What is covered under the AHCIP

The Alberta Health Care Insurance Plan (AHCIP) provides eligible Alberta residents with full coverage for medically necessary physician, and some specific dental and oral surgical health services.
  • Alberta Health relies on the professional judgment of a physician to determine what insured services are deemed medically necessary.
  • You must register for AHCIP coverage to receive insured hospital and physician services if you are new or returning to Alberta.
  • Always carry your personal AHCIP health care card and show it and other ID when you received medical services.

Fully covered services

This list is not intended to cover all instances. If you are not sure a medical service is covered or not, contact the AHCIP office.

Medical services covered under the AHCIP

  • medically required services provided by a physician
  • psychiatrist visits
  • medically required diagnostic services including laboratory, radiological and other diagnostic procedures
  • oral and maxillofacial surgery services
  • bariatric surgery for Albertans who meet the patient eligibility criteria established by Alberta Health Services’ Weight Wise program.

For a complete list of services the AHCIP covers, refer to the Schedule of Medical Benefits, or the Allied Health Services Benefits Schedules.

Hospital visits and stays including:

  • medically necessary nursing services
  • medically required laboratory, x-ray and diagnostic procedures
  • accommodations at a standard level and meals
  • medications administered in a hospital
  • use of the operating room, care room, radiotherapy, physiotherapy and anesthetic facilities
  • routine surgical equipment and supplies
  • inter-facility transfer in Alberta by ambulance.

Alberta Health provides funding to Alberta Health Services for the delivery of hospital services, mental health and addiction services, physiotherapy, midwifery services, cancer services, and home care.

Partially covered services

The AHCIP provides partial coverage for podiatry and optometry services received in Alberta only. These services have benefit limits or maximums per benefit year, which is from July 1 to June 30. The AHCIP also provides coverage for some specialized dental, oral and maxillofacial surgical services.

When the charge for a service exceeds the benefit limit, patients or their secondary insurer (if applicable) must pay the difference in cost. Always discuss treatment details and associated costs with a health care professional before you get the service.

Optometry (vision)

  • Eye exams: Children 18 years and under (1–18) and seniors 65 years and older are eligible for one complete eye exam, one partial exam and one diagnostic procedure per benefit year (July 1 to June 30).
  • AHCIP provides full coverage for some specific medical conditions treated by optometrists. Optometrists cannot charge their patients for services covered by AHCIP, however, the patient is responsible for additional costs incurred at the time of treatment.
  • AHCIP will cover an eye examination for a patient 19–65 years old if the optometrist deems it medically necessary as a result of trauma, a medical condition or episode of illness.
  • Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program.
  • Optometry services received outside Alberta are not covered.

Dental (oral)

  • AHCIP does not cover routine dental care such as cleaning, fillings and the extraction of wisdom teeth.
  • Some specific dental, oral and maxillofacial surgical services are covered by AHCIP. Only limited services in the Oral Maxillofacial Surgery Schedule are covered outside Alberta.
  • Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program.

Podiatry (foot care)

  • AHCIP provides partial coverage for some podiatry services under the basic podiatry program, to a maximum of $250 per benefit year (July 1 – June 30). Podiatrists can charge additional fees for these services.
  • The podiatric surgery program in Calgary provides full coverage for services provided by a podiatric surgeon in an Alberta hospital or non-hospital surgical facility under contract with Alberta Health Services.
    • Podiatric surgeons providing services contracted by Alberta Health Services may not charge their patients for additional costs.
    • A referral from a physician is required.
    • For more information call Health Link at 811 or visit the Alberta Health Services website.
  • Podiatry services received outside Alberta are not covered.

 

Read about what services are NOT covered