Reimbursement may only be made in exceptional situations where the applicant had to pay upfront for an emergency service, or when the vendor refused to honour the HBC. If payment is to be coordinated with a reimbursement insurance plan, the primary carrier must adjudicate the claim first. Reimbursement is only made to the parent/guardian of the eligible child and is not provided for services received outside of Alberta.

Reimbursement cannot exceed the contracted rates as indicated in all applicable schedules and agreements. The benefit administrator must receive the claim within six months from the service date (exception can be authorized by the Manager Medical Contracts and Revenue Administration, the ACHB Program Supervisor or Health Benefits Exception Committee). The service must have been provided after the effective date of coverage and prior to the termination date of coverage.