What is covered under the AHCIP?
$1.5 billion to assist Albertans with prescription drugs, ambulance services, cancer therapy drugs and other health benefits Find out how Alberta is investing in families and communities – Budget 2014 ›
Through the Alberta Health Care Insurance Plan (AHCIP), the ministry provides residents of Alberta with full coverage for medically necessary* physician and some specific dental and oral surgical health services.
You must register for AHCIP coverage to receive insured hospital and physician services if you are new or returning to Alberta.
- Refer to the Schedule of Medical Benefits, or the Allied Health Services Benefits Schedules for complete lists of services the AHCIP covers.
*Alberta Health considers the professional judgment of a physician to determine what insured services are deemed medically necessary.
NOTE: In the case of a discrepancy, the insured services listed in the schedules of medical benefits and outlined in legislation will overrule the list below.
- Vasectomy is covered. However, vasectomy reversal is not covered.
- Cosmetic surgery is not covered. However, some procedures are covered if deemed medically necessary by a physician. These may include:
- Panniculectomy (tummy tuck)
- Breast reduction mammoplasty
- Bariatric surgery is covered for weight loss for extremely obese patients with medical complications from the excessive weight. These include:
- Gastric partitioning
- Laparoscopic adjustable gastric banding
- Gastric bypass procedures
- For more information, visit the Alberta Health Services website
- Visits to a psychiatrist are covered because a psychiatrist is a medical doctor
- Counselling services provided by psychologists or non-physician mental health therapists are not covered regardless of whether or not a referral is made by a patient's physician.
- Alberta Health provides funding to Alberta Health Services to meet the mental health care needs of Albertans. Alberta Health Services offers various mental health services on both an in-patient and outpatient basis. For more information, visit the Alberta Health Services website
- Midwifery is not covered by the Alberta Health Care Insurance Plan but it is available through Alberta Health Services.
- For more information, visit the Alberta Health Services website
- Medically required surgery
- Standard Ward Hospitalization
- Medically necessary use of a semi-private or private room
- Private nursing care, ordered by the attending physician and meeting the hospital’s by-laws
- Pacemakers, steel plates, pins, joint prostheses, valve implants and any goods approved by the Minister (unless they are enhanced goods and services)
- Accommodation and meals at the standard or public ward level
- Necessary nursing services
- Laboratory, radiological and other diagnostic procedures (including interpretation) to maintain health, prevent disease and help diagnose/treat any injury, illness or disability
- Drugs, biologicals and related preparations administered in a hospital (as specified in the Hospitalization Benefits Regulation)
- Use of operating room, case room and anaesthetic facilities, plus the necessary equipment and supplies • Routine surgical supplies
- Use of radiotherapy facilities
- Use of physical therapy facilities
- Services supplied by persons being paid by the hospital
- Hospitalization Benefits (In-patients)
- Transporting a patient in Alberta by ambulance or other commercial vehicle from one facility to another
- Goods and services included in an approved hospital or specific program (unless they are enhanced goods and services)
- Hospitalization Benefits (Outpatients)
- Medically necessary goods and services provided to an outpatient, including goods used in a medical procedure but excluding goods given to a patient to use after discharge.
- Oral and Maxillofacial Surgery Services
- Diagnostic interview and evaluation or consultation
- Insured oral surgery
This information is not intended to cover all instances. If you are unsure whether a medical service is insured, please contact our office.
Provincewide Services are highly specialized procedures, such as organ transplants and major heart surgeries. These services can only be delivered effectively and efficiently at major centers: Edmonton and Calgary.
- Provincewide Services are available to all Albertans in addition to basic health services.
Almost 10% of the Provincewide Services budget is allocated for high-cost drugs such as:
- Transplant Drugs – Transplant patients are eligible for immunosuppressants.
- HIV Drugs – Drugs for the treatment of patients with human immunodeficiency virus type 1 (HIV-1) infection are dispensed through the Southern and Northern Alberta Clinics.
- Other Drugs – Other drugs funded by Provincewide Services include Pulmozyme (for cystic fibrosis), human growth hormone (for pediatric growth hormone deficiency and chronic renal failure), Flolan (for primary pulmonary hypertension) and Visudyne (for classic form of wet age-related macular degeneration).
Limited benefits means that a portion of a health care service cost is covered by the AHCIP, but not the entire cost.
Podiatry, optometry and dental services
The AHCIP provides partial coverage for podiatry and optometry services received in Alberta, but not outside the province. 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.
- Examples of benefit limits for certain services include podiatry, optometry and dental.
Podiatry (foot care)
Some podiatry services, provided in Alberta under the basic podiatry program, are payable at specific rates up to a maximum of $250 per benefit year (July 1 to June 30). Podiatrists can charge more than the Alberta Health Care Insurance Plan covers for basic podiatry services. The patient or their secondary insurer (if applicable), is responsible for paying any additional costs not covered under the Alberta Health Care Insurance Plan. Ask your podiatrist for details.
The podiatric surgery program 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.
- Podiatry services received outside Alberta are not covered.
Some optometry services, if provided in Alberta, are insured. Optometry services received outside Alberta are not covered. Benefits are limited to one complete exam, one partial exam, and one diagnostic procedure per benefit year (July 1 to June 30) for children under 19 years of age and seniors 65 years of age and over.
There are also some benefits for Albertans of all ages for specific medical conditions treated by Alberta optometrists. Optometrists cannot charge their patients for services covered by the Alberta Health Care Insurance Plan. The patient, or their secondary insurer (if applicable), is responsible for paying additional costs not covered under the Alberta Health Care Insurance Plan. Ask your optometrist for details.
Alberta residents 19–64 years old, who require an eye examination for a medical condition, episode of illness or trauma, may be eligible for an eye examination if the optometrist deems it as an insured eye examination. Consult with your health care professional regarding services covered.
Some specific dental, oral and maxillofacial surgical services are fully covered. Routine dental care is not covered, such as cleaning, fillings and the extraction of wisdom teeth. The patient, or their secondary insurer (if applicable), is responsible for paying additional costs not covered under the Alberta Health Care Insurance Plan. Ask your dentist for details.
- To find out what is covered, read the Schedule of Medical Benefits and the Schedule of Oral and Maxillofacial Surgery Benefits
- Read about services not covered by the Alberta Health Care Insurance Plan
The AHCIP does not provide coverage for dental care. However, Alberta seniors with low to moderate incomes may be eligible for the Dental and Optical Assistance for Seniors Program.
- Read the Dental and Optical Assistance for Seniors Program brochure
- For more information on the Dental and Optical Assistance for Seniors Program, call 780-644-9992 or toll-free at 1-877-644-9992 or go to Seniors Supports.