A Guide To AHCIP Plan & Health Card

The Alberta Health Care Insurance Plan or AHCIP is a near-universal healthcare insurance plan offered by the government of the province of Alberta to people residing for more than 183 days in a year in Alberta. The eligibility to apply for AHCIP extends to temporary residents and foreigners who intend to stay in Alberta for a period of up to a year.

    It covers a wide variety of physician and hospital services in Alberta but may prove limited for those that have pre-existing conditions that require regular prescription medication and extensive care. For instance, AHCIP only covers prescription medicines during a hospital stay. So if you have a condition that requires you to take prescription drugs regularly, you might find yourself spending a lot of money out of your pocket to cover the costs.

    It also has limited coverage for dental and mental health services which can be quite limiting in times where mental health illnesses are at an all-time high — so much so that poor mental health poses the second biggest threat to the childhood of Canadian children.

    But fortunately, extended plans do cover procedures that AHCIP doesn’t, have inexpensive premiums and provide comprehensive all-around coverage for all medical services you may need access to. We also discuss those on this page, along with everything you need to know about AHCIP.

    Whether you are new in Alberta and need help applying for insurance in Alberta or are moving to a different state and have concerns about losing your coverage in Alberta — you can find resources for your situation detailed here.

    rocky mountains alberta canada landscape

    Free Healthcare Coverage in Alberta

    Much like the rest of Canada, Alberta also has a public healthcare system administered by the provincial government. It’s funded by federal and provincial taxation levied on its residents, and is thus accessible to nearly everyone who has plans to stay in Alberta for the long term.

    Coverage Summary

    AHCIP Health Coverage is pretty comprehensive in Alberta, but may be limited if the AHCIP insurance healthcare cardholder is traveling outside the province or country. It provides full coverage for physician services that are medically necessary as well as some dental and surgical services in Alberta for all legally eligible adults. Typically, spouses have to apply together and one may be listed as a dependent under the other’s healthcare insurance plan.

    Drug Coverage

    If you have a condition that requires you to use prescription drugs regularly, you might be disappointed by the AHCIP drug coverage. AHCIP only covers the cost of prescription drugs administered during hospitalization, and all after-care costs will need to be supported by yourself.

    Student Coverage

    One great thing about AHCIP is that its benefits extend to all students enrolled in accredited universities in Alberta, including those who aren’t from the province or even Canada. Its comprehensive coverage also helps students save on the costs of buying a third-party insurance, barring the few that have conditions that are beyond the coverage of AHCIP. The only requirement to be eligible for AHCIP Coverage as a student is that you need to be enrolled in a program that is 12 months long and that you plan to remain in Alberta during this time.

    Registering For The Alberta Health Care Insurance Plan

    Anyone who plans to reside in Alberta for more than 183 days in a year may be eligible for Alberta Health Care Insurance coverage. All those that are eligible are required to register with the AHCIP Office before being allotted an AHCIP number and Alberta Health Care Card. All returning residents to Alberta may also be eligible for registration.Although there are many third-party extended coverage options, it’s highly recommended that you get an AHCIP number if you plan to reside in Alberta. It will help you offset costs of private insurance packages too as you will be able to choose coverage that you specifically need — while some of the essentials are already covered under AHCIP.

    Coverage When Travelling In Canada

    If you are planning to travel within Canada, but are leaving Alberta province, make sure you always carry your AHCIP card. According to Alberta.ca, AHCIP coverage may be limited outside of Alberta even if you are traveling to another province. Even if there are limitations, you might still be able to get coverage for some medical services and it’s advisable to have the card on your person just in case.

    Although there are coverage agreements between provinces in Canada, your AHCIP does not cover all aspects as if you were in Alberta. So, you may need to purchase some travel insurance to offset the costs of benefits lost to your move.

    With the additional travel insurance, you don’t have to consider AHCIP eligibility or reimbursements and can put your mind at ease. Travel insurance typically covers injuries, illnesses, medications, medical emergencies, and ambulance services — allowing you to travel comfortably.

