically necessary and supported by documentation from your Alberta physician or dentist.
  • The services must be medical, oral surgical, or hospital services insured under the Alberta Health Care Insurance Plan (AHCIP) or the Hospitalization Benefits Plan.
  • There must be documentation showing the requested services are not available in Canada, and that the health service options available in Canada have been fully utilized.
  • The services cannot be experimental or applied research, for example, clinical trials.

Submitting an application for funding does not guarantee funding approval. The committee bases all funding decisions on current legislation and the medical and clinical information provided.

Ineligible expenses

Services or expenses that are not eligible for funding include (but are not limited to):

  • meals
  • accommodations or lodging costs
  • travel medical insurance
  • take-home drugs
  • medical equipment or supplies
  • experimental or applied research, for example, clinical trials
  • publicly funded services, for example, services in Alberta provided by Alberta Health Services (AHS)
  • mental health services
  • behavioural disorders
  • addiction treatment

Funding application process

The committee is independent and operates at arm’s length from the Government of Alberta and AHS. The committee is required to follow the Out-of-Country Health Services Regulation when making funding decisions.

If a patient obtains health services outside of Canada prior to the committee making a decision on an application, the patient will be responsible for the costs of any non-approved health services.

Apply for funding

A funding application must be submitted to the committee by an Alberta physician or dentist on behalf of their eligible Alberta patient.

The funding request must meet the eligibility requirements.

Funding is limited to the cost of the insured physician and insured hospital services provided outside of Canada with respect to the approved service.

Learn about the out-of-country health services application process for physicians and dentists.

Application review

The committee Chair determines if an application is complete. Only complete applications will be reviewed by the committee.

Applications are considered complete when:

  • all the required information has been submitted
  • the committee Chair has notified the applicant in writing that the application is complete
  • the application has been scheduled for review at an upcoming committee meeting

Committee decisions

After the application is declared complete by the committee Chair, the committee has 60 calendar days to assess the complete application and make a decision at a committee meeting.

All applications are reviewed on their own individual merits and as a unique circumstance for an individual patient. Decisions are made on a case-by-case basis, and within the parameters of current health legislation.

All decisions are based on the medical evidence provided and the committee does not treat previous decisions as binding precedents.

If the application is approved in whole or in part, funding to the extent allowed by the Out-of-Country Health Services Regulation will be provided.

Within 10 business days of making its decision, the committee sends a written copy of its decision with reasons to the applicant and to the Alberta resident on whose behalf the application was made. If the application is approved, the committee’s decision letter provides all the necessary information to make arrangements for the out-of-country service.

Medically urgent applications

Applications for funding of non-emergency health services must be made prior to receiving the services.

For emergency health services, the Alberta physician or dentist must apply to the committee prior to the patient receiving the services, or apply to the committee for reimbursement no later than 365 days after the services are received.

The applying physician or dentist must state that the application is urgent, explain why it is urgent and recommend the timeframe within which the health services should be initiated. If required, the committee will convene and urgent meeting to review the application.

Expenses

Some expenses not approved by the committee may be partially covered by the AHCIP.

Learn about coverage outside Canada.

Contact the Out-of-Country Claims Unit

Out-of-Country Health Services Committee
Phone: 780-415-8744
Fax: 780-415-0963

Address:
PO Box 1360, Station Main
Edmonton, Alberta  T5J 2N3

Appeal a decision

Decisions made by the committee can be appealed to the Out-of-Country Health Services Appeal Panel (Appeal Panel).

Submit an appeal

The Alberta resident or the physician or dentist who submitted their application may submit an appeal to the Appeal Panel.

A written notice of appeal must be received by the Appeal Panel within 60 calendar days of receiving the committee’s decision.

The Appeal Panel can review only the materials originally submitted to the committee as part of the application. The Appeal Panel is not authorized to review new information.

Send the appeal to:

Out-of-Country Health Services Appeal Panel
Phone: 780-638-3899
Fax: 780-644-1445

Address:
PO Box 1360, Station Main
Edmonton, Alberta  T5J 2N3

Appeal decisions

The Appeal Panel has 60 calendar days from the date it receives the written notice of appeal to make its decision.

Once a decision has been made, the Appeal Panel will notify the person making the appeal of its decision in writing within 20 business days.

All Appeal Panel decisions are final.

Legislation

Alberta Health Care Insurance Regulation
Alberta Health Care Insurance Act

Compensation disclosure

Public sector bodies are required to post online the names and compensation paid to:

This is a requirement under the Public Sector Compensation Transparency Act. The postings are required by June 30 each year and will be maintained for 5 years.

Compensation disclosure file

Download the compensation disclosure for the Out-of-Country Health Services Committee and Appeal Panel (CSV, 5 KB).

Contact

Connect with the Alberta Health Care Insurance Plan office.