Coverage for Seniors benefit
The Government of Alberta provides premium-free Alberta Blue Cross Coverage for Seniors for health-related services not covered by the Alberta Health Care Insurance Plan (AHCIP). This coverage is available to all Albertans 65 years of age and older and all recipients of the Alberta Widows’ Pension, and their dependants. Alberta Blue Cross administers Coverage for Seniors 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.
Qualifying for premium-free coverage
When an Alberta resident reaches 65 years of age, the resident and all eligible dependants automatically qualify for premium-free Alberta Blue Cross Coverage for Seniors, sponsored by Alberta Health.
In order to be registered, seniors must provide proof of being 65 years of age or older such as a birth certificate, old age pension entitlement, passport, immigration record, or naturalization or citizenship certificate.
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 Coverage for Seniors:
- Spouse (husband or wife)
- Adult interdependent partner**
- Unmarried children under 21 years of age who are fully dependent on the subscriber
- Unmarried children under 25 years of age who are in full-time attendance at an accredited educational institute
- 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.
Benefits covered under this plan
Prescription drugs listed in the Alberta Drug Benefit List are covered. 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.
- Prescription drugs covered under the plan are listed in the Alberta Drug Benefit List.
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, or
- 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 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.
Seniors, age 65 and over, enrolled in the Coverage for Seniors program do not receive a bill for ambulance services. Alberta Health pays the complete cost of 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 interfacility 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.
Coverage for chiropractic services is up to $25 per visit to a maximum of $200 per person each benefit year. The chiropractor must be a licensed Alberta practitioner.
What is not covered?
The following are not covered under the program:
- Claims for benefit expenses incurred prior to the effective date of coverage.
- Claims for benefit expenses received by Alberta Blue Cross more than 12 months after the service was provided.
- Services covered by the Alberta Health Care Insurance Plan (AHCIP).
- Charges for drugs supplied directly and charged for by a physician, with the exception of allergy serums.
- Registration, admission or user fees charged by a hospital.
- Drug products not listed in the Alberta Drug Benefit List. Ask your pharmacist and/or physician if your prescribed medication is on this list.
- Semi-private or private hospital room.
- Travel insurance for emergency hospital and medical expenses outside of the province or country.