Do You Need More Insurance? Understanding Your Alberta Health Card Coverage

Posted on October 3, 2018

The average Canadian family pays about $12,000 per year when it comes to public health care.

If you're a Canadian citizen you may be trying to wrap your head around that figure. To try to understand what goes into making numbers like that, maybe you've looked into the Alberta Health Care Insurance plan, or AHCIP for short.

In a nutshell, AHCIP gives you an Alberta health card that allows you to get free basic health insurance through the plan.

But what's covered under this plan? Do you still need to think about getting supplemental health insurance for you and your family?

This post is here to help you to figure out what you need to know about Alberta health care coverage under AHCIP.

Keep on reading to understand what is and isn't covered, as well as to find out whether you're eligible to apply.

Are You Eligible for the Alberta Health Care Insurance Plan?

First of all, let's help you to determine whether you are truly eligible for Alberta health care coverage under AHCIP in Canada.

In order to complete an Alberta health card application, you must be a legal citizen of Canada. You must also be able to show that you have made your permanent home in Alberta.

You must live in Alberta for at least 183 days out of the year. You absolutely cannot claim benefits from another Canadian province or territory. You also are not allowed to claim any sort of health care benefits from another country in which you may spend part of the year.

You will also qualify for this coverage if you have been legally proven to be a resident of Alberta, Canada.

Be aware that, if you've moved to Alberta from another country or even province in Canada, you may need to make it through a waiting period before you are eligible for the Alberta Health Care Insurance Plan.

Keep in mind that you are not eligible if your Canadian immigration documents have expired, if you're in a federal penitentiary, if you're a refugee claimant, or if you're in the Canadian Armed Forces.

If this describes you, then it's likely that you'll get your coverage from the Federal Government itself.

If you're a dependent of a non-eligible resident, then you are not exempt from coverage under the AHCIP, as long as you can prove that you live in Alberta.

Remember that a dependent is defined as a married, separated, or divorced spouse. It could also be a child under the age of 21 who is fully dependent on their parents. It also includes children under 25 who are enrolled in school full-time and interdependent partners.

Now, let's take a closer look at what Alberta health care coverage entails.

What's Covered with Your Alberta Health Card?

First of all, let's talk about what you can expect to receive coverage for when you use your Alberta Health Card.

It's important that you remember that only your physician can tell you what is and is not "medically necessary." So, even if you feel like you need a procedure to improve your quality of life? If your doctor can't classify it as a medical necessity, you won't get coverage for it.

Medical Coverage

So, what can you expect in terms of medical coverage?

If you visit a physician for medically-required services, you'll get covered. The same goes for psychiatrist visits.

If you meet the right criteria under the Alberta Weight Wise Program, you may even get coverage for bariatric surgery.

You will also get coverage for oral or maxillofacial surgery. Additionally, if you need lab tests, radiological services, or diagnostic services during an appointment, you'll be able to receive coverage.

Remember that in order for you to get any kind of medical coverage, you need to show that the procedure or appointment took place in Alberta. For additional medical coverage, such as costs relating to midwifery, you should contact the insurance provider directly.

Hospital Coverage

When it comes to the hospital, you can get coverage for inter-facility ambulance transfers in Alberta.

You're also covered for the use of an operating room, surgical equipment and supplies, and any medications that you're given while in the hospital.

You will also be covered for your accommodations, though not a private room, and your food while in the hospital.

Should you need an X-ray, lab tests, or any sort of diagnostic procedure completed, you are also likely to get coverage for that.

The same goes for any sort of nursing services that are deemed medically necessary.

Partial Coverage Options

You may also be able to get at least partial coverage for a few dental, optometry, and podiatry services in Alberta. This usually comes with a maximum benefit per year, and will generally require you to pay at least a part of the overall cost.

Examples of this include eye exams for children under the age of 18, or for seniors over the age of 65.

While dental cleanings aren't covered, nor is wisdom teeth surgery, if you have low to moderate income and are a senior citizen, some exceptions may apply. The best thing to do is to contact the insurance provider directly.

When it comes to foot care, you may be able to qualify for partial coverage for a foot surgery if you can get a referral from a physician.

However, it needs to be shown that the surgery is truly necessary for you to receive even partial coverage.

What the Alberta Health Care Insurance Plan Doesn't Cover

Now that you know what is covered when you use your Alberta health card, let's take a look at what isn't.

Sometimes, it's much easier to take a look at the exemptions in order to determine whether or not buying supplemental health care coverage is the right move for you.

When it comes to medical services, it's important to know that if surgery isn't truly medically required, you likely won't get coverage. This includes cosmetic surgery or vasectomy reversals, for example.

Additionally, you likely will not be covered for any sort of medical advice that you get over the telephone. The same goes for procedures and services that you get from anyone who isn't a doctor.

This includes things like massage therapy, acupuncture, a visit to the chiropractor, or even a psychologist. Also exempt are services given by a nurse practitioner, a physician assistant, and a nutritionist.

Having laser eye surgery, glasses and contact lenses, and even routine eye exams also aren't covered by this plan. Neither are dentures or other dental care.

You'll also need to pay out of pocket for psychology services, medical notes/records for your employer, fertility treatments, and even prescription drugs given to you outside of a hospital.

In the Hospital

Let's quickly go over what you won't be able to get coverage for in a hospital setting under AHCIP.

First of all, you will not be covered for most ambulance services. Additionally, unless it's medically required, you also won't be able to get coverage for a private or a semi-private room in the hospital.

Should you elect to undergo any sort of experimental or holistic treatment, you also won't be able to get coverage for it.

In some cases, you may not even be able to get your anesthetic charges covered. You should not expect to receive coverage under AHCIP for your hearing aids, your prosthetics, or even your mobility devices.

This last area, in particular, is why so many Alberta residents end up opting to buy additional coverage in Canada.

Want to Learn More about the Best Health Insurance in Alberta?

We hope that this post has helped you to better understand what is and isn't covered by your Alberta Health Card under AHCIP.

We know that it can be incredibly challenging to figure out if you're eligible for the Alberta Health Care Insurance Plan, and whether or not it will truly help to handle all of your needs.

Do you feel like you would still benefit from getting supplemental Alberta health care coverage? Do you have conditions that are not covered under AHCIP, and know that you'll need insurance to help you to manage the costs?

We want to be able to help you.

Spend some time on our website to learn more about the best Canadian supplemental health care plans for yourself and your family. Feel free to reach out to us if you have any questions or if you need more information.

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