Fully covered services

The Alberta Health Care Insurance Plan (AHCIP) provides eligible Alberta residents with full coverage for medically necessary physician services, and some dental and oral surgical health services.

Your physician determines what insured services are considered medically necessary.

You must be registered with the AHCIP to receive insured hospital and physician services.

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 not sure a medical service is covered, contact the AHCIP office.

Medical services covered

The following medical services are covered under the AHCIP or publicly funded for individuals registered with 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
    • Albertans receiving bariatric surgery outside Alberta must meet the Weight Wise program’s eligibility criteria
    • a letter from an Alberta physician confirming the criteria have been met is required to be eligible for coverage

Hospital visits and stays

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

The Alberta government provides funding to Alberta Health Services to deliver hospital services, mental health and addiction services, physiotherapy, midwifery services, cancer services, home care and more. Learn more about Alberta Health Services.

Partially covered services

The AHCIP provides partial coverage for podiatry and optometry services received in Alberta only.

These services have benefit limits or maximums per benefit year, which is from July 1 to June 30.

The AHCIP also provides coverage for some specialized dental, oral and maxillofacial surgical services.

When the charge for a service exceeds the benefit limit, you or your secondary insurer (if applicable) must pay the difference in cost. Always discuss treatment details and associated costs with your health care professional before you receive the service.

Optometry (vision)

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

  • eye exams
  • children under 18 years old, 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.

Dental (oral)

The following dental services are partially covered:

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

Podiatry (foot care)

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

The podiatric surgery program in Calgary provides full coverage for services provided by a podiatric surgeon in an Alberta hospital or non-hospital surgical facility under contract with Alberta Health Services.

Podiatric surgeons providing services contracted by Alberta Health Services may not charge you for additional costs. A referral from a physician is required.

Find out more on the Alberta Health Services website or call Health Link at 811.

Services not covered

Some health services are not covered under AHCIP or outside Alberta. This list is not intended to cover all instances.

If you are not sure a medical service is covered contact the AHCIP office.

Medical services not covered

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
  • vaccinations for travel purposes and some immunizations
  • 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

Hospital services not covered

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.

Services not covered outside Alberta

Many services are not covered outside Alberta including:

  • 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

Help with medical expenses not covered by AHCIP

Income tax credits

Some medical expenses not covered by government programs or private insurers may be included on your income tax return for a tax credit.

Find out more on the Canada Revenue Agency website or call them toll-free at 1-800-959-8281.

Contact

Connect with the Alberta Health Care Insurance Plan office.