Palliative Coverage Program
Palliative coverage is a benefit offered to Albertans who have been diagnosed as being palliative.* The program has been updated, effective September 1, 2014.
The Government of Alberta provides these Albertans with access to supplementary health benefits that provide coverage for health-related services not covered by the Alberta Health Care Insurance Plan (AHCIP). By subsidizing the cost of care in the home, a major financial burden is removed for the patient and the family. Alberta Blue Cross administers Palliative Coverage on behalf of Alberta Health.
*Definition – Palliative refers to patients who have been diagnosed by a physician or nurse practitioner as being in the end stage of a terminal illness or disease, are aware of their diagnosis and have made a voluntary informed decision related to resuscitation, and for whom the focus of care is palliation and not treatment aimed at a cure.
Who is eligible?
The program is open to residents of Alberta who are registered with the Alberta Health Care Insurance Plan and who have been diagnosed as being palliative.
The program excludes those patients whose residence provides publicly funded drugs, diabetic supplies and ambulance services; these include long-term care facilities, acute care hospitals and psychiatric hospitals.
Applying for the program
- The application form must be completed and signed by both the patient (or guardian) and physician or nurse practitioner.
- Mail or fax it to:
Attn: Alberta Palliative Coverage Program
PO Box 1360 Station Main
Edmonton, Alberta T5J 2N3
The application form is also available from Alberta Blue Cross, your physician or nurse practitioner, the palliative care program or home care offices in your area.
The patient or guardian will receive written notification from Alberta Health regarding acceptance into the program. Alberta Blue Cross will mail an ID card to the patient or guardian.
When does coverage begin?
The physician or nurse practitioner determines the effective date. This date must not be more than 30 days prior to the date Alberta Health receives the application. The coverage will continue as long as the patient is diagnosed as being palliative. Verification by the patient’s physician or nurse practitioner is required every six months.
The co-payment (the portion of the prescription cost the patient pays to the pharmacy when a prescription is filled) is 30% to a maximum of $25. For most prescriptions, $25 is the maximum required for each prescription.
There are a few cases when a patient may pay more than the $25 co-payment maximum:
- If the drug is not listed on the Alberta Drug Benefit List or the Palliative Coverage Drug Benefit Supplement; or
- If the patient chooses a more expensive brand of drug than the lowest-cost or generic brand; or
- If the brand of drug costs more than the maximum cost set by Alberta Health for that drug.
To avoid surprises, it is important to ask the pharmacist about the cost of the prescription before it is filled.
The lifetime maximum co-payment amount that is the responsibility of the patient is $1,000.
For insulin-treated diabetics only. Up to a maximum of $600 per eligible person each benefit year (July 1 – June 30) for diabetic supplies purchased from a licensed pharmacy. Diabetic supplies include needles, syringes, lancets and urine and blood glucose testing strips.
There is no co-pay for eligible diabetic supplies.
Ambulance services are covered to the maximum rate established by Alberta Health for transportation to and from a public, general, or active treatment hospital in the event of illness or injury.
Transportation must be provided in a ground vehicle licensed under the Emergency Health Services Act and regulations. It does not include interfacility transfer by ambulance.
What is not covered?
- Infusion equipment and supplies.
- Benefit expenses incurred prior to the effective date of coverage.
- Benefit expenses submitted more than 12 months after the service date.
- Charges for drugs and injectables supplied directly and charged for by a physician, excluding allergy serums.
How to receive benefits / Contact information
After you have received a notification advising that you are accepted in the Palliative Coverage program, you will receive an Alberta Blue Cross ID card issued in your name.
Eligible prescription drugs and diabetic supplies can be obtained at your local pharmacy by showing your Alberta Blue Cross ID card. Ambulance services can also be obtained by showing the Alberta Blue Cross ID card to the ambulance service provider.
If you are covered by more than one supplementary health benefit plan, eligible expenses may be coordinated between plans to maximize your benefits.
To claim reimbursement for eligible benefits, submit your claim using the Alberta Blue Cross claim form also available at any Alberta Blue Cross office, or your pharmacy .
To be eligible for reimbursement, claims must be received by Alberta Blue Cross within 12 months of the service date.
- Read more on how to claim your benefits through Alberta Blue Cross
- If you have more questions, contact Alberta Blue Cross