Covered services
The Alberta Health Care Insurance Plan (AHCIP) provides eligible Alberta residents with full coverage for medically necessary physician services, and some dental and oral surgical health services.
Your physician determines what insured services are considered medically necessary.
You must be registered with the AHCIP, using your personal health care card, to receive insured hospital and physician services.
The Alberta government provides funding to Alberta Health Services to deliver hospital services, mental health and addiction services, physiotherapy, midwifery services, cancer services, home care and more. Learn more about Alberta Health Services.
-
Medical services covered
The following medical services are covered under the AHCIP
- medically required services provided by a physician
- psychiatrist visits
- medically required diagnostic services including laboratory, radiological and other diagnostic procedures
- oral and maxillofacial surgery services
- bariatric surgery for Albertans who are eligible under the Weight Wise program
- breast augmentation and mastectomy for transgender surgery
- patient eligibility must be determined and approved before breast surgery can be completed under Alberta’s Gender Reaffirming Surgery Program
- surgeons must complete and submit the approval form
- learn more about transgender medically necessary breast augmentation and medically necessary mastectomy surgery
For a complete list of services the AHCIP covers, see the Schedule of Medical Benefits, or the Allied Health Services Benefits Schedules.
If you are still not sure a medical service is covered, contact AHCIP.
-
Hospital visits and stays
The following hospital services are covered:
- medically necessary nursing services
- medically required laboratory, x-ray and diagnostic procedures
- accommodations at a standard level and meals
- medications administered in a hospital
- use of the operating room, care room, radiotherapy, physiotherapy and anesthetic facilities
- routine surgical equipment and supplies
- inter-facility transfer in Alberta by ambulance
Partially covered services
The AHCIP provides partial coverage for podiatry and optometry services received in Alberta only. These services have benefit limits or maximums per benefit year, which is from July 1 to June 30.
The AHCIP also provides coverage for some specialized dental, oral and maxillofacial surgical services.
When the charge for a service exceeds the benefit limit, you or your secondary insurer (if applicable) must pay the difference in cost. Always discuss treatment details and associated costs with your health care professional before you receive the service.
-
Optometry (vision)
Some optometry services are covered under the AHCIP, but not outside Alberta:
- eye exams
- children 18 years old and under, and seniors 65 years and older are eligible for one complete eye exam, one partial exam and one diagnostic procedure per benefit year (July 1 to June 30)
- full coverage for some specific medical conditions treated by optometrists
- optometrists cannot charge you for services covered by AHCIP, but you are responsible for additional costs incurred at the time of treatment
- full coverage, if you are 19 to 65 years old, for an eye exam your optometrist deems is medically necessary as a result of trauma, a medical condition or episode of illness
Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program.
-
Dental (oral)
The following dental services are partially covered:
- some specific dental, oral and maxillofacial surgical services are covered
- limited services in the Oral Maxillofacial Surgery Schedule are covered outside Alberta
Seniors with low to moderate incomes may be eligible for some benefits under the Dental and Optical Assistance for Seniors Program.
-
Podiatry (foot care)
Some podiatry services are covered under the AHCIP, but not outside Alberta:
- partial coverage for some podiatry services under the basic podiatry program, to a maximum of $250 per benefit year (July 1 to June 30)
- podiatrists can charge additional fees for these services
Albertans are also eligible to receive full coverage for services provided by a podiatric surgeon in an Alberta hospital or non-hospital surgical facility under contract with Alberta Health Services.
In order to access services from podiatric surgeons contracted by Alberta Health Services, a referral from a physician is required.
Find out more by calling Health Link at 811.
Services not covered
Some health services are not covered under AHCIP or outside Alberta. This list is not intended to cover all instances.
For a complete list of services the AHCIP covers, see the Schedule of Medical Benefits, or the Allied Health Services Benefits Schedules.
If you are still not sure a medical service is covered, contact AHCIP.
-
Medical services not covered
Medical services not covered under the AHCIP include:
- non-medically required surgery such as cosmetic procedures, vasectomy reversal, abdominoplasty (tummy tuck)
- medical advice with a patient by telephone, unless otherwise stated in the Schedule of Medical Benefits or Schedule of Oral and Maxillofacial Surgery Benefits
- health services provided by a provider other than a physician – for example: chiropractor, acupuncturist, massage therapist, homeopath, nutritionist, psychologist, physician assistant or nurse practitioner
- vision care such as routine eye exams for residents 19 to 64 years of age, refractive laser eye surgery, eyeglasses and contact lenses
- routine dental care services, such as cleaning, fillings and extraction of wisdom teeth
- dentures
- prescription drugs provided in non-hospital settings
- learn about drug coverage and services
- vaccinations for travel purposes and some immunizations
- call Health Link at 811 or go to Alberta Health Services – Immunization to find out about immunizations and exceptions
- assisted reproductive technologies, including fertility treatments and in vitro fertilization
- health services requested by a third-party, such as medicals for employment, insurance or sports
- medical forms and notes
- clinical psychologist services
- driver’s medical exam
-
Hospital services not covered
Hospital services not covered under the AHCIP include:
- private and semi-private hospital rooms (unless medically necessary)
- ambulance services (except inter-facility transfers)
- anesthetic charges for services not covered by the AHCIP
- for dental service exceptions, contact your dentist
- procedures that are experimental or undergoing clinical trials
- hearing aids, medical and surgical appliances, prosthetics, supplies, mobility devices, etc.
- Alberta Aids to Daily Living may provide some of these services.
-
Services not covered outside Alberta
Many services are not covered outside Alberta including:
- vision care
- mental health and addiction services
- physiotherapy
- midwifery services
- cancer services
- home care services
- podiatry and optometry services
- dentistry services except for medically required oral surgery
Medical expenses
Help with othermedical expenses
- Drug Coverage and Supplementary Health Benefits
- Alberta Aids to Daily Living
- Dental and Optical Assistance for Seniors
Income tax credits
Some medical expenses not covered by government programs or private insurers may be included on your income tax return for a tax credit.
Find out more on the Canada Revenue Agency website or call them toll-free at 1-800-959-8281.