    Coverage When Travelling Out of Canada

    AHCIP coverage abroad is quite limited, and as of April 1, 2020, only emergency hospital or physician services administered outside of Canada will be eligible for reimbursement under the AHCIP Plan. Alberta.ca strongly recommends that all outbound travelers purchase extended or travel coverage when traveling overseas.

    Services and expenses that the AHCIP does not cover outside Canada include:

    Elective (non-emergency) treatment and surgery
    Lab services received outside of a hospital
    Travel, food, lodging, or other expenses associated with receiving health services outside of Alberta
    Chiropractic services
    Acupuncture
    Massage therapy
    Homeopathic services
    Nutritionist’s advisory and consultation services
    Visits to a Psychologist
    Visits to a Podiatrist
    Optometric Services
    Services administered by a physician's assistant
    Nurse practitioner’s services
    Air or ground ambulance services
    Mental health services that are not offered by general hospitals
    Publicly funded services (services that are funded by Alberta Health Services) such as home care, behavioral disorders, treatment for addictions, etc.
    Prescription drugs
    Any medical or surgical appliances, including prosthetics
    Experimental treatments or clinical trials

    Note: AHCIP Plan members can submit claims for reimbursement for eligible overseas health costs if they use emergency medical services outside of Canada.

    Applying For An Alberta Health Care Card

    You have to fill out a form for AHCIP coverage to apply for AHCIP coverage if you are eligible. Eligibility doesn’t guarantee that an AHCIP number will be assigned to you, especially if your documents are not complete. Coverage is subject to approval, so make sure to read instructions and compile documents carefully before applying.

    Note: If you and your spouse are not eligible for coverage, it is still possible that the coverage extends to your children. A special form for Children of Non-Eligible Parents needs to be filled out for consideration.

    How To Apply In Person

    Once you have gathered your original documents and filled out the application form, you can go to the office of any authorized registry agent to apply for AHCIP health at no fee.

    How To Apply By Mail

    If you wish to apply for the Alberta Health Card by mail, you can post the application along with photocopies of your original documents to the AHCIP office. They will process your application within 6 weeks and if approved, send you the AHCIP card by post too.

    How to Apply Online

    Currently the Alberta Health Office doesn’t accept online applications for new and/or old applicants. The AHCIP procedure requires all documents to be checked and verified and as such must be brought to the office personally or sent by mail. You can print and fill out the application form in advance to save time.

    Forms And Documentation Required To Register

    Depending on your legal status in Canada, you will be required to prove not only your identity and proof of residence in Alberta but also your legal entitlement to be in Canada in the first place.

    As such, the documents you need for your application will differ depending on whether you are a Canadian citizen or not.

    You can submit any of these documents to prove your Alberta Residency:

    • Alberta driver’s license
    • Bills such as utilities and phone bills
    • Mortgage or rental agreement
    • Home insurance
    • Vehicle registration

    To prove your legal identity for AHCIP coverage, you can submit any of the following:

    • Canadian passport
    • Permanent resident card (both sides)
    • First Nations/Inuit/Métis card (both sides)
    • Alberta driver’s license
    • Alberta registries ID card
    • Canadian citizenship card

    Any of these documents can be submitted to prove your legal entitlement to be in Canada:

    • Canadian passport
    • Permanent resident card (both sides)
    • First Nations/Inuit/Métis card (both sides)
    • Canadian birth certificate
    • Canada entry document (both sides)
    • Canadian citizenship card or certificate (both sides)

    Note: If you are an international student moving to Canada, you are entitled to Alberta health care coverage from the date you establish residency in Alberta but must apply with the AHCIP Office within 3 months of moving to Alberta.

    Renewing or Replacing Your Alberta Health Care Card

    If you have lost access to your Alberta health care card due to a move outside the province for longer than the permitted time period of 212 per year and had failed to notify the AHCIP Office of your departure for vacation, you risk losing your AHCIP coverage.

