Health care services covered in Alberta

The following medical services are covered under the AHCIP

• medically required services provided by a physician
• psychiatrist visits
• medically required diagnostic services including laboratory, radiological and other diagnostic procedures
• oral and maxillofacial surgery services
• bariatric surgery for Albertans who are eligible under the Weight Wise program
  • learn about bariatric surgery eligibility and the Weight Wise program
• breast augmentation and mastectomy for transgender surgery
  • patient eligibility must be determined and approved before breast surgery can be completed under Alberta’s Gender Reaffirming Surgery Program
  • surgeons must complete and submit the approval form
  • learn more about transgender medically necessary breast augmentation and medically necessary mastectomy surgery

For a complete list of services the AHCIP covers, see the Schedule of Medical Benefits, or the Allied Health Services Benefits Schedules.

If you are still not sure a medical service is covered, contact AHCIP.

The following hospital services are covered:

• 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

Some optometry services are covered under the AHCIP, but not outside Alberta:

• eye exams
• 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 for some specific medical conditions treated by optometrists
  • optometrists cannot charge you for services covered by AHCIP, but you are responsible for additional costs incurred at the time of treatment
• 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 episode of illness

Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program.

The following dental services are partially covered:

• some specific dental, oral and maxillofacial surgical services are covered
• limited services in the Oral Maxillofacial Surgery Schedule are covered outside Alberta

Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program.

Some podiatry services are covered under the AHCIP, but not outside Alberta:

• partial coverage for some podiatry services 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

Albertans are also eligible to receive full coverage for services provided by a podiatric surgeon in an Alberta hospital or non-hospital surgical facility under contract with Alberta Health Services.

In order to access services from podiatric surgeons contracted by Alberta Health Services, a referral from a physician is required.

Find out more by calling Health Link at 811.

Medical services not covered under the AHCIP include:

• non-medically required surgery such as cosmetic procedures, vasectomy reversal, abdominoplasty (tummy tuck)
• medical advice with a patient by telephone, unless otherwise stated in the Schedule of Medical Benefits or Schedule of Oral and Maxillofacial Surgery Benefits
• health services provided by a provider other than a physician – for example: chiropractor, acupuncturist, massage therapist, homeopath, nutritionist, psychologist, physician assistant or nurse practitioner
• vision care such as routine eye exams for residents 19 to 64 years of age, refractive laser eye surgery, eyeglasses and contact lenses
• routine dental care services, such as cleaning, fillings and extraction of wisdom teeth
• dentures
• prescription drugs provided in non-hospital settings
  • learn about drug coverage and services
• vaccinations for travel purposes and some immunizations
  • call Health Link at 811 or go to Alberta Health Services – Immunization to find out about immunizations and exceptions
• assisted reproductive technologies, including fertility treatments and in vitro fertilization
• health services requested by a third-party, such as medicals for employment, insurance or sports
• medical forms and notes
• clinical psychologist services
• driver’s medical exam

Hospital services not covered under the 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.

Many services are not covered outside Alberta including:

• vision care
• mental health and addiction services
• physiotherapy
• midwifery services
• cancer services
• home care services
• podiatry and optometry services
• dentistry services except for medically required oral surgery