Out-of-country health services application process

The process and form physicians and dentists must complete to apply for out-of-country health services funding for their patients.

Overview

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.

How to apply

Only an Alberta physician or dentist can complete and submit the application on behalf of their eligible Albertan patient.

1. Complete the application form

Download the Out-of-Country Health Services application form (PDF 130 KB)

The Out-of-Country Health Services application form or referral letter must include:

  • the health services or treatment needed
  • expected duration of the initial out-of-country health services and the dates when the health services will be provided
  • the number and frequency of expected out-of-country follow-up visits, if any
  • address of the out-of-country facility where the health services will be provided
  • name and specialty of the out-of-country physician who will provide or coordinate the health services
  • the arrangements made for follow-up care in Alberta or elsewhere in Canada

2. Reason for funding request

Include the reason for seeking funding for out-of-country health services and at least one of the following to support that reason:

  • documentation confirming that relevant health services in Alberta and elsewhere in Canada have been fully utilized
  • documentation confirming that the health service is not available in Alberta or elsewhere in Canada
  • an explanation for why health services that are available in Alberta or elsewhere in Canada are not being utilized

3. Patientís health status

Include the patientís recent health summary relevant to the health service funding request. The summary must include:

  • the clinical diagnosis relevant to the application
  • any health services previously provided for the condition, when and where they were provided, and the outcomes
  • copies of existing relevant findings or reports from specialists or consultants in the field of medicine or dentistry relevant to the condition for which funding of health services is requested
  • copies of relevant diagnostic and laboratory reports
  • additional health services considered or explored but not pursued and the reason(s) why, if applicable

4. Relevant information

Include any information relevant to the application.

  • The Committee does not have access to any electronic health records. The Committee can only review information physically submitted with the application. Please submit all information relevant to the services requested.
  • Do not include invoices, receipts, or any other information related to the costs of out-of-country services with the application.

Health information is collected and used by the Committee or the Appeal Panel under sections 20 and 27 of the Health Information Act and the Out-of-Country Health Services Regulation for the purpose of determining the patientís eligibility for funding under the Regulation. Direct all inquiries regarding the collection of this information to the Committee Chair.

5. Submit the application

Send the application form, letters, and supporting documents to:
Chair, Out-of-Country Health Services Committee
PO Box 1360, Station Main
Edmonton, AB T5J 2N3

Hours: 8:15 am to 4:30 pm (open Monday to Friday, closed statutory holidays)
Phone: 780-415-8744
Toll free: 310-0000 before the phone number (in Alberta)
Fax: 780-415-0963