    As a rule of thumb, each time you have a major life change (marriage, divorce, the birth of a child, long-term move away from the province, etc), you must notify the AHCIP Office so they can assist you in maintaining your coverage.

    Renewing Your Alberta Health Card

    If you recently got married, changed your relationship status, or have a child who is no longer qualified to be dependent, it is time to contact your AHCIP office and submit an adequate request to renew your AHCIP Card.

    Here are the forms you need to fill out, depending on why you are updating your AHCIP account:

    Just as you would while applying for a new Alberta health care card, you need to fill out the forms and bring them to the authorized registry agent’s office. You can also mail the form along with photocopies of supporting documents.

    Replacing Your Alberta Health Card

    If your Alberta healthcare card has been lost, broken, or damaged — you can fill out a form for replacing it. The form would need to be mailed or brought to an authorized registry agent’s office for it to be processed. You can reach out to their phone support line to request a replacement.

    Here is how to reach the AHCIP Office:

    Phone: 780-427-1432
    Toll free: 310-0000 before the phone number (in Alberta)
    TTY: 780-427-9999
    Toll free TTY: 1-800-232-7215
    Fax: 780-422-0102
    Email: health.ahcipmail@gov.ab.ca

    For general information or non-personal questions only.

    Changing Your Address On Your Alberta Health Care Card

    In case you changed your residency within Alberta province and you need to update your address on your AHCIP card, just fill in the form and submit it in person or via mail to the AHCIP office.

    AHCIP Coverage Details

    Even if some services are covered under AHCIP, you need to check if the coverage is partial or full to get an accurate cost estimate of your medical bills. For instance, optometry, dental and podiatry services have certain limitations under AHCIP and are not covered outside of Alberta. There are yearly benefit limits to these and you and your dependents may need to cover some parts of the procedures’ costs. If you’re unsure about the amount that you will have to pay to cover the difference, it’s best to consult the healthcare professional before you schedule for the procedure.

    It is important to note that the benefit limits for a year end on June 30 and are renewed on July 1 — so if you have already met your quota for the maximums for that year, you can wait for the benefits to renew. But let’s face it: waiting months for public health insurance benefits to renew will hardly be feasible if you need medical attention. Getting third-party insurance coverage to extend the coverage of your Alberta health care insurance is recommended, or you will need to have a financial plan to pay for costs of services that are partially or not covered at all under AHCIP.

    We listed all the possible coverages for medical care included with Alberta’s plan down below:

    • Medically necessary services that are provided by a physician.
    • Medically necessary nursing services.
    • Visits to a psychiatrist (but not a psychologist or psychotherapist).
    • Radiological diagnostics, X-rays, laboratory testing, and other diagnostic procedures (Only if medically required).
    • Maxillofacial surgery services.
    • Oral surgery services.
    • Bariatric surgery (Only for those eligible under the Weight Wise program).
    • Mastectomy and breast augmentation as part of transgender surgery. The patient will need to get approval under Alberta’s Gender Reaffirming Surgery Program before surgery can be funded by an AHCIP card.
    • Stay in a standard hospital ward with meals (semi-private and private wards are only available under circumstances deemed medically necessary by the physicians).
    • Medications administered during the hospital stay (but not after).
    • Costs of using an operating room, care room, or specialized services like radiotherapy, physiotherapy
    • Standard anesthetic facilities.
    • Equipment or supplies used routinely during surgical procedures.
    • Ambulance transfer from one medical facility to another (costs to the hospital from a residence are not covered).
    • Alberta Health Services also receives funding from the provincial government to provide mental health and addiction services, physiotherapy, midwifery services, cancer services, and home care.

    Optometry and vision services partially covered under AHCIP:

    • Eye exams
    • One complete eye exam, one partial exam, and one diagnostic procedure per year (only for children below 18 and senior citizens above the age of 65)
    • Full coverage for some optometric conditions
    • Full coverage for eye exams that are medically necessary as a result of an episode of illness or trauma to the eye.

