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Health Benefits Card Coverage

Published Date: April 01, 2006
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01 Alberta Health Care Insurance Plan (AHCIP)

INTENT

The Alberta Health Care Insurance Plan (AHCIP), administered by Alberta Health, provides for basic medical services, in-patient and outpatient hospital services.

POLICY

Community and Social Services does not duplicate coverage of medical procedures provided under the AHCIP.

Community and Social Services enrolls eligible clients into the AHCIP Community and Social Services group.

AHCIP Covered Medical Services
The Alberta Health website provides details of AHCIP coverage, registration procedure and forms, and eligibility.

Basic Medical Services may include:

  • Insured, medically-required services provided by a physician or osteopath
  • Specified oral surgical procedures provided by an oral surgeon
  • Routine eye exams for children up to and including 19 year olds and seniors 65 and over
  • Eye exams for adults when health risk is assessed by an ophthalmologist (medical doctor specializing in eye diseases). An ophthalmologist must perform the eye exam.
  • Podiatric services
  • Physical therapy


In-Patient Hospital Services
may include:

  • Accommodation and meals at public ward level
  • Necessary nursing care
  • Diagnostic and treatment services
  • Drugs and routine surgical supplies provided and administered in a hospital
  • Transportation within Alberta between hospitals, and from a hospital to a nursing home when ordered by a physician
  • Special services on physician’s order (e.g., private room)


Out-Patient Hospital Services
may include:

  • Emergency treatment and, where available, day surgery
  • Diagnostic laboratory and radiological procedures
  • Specialized clinics, such as orthopedic and diabetic clinics
  • Physical, occupational, speech, respiratory and psychiatric therapy


Eligibility for AHCIP
Eligibility for the AHCIP is determined by Alberta residency. Persons coming to Alberta from another province are covered by the other province’s health care insurance plan for up to three months.

Members of the Armed Forces or the RCMP, or inmates of federal correctional institutions have their health coverage with the federal government and are not registered in the AHCIP. However, their dependants residing in Alberta are eligible for AHCIP coverage.

Status/Registered Indians
Health Canada is responsible for providing health benefits to First Nations persons registered under the Indian Act, and specified Innu and Inuk persons, no matter where they live. Health benefits are provided through the Non-Insured Health Benefits Program of Health Canada’s First Nations and Inuit Health Branch. The federal government is not responsible for health benefits of dependants who do not have Registered Status.

Exception
In Alberta, Health Canada benefits include coverage for the eligible individual and all dependants listed on the person’s AHCIP file, regardless of the dependant’s status or lack of under the Indian Act. If a dependant is not listed on the AHCIP file, Health Canada does not provide coverage for the dependant.

AHCIP Community and Social Services Group
Community and Social Services enrolls eligible clients into the AHCIP Community and Social Services group unless the person:

  • Is not eligible for AHCIP insurance
  • Is 65 years or older
  • Has AHCIP group coverage through their employer or spouse/partner’s employer
  • Is covered as a dependant on someone else’s AHCIP coverage
  • Is eligible for health coverage through the federal government


Procedures for AHCIP Registration
To provide a client with AHCIP coverage under Community and Social Services’s group registration, their personal health number (PHN) and the number of each dependant must be obtained and correctly recorded on LISA indicating AHCIP status 1.

If the PHN is not available, the client should contact AHCIP. If they encounter severe difficulties in obtaining their PHN, the worker may assist by requesting the information on behalf of the client. The worker identifies the worksite code, unit and caseload.

AHCIP telephone number is:

Edmonton 780‑427‑1432

Backdating Coverage
If a recipient should have been registered under Community and Social Services’s group coverage but was not, the worker completes the EMP 2265 AHCIP Memorandum for Income Support Clients.

New AHCIP Registration
When a recipient has not been previously registered with the AHCIP, the worker informs the client to apply for coverage. When the client is unable to do so, the worker may assist the client by completing the AHC 102 Application for Alberta Health Care Insurance Plan Coverage.

The effective date of coverage is the date of arrival if arriving from outside Canada, or the first day of the third month following the date residence was established in Alberta, if arriving from another province.

In the case of IS recipients, the AHCIP has agreed to waive the 90-day waiting period and provide immediate coverage if they do not have valid health coverage from the province from which they came or are residents of Alberta who have never been registered with the AHCIP.