Non-Group coverage benefit

The Government of Alberta offers Non-Group Coverage to ensure all Albertans have access to an economical supplementary health benefits program that provides coverage for a variety of health-related services not covered by the Alberta Health Care Insurance Plan (AHCIP). Alberta Blue Cross administers Non-Group Coverage on behalf of Alberta Health.

This program does not provide travel coverage. If you are planning to travel outside of the province or country, it is strongly recommended you purchase travel insurance to cover emergency hospital and medical expenses.

Apply for coverage

Coverage will become effective on the first day of the fourth month after Alberta Health receives your application.

If you submit your application within 30 days of other supplementary coverage ending, coverage will begin the first day of the following month.

To cancel Non-Group Coverage, Alberta Health must be notified. Coverage will be cancelled the last day of the month in which notification is received.

Eligibility

Alberta Blue Cross Non-Group Coverage is available to all Alberta residents under 65 years of age and their dependants, as registered under the Alberta Health Care Insurance Plan (AHCIP) provided there is no amount owing on their AHCIP account and they are not eligible to receive the Alberta Widows’ Pension.

Single coverage—available to Alberta residents with no dependants

Family coverage—available to Alberta residents and eligible dependants. The same dependants covered under the subscriber’s AHCIP account must be included on the subscriber’s Non-Group Coverage:

  1. Spouse (husband or wife) 
  2. Adult interdependent partner** 
  3. Unmarried children under 21 years of age who are fully dependent on the subscriber 
  4. Unmarried children under 25 years of age who are in full-time attendance at an accredited educational institute 
  5. Unmarried children 21 years of age or older who are fully dependent on the subscriber because of a mental or physical disability

Alberta Health-sponsored supplementary plans cover pre-existing health conditions – no medical review is required.

Note: Albertans 65 years of age and over may apply for the Coverage for Seniors program

Benefits covered under this plan

A $50 annual deductible is applied to the total of all eligible health benefit expenses incurred in a benefit year, except for prescription drugs and diabetic supplies. The benefit year runs from July 1 to June 30. When no claim has been made for health benefits in a benefit year, any such expenses incurred during April, May or June that do not exceed $50 may be carried forward into the next benefit year and credited, in whole or in part, toward the deductible in that year.

Prescription drugs

The co-payment (the portion of the prescription cost you pay to your pharmacy when you have your prescription filled) is 30% to a maximum of $25. For most prescriptions, you will not pay more than $25 for each prescription..

There are a few cases when you might have to pay more than the $25 co-payment maximum:

  • If your drug is not listed in the Alberta Drug Benefit List
  • If you want a more expensive brand of drug than the least cost alternative or generic product, or
  • If the brand of drug you want costs more than the maximum cost set by Alberta Health for that drug.

To avoid surprises, ask your pharmacist about the cost of your prescription before it is filled.

Diabetic supplies

Diabetic supply coverage is for insulin-treated diabetics only. Up to a maximum of $600 per eligible person each benefit year is covered for diabetic supplies purchased from a licensed pharmacy. Diabetic supplies include needles, syringes, lancets, and both blood glucose and urine testing strips.

Ambulance services

Ambulance service charges to the maximum rate established by Alberta Health for transportation to or from a public, general, active treatment hospital in the event of illness or injury are covered. Transportation must be provided in a ground vehicle licensed under the Emergency Health Services Act and regulations. It does not include inter-facility transfer by ambulance.

Clinical psychological services

Coverage for clinical psychological services are up to $60 per visit, to a maximum of $300 per family each benefit year, for treatment of mental or emotional illness by a registered chartered psychologist.

Home nursing care

Coverage for home nursing care is up to $200 per family each benefit year for nursing care provided in the patient’s home by written order of a physician. Home nursing care must be provided by a registered nurse or licensed practical nurse who is not a relative of the patient.

Prosthetic and orthotic benefits

Coverage for prosthetic and orthotic benefits is up to 25% of the maximum allowable amount for items included on the benefit list as defined by Alberta Health. Coverage includes the purchase or repair of artificial eyes, prosthetic devices (except myoelectric-controlled prostheses) and braces required for six months or longer. A physician’s written order is required. Foot orthotics are not included as a benefit.

Mastectomy prosthesis

Coverage for mastectomy prostheses is up to 25% of the maximum allowable amount for the mastectomy prosthesis included on the benefit list as defined by Alberta Health. This does not apply to the purchase of a supporting brassiere.

Hospital accommodation

In a publicly funded active treatment hospital, you are covered for the difference in cost for a private or semi-private hospital room. Show your Alberta Blue Cross card when you are admitted, as all Alberta hospitals bill Alberta Blue Cross directly.

What is not covered

The following are not covered under the program:

  1. Claims for benefit expenses incurred prior to the effective date of coverage.
  2. Claims for benefit expenses received by Alberta Blue Cross more than 12 months after the service was provided.
  3. Services covered by the Alberta Health Care Insurance Plan (AHCIP).
  4. Charges for drugs supplied directly and charged for by a physician, with the exception of allergy serums.
  5. Registration, admission or user fees charged by a hospital.
  6. Drug products not listed in the Alberta Drug Benefit List. Ask your pharmacist and/or physician if your prescribed medication is on this list.
  7. Travel insurance for emergency hospital and medical expenses outside of the province or country.

How to claim for benefits