    Podiatry and footcare services covered partially under AHCIP:

    • Maximum benefits of up to $250 per benefit year for some podiatry services.
    • If you require the services of a podiatric surgeon at a hospital or any other surgical facility that has a contract with Alberta Health Services — you may be eligible for full coverage. A referral letter from a physician is a prerequisite for receiving the services of a podiatric surgeon.
    dentist instruments

    Dental

    Dental services partially covered under AHCIP:

    Specific dental, maxillofacial and oral surgical health services. Limited services under the Oral Maxillofacial Surgery Schedule can also be covered outside Alberta. More oral surgical health services are available with private health insurance or an extended AHCIP plan such as co-pay.

    Dental Costs

    As per Alberta.ca website, the cost of dental services that aren’t covered under publicly funded insurance plans such as AHCIP are the highest in all of Canada.

    While the government plans to bring the costs in line with other provinces in the future, the Dental Fee Guide by dentalhealthalberta.ca offers detailed information on what those costs are as of today.

    Depending on the procedure you are looking to do and whether you are going to a specialist or a general dentist, the fee will vary. Be mindful that the actual fee of the dentist you choose may differ from those listed in the guide — it’s best to treat the guide as a reference and do your own due diligence to estimate the final costs.

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    Prescription Drugs

    Prescription drugs are only covered under AHCIP if they are administered during a hospital stay. Outside of the hospital, you will need to bear the costs of filling the prescription.

    Prescription Drug Costs

    In Alberta, pharmacy services can range from administering an injection to providing a prescription in an emergency, but are usually not covered under AHCIP. Select Albertans, including all senior citizens may be eligible for these at no charge. In the majority of cases, however, you will need to bear the cost of the drug, a dispensing fee of up to $12.15 and any stocking/inventory charges associated with filling your prescription. More details regarding prescription services are available on https://www.alberta.ca/pharmacy-services-and-fees.aspx

    high school students and teacher.

    Student Benefits

    Depending on your legal status in Alberta as a student, your eligibility for AHCIP will differ. All eligible students are entitled to regular benefits under AHCIP.

    Here is what applies to you depending on your legal status in Alberta:

    You are an Albertan student whose parents also have the Alberta Health Care Insurance Plan:

    Albertan students that grew up in Alberta may be eligible to remain on their parents’ AHCIP plan up to the age of 21 as dependents, and up to the age of 25 if they are enrolled at an accredited four-year university.

    You are an Albertan student who is planning to study at an educational institute outside of Alberta in another province or country:

    Albertan students who are enrolled at a university in another province or country may opt to keep their AHCIP coverage even while away from Alberta if they want to eventually return to Alberta. AHCIP office should be notified of your plans in advance to minimize the risk of losing coverage.

    You are a Canadian student studying in Alberta.

    Canadian students who wish to return to their home province after the completion of their studies in Alberta should retain their home province’s healthcare insurance card. If you wish to work and live in Alberta after you have finished your studies, you can start the process of applying for Alberta health care coverage.

    You are an international student studying in Alberta.

    If you are an adult student who has a permit to study or stay in Alberta for at least 12 months, you are eligible to apply for AHCIP coverage. If your program is at least 3 months long but you have a letter stating your intent to remain in Alberta for at least 12 months — you may be eligible too.

    Note: Students who are not of legal age may need to be put on a custodian’s AHCIP account.

    Senior Benefits

    A special publicly funded program provides extended health service benefits premium-free for eligible senior citizens above the age of 65. Under Alberta Seniors Benefit, permanent residents and citizens of Canada that have lived for at least 3 months in Alberta and receive an Old Age Security pension are eligible. All benefits and claims associated with the Alberta Seniors Program are administered by Alberta Blue Cross.

    Alberta created this program in order to meet the medical and healthcare needs of single seniors who have an income below $29,285 per year. If you’re a senior couple who has a combined income of $47,545 — you are also eligible to receive the benefits of this program. Benefits you are eligible for are determined in part by your income, marital status, and housing category.

