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COVID-19 Updates: Taking steps to return to normal.
Only licensed Alberta physicians and dentists may apply for out-of-country health services funding for their patients.
Under the Alberta Health Care Insurance Plan (AHCIP), the Out-of-Country Health Services Committee (Committee) considers applications for funding of insured medical, oral surgical, and/or hospital services that are not available in Canada for eligible Albertan patients with valid AHCIP coverage.
Only a licensed Alberta physician or dentist can complete and submit the application on behalf of their eligible Albertan patient who hold valid AHCIP coverage.
Download the Out-of-Country Health Services application form (PDF, 130 KB)
The Out-of-Country Health Services application form or referral letter must include:
Include the reason for seeking funding for out-of-country health services and at least one of the following to support that reason:
Include the patient’s recent health summary relevant to the health service funding request. The summary must include:
Include any information relevant to the application.
The Committee does not have access to any electronic health records. The Committee can only review information physically submitted with the application. Please submit all information relevant to the services requested.
Do not include invoices, receipts, or any other information related to the costs of out-of-country services with the application.
Health information is collected and used by the Committee or the Appeal Panel under sections 20 and 27 of the Health Information Act and the Out-of-Country Health Services Regulation for the purpose of determining the patient’s eligibility for funding under the Regulation.
Direct all inquiries regarding the collection of this information to the Committee Chair.
Send the application form, letters, and supporting documents to:
Chair, Out-of-Country Health Services Committee
PO Box 1360, Station Main
Edmonton, Alberta T5J 2N3
Hours: 8:15 am to 4:30 pm (open Monday to Friday, closed statutory holidays)
Phone: 780-415-8744
Toll free: 310-0000 before the phone number (in Alberta)
Fax: 780-415-0963
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