AHCIP coverage within Canada

Albertans are advised to always carry their personal health care card, especially when outside Alberta in another province or territory within Canada you may be asked to present your card when obtaining insured physician and hospital services.

Under the Alberta Health Care Insurance Plan (AHCIP) and the Hospitals Act, the AHCIP provides coverage for insured physician and hospital services in Alberta and elsewhere in Canada.

Physician services

The provinces and territories, with the exception of Quebec, participate in reciprocal agreements. Alberta's legislation and the reciprocal agreements permit reimbursement only for insured medical services, and the amounts reimbursed are paid in accordance with the rules and at the rates established by the province that provided the services.

Hospital services

All provinces and territories participate in reciprocal hospital agreements. The hospital rates payable under legislation and these agreements are established on an annual basis.

Payment for hospital services are limited to those "goods and services if provided in Alberta would be insured services," and only covers those services if they are provided in a publicly funded hospital. As such, reimbursement for private facility fees, goods or services (such as private MRIs) is not permitted. In addition, the AHCIP does not cover food, lodging, transportation or other costs related to the obtaining of health services outside of Alberta.

Albertans may have to pay up front for hospital services and insured oral surgical services, and may apply to the AHCIP for reimbursement of these costs.

Permanent residents of another province/territory who must see a doctor while in Alberta may have to pay

Out-of-province patients may be asked to show their valid health care card and identification from their home province/territory at each physician visit in Alberta. If the patient receives an insured in-patient or outpatient service, Alberta Health will bill the home province/territory through the reciprocal billing process. Quebec does not participate in the medical reciprocal process but does participate in hospital reciprocal billing.

Out-of-province patients who cannot show a valid health care card from their home province/territory, and patients from Quebec, may be billed directly by the physician at Alberta rates. The patient can then submit the receipt to the home province for the insured portion of the service.