    For instance, if you do not have any non-deductible income, you will receive maximum benefit according to your housing type and marital status. Each dollar of non-deductible income you report reduces the maximum benefit you may receive.

    Here are the services provided to seniors that are not covered under AHCIP alone:

    Type of Service

    Coverage Details

    How to Avail Benefits

    Prescription Drugs

    All prescription drugs listed in the Alberta Drug Benefit List are covered and the co-payment is limited to 30% of the costs (with a maximum limit of $25 per prescription in the majority of the cases).

    If the prescription medicine you require exceeds the maximum cost set by the government of Alberta for that drug, co-pay costs may go above the usual $25.

    Check the Alberta Drug Benefit List if you or your loved ones plan to take advantage of this program.

    Note: If the drug you require is not listed in the Alberta Drug Benefit List or is a more expensive brand of the drug than the most cost-effective or generic drug available for that category — you may have to pay more than $25 in co-pay payments per prescription

    Diabetic Supplies

    If you have been diagnosed with diabetes and require insulin shots to manage the condition, you are eligible to receive healthcare coverage for diabetic supplies like test strips, lancets, needles, and syringes under the Alberta Seniors Health Benefits program for up to $2400. No co-pay payments are required  and benefits renew every benefit year.

    Diabetic supplies can be purchased at any licensed pharmacy in order to avail coverage for this portion of the Alberta Seniors Health Benefits scheme.

    Ambulance Services

    While AHCIP only covers costs of ambulance transfers from one medical facility to another, senior citizens do not have to pay any ambulance fees even for transfers from their residence under Alberta Seniors Health Benefits.

    Call Emergency services for an ambulance as per usual.

    Clinical Psychological Services

    Services rendered by a Clinical Psychologist in Alberta for any emotional or mental illness are covered up to a maximum of $300 per family per benefit year. For each individual session, the program covers up to $60 of the costs of the visit.

    You can avail the services at any hospital, community clinic, mental health facility or specialty clinic.

    Home Nursing Care

     If a physician determines that a senior citizen requires in-home nursing services, the Seniors Health Benefits program covers up to $200 of the costs per family per benefit year.

    A physician must determine that you require in-home care.

    Chiropractic Services

    Services rendered by a licensed Alberta chiropractor can be covered for up to $25 per visit, with a maximum limit of $200 per person per benefit year.

    Services can be availed at the office of any licensed Alberta chiropractor.

    Dental and Optical Assistance

    Benefits vary, depending on the marital and housing status of the senior.

    More details on: https://www.alberta.ca/dental-optical-assistance-seniors.aspx

    These additional benefits are only available for seniors who are eligible under the Seniors Program for Low to Moderate Income Individuals.

    Permanents residents and citizens of Canada are both eligible, and must fill out a form for the Seniors Financial Assistance program.

    Here are the benefits available under the Seniors Financial Assistance Program to help with their monthly living expenses:

    For a single senior

    Type of residence        

    Maximum annual benefit (where income for calculating benefit is $0)

    Homeowner, renter, lodge resident

    $3,431        

    Long-Term Care Centre or Designated Supportive Living Facility

    $11,771

    Other Residence Categories

    $2,390

    For a senior couple

    Type of residence        

    Maximum annual benefit (where income for calculating benefit is $0)

    Homeowner, renter, lodge resident

    $5,146

    Long-Term Care Centre or Designated Supportive Living Facility

    $15,202

    Other Residence Categories

    $4,779

    Note: As the maximum benefits are allotted only to those seniors that have an individual/combined non-deductible income of $0, the amount allotted at different income levels will differ. Use the seniors benefits estimator here to calculate the actual amount you will receive.

    AHCIP Eligibility and Common Procedures

    Considering that there are many factors to consider when utilizing any of the services listed under Alberta Health Care Insurance, there tends to be a great deal of confusion over what's covered and what’s not.

