Albertans who need medical services outside Canada can be compensated by their Albertan Heath Care Insurance Policy (AHCIP). However, they will only be funded for services that are covered by AHCIP. For services not covered by AHCIP they have to apply to the Out of Country Health Services Committee (OOCHSC).
Coverage through AHCIP
Albertans who get medical services outside Canada will be reimbursed when they return. Amount reimbursed by the AHCIP will be the lesser of these charges – (1) the amount charged by an Albertan physician or (2) the amount charged physician abroad for similar services. For example, if an Albertan goes to the US for health services and the physician charges $60 where an Albertan physician would have charged $40, then reimbursement for services rendered will be $40, that is the lesser of the two. If admission into hospital as a patient is required then in-patient charge rates reimbursed will be Canadian hospital rates, excluding the day the patient is discharged. A similar rule is applied for out-patient fees. Further costs will not be reimbursed by AHCIP.
How to make a claim to AHCIP for reimbursement
Claims for reimbursement from AHCIP must be made within 365 days of receiving health services outside Canada. The claims application as well the statements and proofs must be submitted in and translated to English respectively. The claims form can be received through mail or the format can be downloaded via internet. It can take up to 16 days for the claim to be processed after which you will receive a mail regarding the decision made by the AHCIP.
Grounds on which AHCIP may refuse reimbursement
- AHCIP may refuse to reimburse your claims if you have been out of the country for far too long.
- AHCIP will refuse reimbursement on claims for services not covered by AHCIP.
- AHCIP needs to be contacted if you take regular vacations every year or they may refuse health coverage.
- AHCIP will refuse reimbursement of claims if you do not have your health card.
Coverage through OOCHSC
OOCHSC provides coverage of insured services that are not provided in Canada. Application to OOCHSC must be done by an eligible Albertan’s personal physician or dentist. If the request is denied, then an appeal can be made to the out of country health services appeal panel within 60 days of rejection. However, this panel cannot hear appeals of claims directly denied by AHCIP.
The services covered by AHCIP are insufficient for Albertan’s suffering from a severe condition. These citizens should apply for supplementary insurance outside Canada. Health coverage outside Canada is an important safety measure for any Albertan leaving the country. If you feel AHCIP has denied reimbursement of services rendered abroad on flimsy grounds please contact a lawyer.