Out-of-country health services application process for physicians and dentists

The Alberta Health Care Insurance Plan only provides full funding for out-of-country health services if the service or treatment is not available in Canada.

Important: On behalf of an Alberta resident, an Alberta physician or dentist must complete and submit the applications.

Application process

1. Required: a referral letter or a completed Out-of-Country Health Services application form that includes the following information –

  • The health services or treatment for which funding is requested.
  • Expected duration of the initial out-of-country health services and the dates on which 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 obtained.
  • Name and specialty of the out-of-country physician who will provide or coordinate the health services.
  • The arrangements that have been made for follow-up care in Alberta or elsewhere in Canada.

2. The reason for seeking funding for out-of-country health services and a minimum of 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. The patient’s recent health summary, prepared by an Alberta physician or dentist that is relevant to the health service for which funding is being requested. 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;
  • if applicable, additional health services considered or explored but not pursued and the reason(s) why.

4. Any other information relevant to the application. Note:

  • The Committee does not have access to Alberta residents’ electronic health records. The Committee can only review information physically submitted with the application; therefore, submitting all information relevant to the services being requested is very important.
  • Do not include invoices, receipts, or any other information related to the costs of out-of-country services with the application.
  • This 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 patient’s eligibility for funding under the Regulation. Inquiries regarding the collection of this information may be directed to the Committee Chair.

5. All application letters, forms and supporting documents must be sent to:

Chair, Out-of-Country Health Services Committee
PO Box 1360, Station Main
Edmonton, AB T5J 2N3
Phone: 780-415-8744
Fax: 780-415-0963

If you need additional information, call 780-415-8744, or toll-free in Alberta dial 310-0000, then 780-415-8744.