    We don't blame you — everything from where your treatment is administered to the status of your residency in Alberta, from your marital status to your enrollment in a university — it all affects how the provincial system sees your coverage under the AHCIP. As such, the requirements can seem overwhelming and unnavigable. Knowing what exactly isn’t covered allows you to plan for a contingency plan in advance.

    What Isn’t Covered Under Alberta Health Care Insurance Plan

    Medical services

    • Surgical procedures that are not medically necessary.
    • Telephone consultations with doctors.
    • Health services provided by a provider other than a physician (i.e. chiropractor, acupuncturist, massage therapist).
    • Prescription drugs provided outside of hospitals.
    • Travel vaccinations and some other immunizations.
    • Health services requested by a third party, such as medical examinations needed for employment, insurance, or sports.
    • Forms and notes for medical care.
    • The medical exam for drivers who are 74.5 years old or older
    • Diagnostic imaging referred by chiropractors, physiotherapists, and audiologists
    • Allergist and allergy testing
    • Sleep physician and CPAP machines

    Dental

    • Filling, cleaning, and extraction of wisdom teeth and other routine dental care services
    • Cost of dentures

    Vision

    • Vision care such as routine eye exams for residents 19 to 64 years of age;
    • Eyeglasses and Contact lenses
    • Refractive Laser Eye Surgery

    Surgery

    • Cosmetic procedures
    • Vasectomy reversal
    • Abdominoplasty (tummy tuck)

    Hospital visits and stays

    • Hospital rooms that are private or semi-private (unless medically necessary)
    • Ambulance services (except transfers between facilities)
    • Anesthetic charges for services not covered by the AHCIP
    • Hearing aids, medical and surgical appliances, prosthetics, supplies, mobility devices, etc.
    • Costs of giving birth in a hospital

    Therapy and Counselling

    • Clinical Psychologist services

    Cosmetic Surgeries

    • Surgeries like reverse vasectomy, breast reduction, and rhinoplasty.
    • Procedures like abdominoplasty (tummy tuck)
    • Any form of cosmetic procedure like botox fillers

    Reproductive Health

    • In vitro fertilization and assisted reproductive technologies.
    • Services provided by a gynecologist
    • Treatment for sexual health issues such as erectile dysfunction
    • Fertility treatment and supplements
    • Contraceptives and birth control (including IUD insertion)

    Extended Alberta Health Care Coverage Plans

    Although AHCIP is a great basic healthcare insurance coverage plan, it can prove very limiting for Alberta residents.As you have seen, there are many expensive medical services that are not covered under AHCIP or have limited coverage. To protect yourself against the burdens of bearing high costs for services that have been delisted from the AHCIP coverage, you can opt for a private insurance plan to go along with your provincial healthcare insurance.

    Without an extended healthcare package, you can expect to pay hundreds of dollars out of your own pocket for ambulance services, psychological services, hearing aids, dental and more. Extended Alberta health care coverage plans can also remove some of the location-based limitations AHCIP has, in that they can allow you to avail those services outside of Alberta.

    Consider the following costs to evaluate if an extended healthcare package along with AHCIP makes sense for you:

    • Ambulance services: $200 to $800 or more
    • Home nursing care: Up to $75 per hour
    • Podiatrist: Up to $50 per visit
    • Chiropractor: Up to $75 per visit
    • Psychologist: Up to $150 per hour
    • Wheelchair: Rental $50 to $200 per month, purchase $1,000 to $2,000.

    Note: Extended healthcare can be provided by an employer as well and may even offer coverage benefits for your family. Be sure to check with your employer about the healthcare benefits they offer for their employees before you buy your own private insurance. If you want to see how the extended insurance packages compare to AHCIP and each other, be sure to check out our AHCIP comparison guide.

    When you’re ready to upgrade the healthcare plan for your loved ones and yourself, we at Insurdinary.ca can help you pick out the best extended insurance plan for your needs. Contact us today.

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