Palliative care health benefits

Overview

The Palliative Coverage Program provides subsidized benefits to Albertans who are diagnosed as palliative and remain in their home or in a hospice where access to publicly funded drugs, diabetes supplies and ambulance services are not included.

Palliative refers to patients who have been diagnosed by a physician or nurse practitioner as being in the end stage of a terminal illness or disease. Patients are aware of their diagnosis and have made a voluntary informed decision related to resuscitation, and the focus of care is palliation and not treatment aimed at a cure.

Albertans who are palliative are provided access to supplementary health benefits that provide coverage for health-related services not covered by the Alberta Health Care Insurance Plan (AHCIP).

By subsidizing the cost of care in the home, a major financial burden is removed for the patient and the family.

Alberta Blue Cross administers Palliative Coverage. There are no premiums to pay.

Eligibility

The program is open to Albertans registered with the AHCIP and who have been diagnosed as being palliative.

The program excludes patients who live in residences that provide publicly funded drugs, diabetes supplies and ambulance services. These residences include long-term care facilities, acute care hospitals and psychiatric hospitals.

Apply for the program

Download and complete the Palliative Coverage Program application form  (PDF, 156 KB)

You can also get the application form from Alberta Blue Cross, your physician or nurse practitioner, the palliative care program or home care offices in your area.

The application form must be completed and signed by both the patient, or guardian, and physician or nurse practitioner.

Mail it to:

Alberta Health
Attn: Alberta Palliative Coverage Program
PO Box 1360 Station Main
Edmonton, Alberta  T5J 2N3

Fax: 780-422-0102

The patient or guardian will receive written notification from the Ministry of Health regarding acceptance into the program. Alberta Blue Cross will mail an ID card to the patient or guardian.

When coverage begins

The physician or nurse practitioner determines the effective date of coverage. This date must not be more than 30 days prior to the date the program office receives the application. The coverage will continue as long as the patient is diagnosed as being palliative.

Benefits provided

Prescription drugs

Prescription medications, specific laxatives and solutions for hydration therapy are covered if listed in the Alberta Drug Benefit List or Palliative Care Drug Benefit Supplement.

Effective March 1, 2020, there is no co-payment for eligible prescriptions.

A patient will be responsible for additional costs if:

• your drug is not listed in the Alberta Drug Benefit List, or the Palliative Coverage Drug Benefit Supplement, or
• you want a more expensive brand of drug than the least cost alternative, maximum allowable cost product or generic product, or
• the brand of drug you want costs more than the maximum cost set by the Alberta government for that drug

To avoid surprises, ask your pharmacist about the cost of your prescription before it is filled.

Diabetes coverage

Plan members with diabetes will receive coverage for eligible diabetes supplies purchased from a licensed pharmacy, up to a maximum of $2,400 per eligible person depending on the method of diabetes management. (Read the Coverage Maximums for Diabetes Supplies fact sheet (PDF, 76 KB)). This benefit will be for each benefit year, that is, July 1 to June 30. Eligible diabetes supplies include test strips, needles, syringes, and lancets.

Continuous Glucose Monitors (CGMs) are available to Albertans under 18 years old who are living with diabetes. A prescription from an endocrinologist or pediatrician is required. Learn more about the eligibility criteria (PDF, 35 KB). These devices are not included in the $2,400 annual maximum for diabetes supplies.

Ambulance services

Ambulance services are covered to the maximum rate established by the Alberta government for treatment, and transportation to and from a general, active treatment hospital in the event of illness or injury.

Transportation must be provided in a ground vehicle approved under the Emergency Health Services Act and regulations. It does not include interfacility transfer by ambulance.

• Read more about ambulance service in Alberta
• Learn more about health care facilities

What is not covered

Supplies or expenses not covered include:

• infusion equipment and supplies

• claims for benefit expenses incurred prior to the effective date of coverage
• claims for benefit expenses received by Alberta Blue Cross more than 12 months after the service was provided
• services covered by the AHCIP
• charges for drugs supplied directly and charged for by a physician, with the exception of allergy serums
• registration, admission or user fees charged by a hospital
• drug products not listed in the Alberta Drug Benefit List – ask your pharmacist or physician if your prescribed medication is on this list
• semi-private or private hospital room
• travel insurance for emergency hospital and medical expenses outside of the province or country

How to receive benefits

After you have received a notification advising that you are accepted into the Palliative Coverage program, an Alberta Blue Cross ID card issued in your name will be mailed to you.

Eligible prescription drugs and diabetic supplies can be obtained at your local pharmacy by showing your Alberta Blue Cross ID card. Ambulance services can also be obtained by showing the Alberta Blue Cross ID card to the ambulance service provider.

If you are covered by more than one supplementary health benefit plan, eligible expenses may be coordinated between plans to maximize your benefits.

To claim reimbursement for eligible benefits, submit your claim using the Alberta Blue Cross claim form (PDF, 158 KB) also available at any Alberta Blue Cross office, or your pharmacy .

To be eligible for reimbursement, claims must be received by Alberta Blue Cross within 12 months of the service date.

• Read more on how to claim your benefits through Alberta Blue Cross

If you have more questions, contact Alberta Blue Cross