Does AHCIP cover all types of treatment?

The Alberta Health Care Insurance Plan (AHCIP) does not cover all types of treatment and medical services. This provincial health insurance program provides Alberta residents with access to essential medically necessary services, but has clear limitations on which services are covered in full, partially, or not at all.

Services fully covered by AHCIP

AHCIP provides full coverage for the following medically necessary services:

  • Medical services provided by physicians
  • Visits to psychiatrists (but not psychologists)
  • Medically necessary diagnostic services, including laboratory, radiological, and other diagnostic procedures
  • Oral and maxillofacial surgery services
  • Bariatric surgery for Albertans who meet the Weight Wise program criteria
  • Breast augmentation and mastectomy for transgender surgery (subject to approval)
  • Vasectomy (but not vasectomy reversal)

Hospital services

When hospitalized, AHCIP covers:

  • Medically necessary nursing services
  • Medically necessary laboratory, X-ray, and diagnostic procedures
  • Standard room and board
  • Medications administered in the hospital
  • Use of operating room, nursing, radiotherapy, and anesthesiology facilities
  • Routine surgical equipment and supplies
  • Inter-facility transportation in Alberta by ambulance

Services partially covered by AHCIP

Some services are only partially covered by AHCIP:

Podiatric services (foot care)

AHCIP provides partial coverage for podiatry services that have benefit limits or annual benefit maximums and are only covered within Alberta.

Ophthalmology services (vision)

Coverage depends on the patient's age:

  • Full coverage for children under 18 and adults over 65
  • No coverage for routine eye exams for individuals aged 19-64 (unless medically necessary)

Dental services

AHCIP provides partial coverage for certain specific dental, oral, and maxillofacial surgical services. For low- and moderate-income seniors, the Senior Dental and Vision Assistance Program is available (limited to $5,000 every five years for eligible procedures).

Services not covered by AHCIP

AHCIP does not cover a significant number of medical services:

Alternative medicine and additional services

  • Complementary or alternative medical treatments, such as chiropractic, massage, naturopathic, dietitian, or social worker services
  • Psychologist services (although psychiatric counseling is covered)
  • Physical therapy in private clinics (although some physical therapy services may be covered in hospitals)

Medications and medical equipment

  • Prescription drugs, except those prescribed during a hospital stay
  • Eyeglasses, contact lenses, or laser vision correction
  • Medical devices or mobility aids, such as wheelchairs
  • Hearing aids

Cosmetic procedures and non-essential services

  • Cosmetic surgery (e.g., tummy tucks), unless medically necessary
  • Medical certificates and form filling
  • Travel vaccinations and some immunizations

Emergency services

Emergency services are not covered by AHCIP, except for transfers from one medical facility to another. Patients must pay for these services themselves or through private insurance.

Private and semi-private hospital rooms

Private and semi-private hospital rooms are not covered unless they are medically necessary.

Special coverage for different population groups

Coverage for seniors (65+ years old)

The Alberta government provides seniors with free coverage for prescription drugs and other medical services not included in the AHCIP through the Coverage for Seniors Program:

  • The program is automatically added to your AHCIP account on the first day of the month after your 65th birthday
  • Coverage includes prescription drugs, some dental and vision services
  • The program does not include travel insurance

Coverage for children

Children in Alberta have access to extended coverage through the Alberta Child Health Benefit:

  • The program covers medical services such as eyeglasses, prescription drugs, and dental care that are not available through standard AHCIP coverage
  • Families with limited income are eligible

Coverage for services outside Alberta

Coverage within Canada

AHCIP provides coverage for insured medical and hospital services in other provinces of Canada:

  • In most cases, if you present a valid Alberta health care card to a medical or hospital service provider outside the province and receive insured services, it will not cost you anything
  • If AHCIP does not cover a service in Alberta, it will not be covered outside Alberta
  • Alberta has reciprocal agreements with all provinces and territories except Quebec for insured drug services

Coverage outside Canada

AHCIP covers only limited expenses for doctors and hospitals outside Canada:

  • For expenses incurred outside the country, AHCIP covers a maximum of $100/day for hospital services
  • A maximum of $50/day for outpatient services
  • The patient is responsible for paying the difference between the amount charged and the amount reimbursed by AHCIP

Additional programs and coverage

Due to AHCIP limitations, many Albertans choose additional private insurance to cover services not included in the government plan:

Non-Group Coverage Program

The Non-Group Coverage Program provides all Albertans with access to an affordable program of additional medical benefits not covered by AHCIP:

  • Available to all Alberta residents under age 65 and their dependents enrolled in AHCIP
  • Monthly premium for Non-Group Coverage

Private Insurance

Private insurance plans may cover:

  • Dental services
  • Prescription drugs
  • Physical therapy
  • Psychological services
  • Eyeglasses and contact lenses
  • Emergency services
  • Private and semi-private hospital rooms

Conclusion

AHCIP does not cover all types of treatment. Although the program provides access to essential medically necessary services, there are significant limitations on coverage. Many services that many people consider important for overall health, such as dental care, prescription drugs, physical therapy, psychological services, and vision care, are only partially covered or not covered at all.

To ensure comprehensive health coverage, Alberta residents are encouraged to consider purchasing additional private insurance to cover services not included in AHCIP. Specific population groups, such as children, seniors, and low-income individuals, may have access to additional programs that expand standard AHCIP coverage.