Out-of-country health services funding requests

Role of the Out-of-Country Health Services Committee

Under the Alberta Health Care Insurance Plan, 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.

  • Applications for funding of health services that are non-emergent in nature must be made prior to receiving the services.
  • For emergency health services, the Alberta physician or dentist may apply to the Committee prior to the patient receiving the services, or no later than 365 days after the services are received.
  • Out-of-Country Health Services funding does not cover:
    • meals, lodging costs, travel medical insurance, take-home drugs, medical equipment or supplies,
    • services cannot be experimental or applied research (e.g., clinical trials),
    • publicly funded services (e.g., services in Alberta provided by Alberta Health Services),
  • Mental health services, behavioral disorders or addiction treatment are not eligible for Out-of-Country Health Services funding.
  • An application to the Committee must be made by an Alberta physician or dentist on behalf of eligible Alberta residents. The Committee is independent and operates at arm’s length from the Ministry of Health and Alberta Health Services, but is required to follow the Out-of-Country Health Services Regulation when making funding decisions.

NOTE: Only an Alberta physician or dentist can apply for funding on behalf of an eligible Alberta resident.

Applications must meet certain conditions

  • The Alberta physician or dentist must apply on behalf of an Alberta resident who is registered with, and has not opted out of, the Alberta Health Care Insurance Plan.
  • The services must be medically necessary according to the Alberta physician or dentist.
  • The services must be medical, oral surgical, or hospital services insured under the Alberta Health Care Insurance Plan or the Hospitalization Benefits Plan.
  • There must be documentation showing the requested services are not available in Canada, and the health services available in Canada have be fully utilized.
  • The services cannot be experimental or applied research (e.g., clinical trials).

NOTE: Submitting an application for funding does not guarantee funding approval. The Committee bases all funding decisions on current legislation and the medical and clinical information.

Only complete applications will be reviewed

Applications are considered complete when:

  1. all the required information has been submitted,
  2. the Committee Chair has notified the applicant in writing that the application is complete, and
  3. the application has been scheduled for review at an upcoming Committee meeting.

The decision to approve or deny funding will be made at a Committee meeting.

NOTE: If a patient obtains a health service outside of Canada prior to the Committee making a decision on an application in relation to that health service, the patient will be responsible for the costs of any non-approved health services.

Application decisions

Once the Committee Chair has determined that an application is complete, the Committee has 60 calendar days to assess the application and make a decision.

All applications are reviewed by the Committee on the basis of their own individual merits.

  • The Committee’s decisions are made on a case-by-case basis, and within the parameters of current health legislation.
  • Each application is reviewed as a unique circumstance for an individual patient.
  • All decisions are based on the medical evidence provided and the Committee does not treat previous decisions as binding precedents.

If the application is approved in whole or in part, funding to the extent allowed by the Out-of-Country Health Services Regulation will be provided.

  • Funding is limited to the cost of the insured physician and insured hospital services provided outside of Canada with respect to the approved service.
  • The costs for take-home drugs, medical equipment, accommodation and subsistence, travel health insurance for unexpected emergency illness, as well as other supplies, are not covered.

Within 10 business days of making its decision, the Committee will send a written copy of its decision with reasons to the applicant and to the Alberta resident on whose behalf the application was made.

If the application is approved the Committee’s decision letter will provide all the necessary information to make arrangements for the out-of-country service.

Medically urgent applications

If the application is medically urgent, the applying physician or dentist must state this on the application, give the reasons for the urgency, and recommend the timeframe within which the health services should be initiated. If required, the Committee will convene an urgent meeting to review the application.

Appealing a decision

Decisions made by the Committee can be appealed. Appeals may be submitted by the Alberta resident or a physician or dentist acting on the resident’s behalf.

About the Committee

The Out-of-Country Health Services Committee is composed of 4 Alberta physicians and 1 non-voting chair who is an employee of the Ministry of Health. The Minister of Health appoints Committee members. The Committee was established under the Alberta Health Care Insurance Act and continues under the Out-of-Country Health Services Regulation.

The Committee is independent and operates at arm’s length from the Ministry of Health but must follow the Out-of-Country Health Services Regulation when making funding decisions.

More information