Coverage and claims for services outside Alberta

Coverage within Canada

Albertans are advised to always carry their Alberta Personal Health Card 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 within Canada.

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.
• Albertans may have to pay for hospital services up front and may apply to the AHCIP for reimbursement.  Read the Out-of-Province Claim form instructions and download the form (AHC0693), or contact AHCIP if you have more questions.   
• 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 insured oral surgical services and may apply to the AHCIP for reimbursement of these costs. See the Schedule of Oral and Maxillofacial Surgery Benefits for more information.

Coverage outside Canada

Alberta Health and Wellness provides two sources of funding for Albertans who wish to receive insured medical treatment outside Canada: the Alberta Health Care Insurance Plan (AHCIP), and the Out-of-Country Health Services Committee.

Coverage under the AHCIP

• Insured physician services received outside Canada are paid at the lesser of the amount claimed, or the rate an Alberta physician would be paid for that service or the most similar service.
• The services and rates paid to Alberta physicians are listed in the Schedule of Medical Benefits.
• The rate for in-patient hospital services is $100 (Canadian) per day, not including the day of discharge. The rate for outpatient services is $50 (Canadian) per day, with a limit of one visit per day. These hospital services rates are the maximum that is reimbursed for all services provided to a patient, such as room and board, nursing, laboratory and x-ray services, medical supplies and prescription drugs. Insured hospital services must be provided by a general or auxiliary hospital. Hospital services provided in a private health facility are not eligible for reimbursement. The AHCIP does not cover food, lodging or other travel expenses.
• Alberta Health and Wellness covers only limited physician and hospital costs outside of Canada. It is strongly recommended that Albertans obtain travel insurance when outside the province or outside Canada, as costs for services can be much higher than in Alberta.

Submitting a claim to the AHCIP for services obtained outside Alberta

To submit a claim for reimbursement of the cost of insured health services received outside Alberta or Canada, complete the applicable form (below) and submit it along with itemized statements and proof of payment. Claims for health costs incurred outside Alberta or Canada must be submitted within 365 days from the date of service. If the invoices are not in English, they must be translated before submission.

NOTE: Do not use these forms for the Out-of-Country Health Services Committee. Read more about the Out-of-Country Health Services Committee

• Claim Form for Out of Province Physician / Practitioner Services Form AHC0693
• Claim Form for Out-of-Country Health Services Form AHC0934

To request the claims forms be mailed to you, contact AHCIP.

Please send your completed claim form along with itemized statements and proof of payment by mail or fax to the AHCIP at:

Alberta Health and Wellness
Out-of-Country / Province Claims
PO Box 1360 Stn Main
Edmonton, Alberta T5J 2N3
Fax number: 780-422-1958

Please allow 16 weeks for processing. Once you receive a letter and Statement of Account explaining the decision on your claim, you may make reference to the subscriber explanatory codes on your statement.

• AHCIP SOMB Subscriber Explanatory Codes  May 2011

If you have questions, contact us at 780-422-1954.

Out-of-Country Health Services Committee and Appeal Panel

Out-of-Country Health Services Committee

The Out-of-Country Health Services Committee (OOCHSC) considers applications for funding of insured medical, oral surgical and/or hospital services that are not available in Canada. Applications must be made by Alberta physicians or dentists on behalf of eligible Alberta residents. 

The OOCHSC operates at arm's length from Alberta Health and Wellness and, when making funding decisions, is required to follow the legislated criteria outlined in the Out-of-Country Health Services Regulation 80/2011.

NOTE: Do not use the OOCHSC application form to submit a claim to the AHCIP for reimbursement.  Read about submitting a claim to the AHCIP.

• Out-of-Country Health Services Committee information sheet 2012
• Out-of-Country Health Services Committee application form  2011

If you have questions, contact us at 780-415-8744. 

Out-of-Country Health Services Appeal Panel

If the Out-of-Country Health Services Committee (OOCHSC) denies an application for funding of insured medical, oral surgical and hospital services received outside of Canada, an appeal can be made to the Out-of-Country Health Services Appeal Panel within 60 days of receiving the OOCHSC decision. 

• Out-of-Country Health Services Appeal Panel Information Sheet 2012

If you have questions, contact us at 780-638-3899. 

More information on coverage outside Alberta

Extended absence from Alberta

You must maintain your Alberta Health Care Insurance Plan coverage if you leave Alberta for another part of Canada and intend to return within 12 months, or leave for another country and intend to return within six months. If you are leaving for a longer period and intend to return to Alberta, you may be considered for one of the the following extensions of coverage:

• 4 years (48 months) for absence due to work, business or missionary service;
• 2 years (24 months) for travel, personal visits or educational leave (sabbatical); or
• The time period you are a full-time student at an accredited educational institute.

If you are physically present in Alberta for at least 183 days in a 12 month period, you remain eligible for continued Alberta Health Care Insurance Plan coverage. If you are away longer, contact us.