Health and dental insurance Alberta

The Alberta Health Care Insurance Plan (AHCIP), provides Alberta residents with full coverage for medically necessary* physician and some specific dental and oral surgical health services. (*The professional judgment of a physician is used to determine what insured services are deemed medically necessary.)

Popular health services covered or not covered

NOTE: In the case of a discrepancy, the insured services listed in the schedules of medical benefits and outlined in legislation will overrule the list below.

Vasectomy is covered. However, vasectomy reversal is not covered. Cosmetic surgery is not covered. However, some procedures are covered if deemed medically necessary by a physician. These may include: Panniculectomy (tummy tuck) Breast reduction mammoplasty Bariatric surgery is covered for weight loss for extremely obese patients with medical complications from the excessive weight. These include: Visits to a psychiatrist are covered because a psychiatrist is a medical doctor Counselling services provided by psychologists or non-physician mental health therapists are not covered regardless of whether or not a referral is made by a patient's physician. Alberta Health provides funding to Alberta Health Services to meet the mental health care needs of Albertans. Alberta Health Services offers various mental health services on both an in-patient and outpatient basis. For more information, visit the Alberta Health Services website

Basic services covered in Alberta

Examinations Medically required surgery Standard Ward Hospitalization Medically necessary use of a semi-private or private room Private nursing care, ordered by the attending physician and meeting the hospital’s by-laws Pacemakers, steel plates, pins, joint prostheses, valve implants and any goods approved by the Minister (unless they are enhanced goods and services) Necessary nursing services Laboratory, radiological and other diagnostic procedures (including interpretation) to maintain health, prevent disease and help diagnose/treat any injury, illness or disability Drugs, biologicals and related preparations administered in a hospital (as specified in the Hospitalization Benefits Regulation) Use of operating room, case room and anaesthetic facilities, plus the necessary equipment and supplies • Routine surgical supplies Use of radiotherapy facilities Use of physical therapy facilities Services supplied by persons being paid by the hospital Hospitalization Benefits (In-patients) Transporting a patient in Alberta by ambulance or other commercial vehicle from one facility to another Goods and services included in an approved hospital or specific program (unless they are enhanced goods and services) Hospitalization Benefits (Outpatients) Medically necessary goods and services provided to an outpatient, including goods used in a medical procedure but excluding goods given to a patient to use after discharge. Oral and Maxillofacial Surgery Services Diagnostic interview and evaluation or consultation Insured oral surgery

Specialized procedures

Provincewide Services are highly specialized procedures, such as organ transplants and major heart surgeries. These services can only be delivered effectively and efficiently at major centers: Edmonton and Calgary.

Provincewide Services are available to all Albertans in addition to basic health services.

Almost 10% of the Provincewide Services budget is allocated for high-cost drugs such as:

Transplant Drugs – Transplant patients are eligible for immunosuppressants. HIV Drugs – Drugs for the treatment of patients with human immunodeficiency virus type 1 (HIV-1) infection are dispensed through the Southern and Northern Alberta Clinics. Other Drugs – Other drugs funded by Provincewide Services include Pulmozyme (for cystic fibrosis), human growth hormone (for pediatric growth hormone deficiency and chronic renal failure), Flolan (for primary pulmonary hypertension) and Visudyne (for classic form of wet age-related macular degeneration).