AHCIP: Summary of Benefits and Coverage OverviewPosted:
Originally posted on https://www.insurdinary.ca/alberta-health/
The Alberta Health Care Insurance Plan (AHCIP), also known as Alberta’s Provincial Healthcare Plan, is designed to serve Alberta residents and provides a number of coverage and benefits.
To be eligible or qualify for this plan, you must reside in Alberta and you must register yourself and/or your dependents to this plan.
One interesting thing with the AHCIP is that it does not require Alberta residents to pay any premium. Also, it covers services that are considered to be medically necessary but it does not cover every expense or service.
Services Or Expenses Covered By The Plan
- The plan covers services considered by a qualified physician as medically necessary.
- It also covers standard hospital wards which may include semi-private rooms and private rooms, provided that they are medically required but this is not usually the case.
- Medical exams.
- Nursing services that are medically essential.
- Laboratory and diagnostic processes.
- Eye exams for children from 0 to 18 and for seniors 65 and above.
- Surgical procedures such as vasectomies (not vasectomy reversal), oral and maxillofacial surgery, bariatric surgery for obese residents. The bariatric surgery only applies if the resident meets the Alberta Weight Wise program requirements.
- Other expenses covered include medications not administered in a hospital, transportation from a medical facility to another, and psychiatrists.
Services Or Expenses That Are Partially Covered By The Plan
AHCIP may cover the following services or expenses partially.
- Several podiatry services are not covered but some may be covered up to $250 maximum per year. To get more details on this feature, contact Alberta government.
- Some dental and oral services may be covered if they are considered to be medically essential.
- Some dental services for seniors whose income level are considered to be low to moderate.
- If the treatment or services of an optometry procedure are necessary due to some medical conditions, the optometry cost may be covered. To get more details on this feature, contact Alberta government.
Services Or Expenses Not Covered By The Plan
AHCIP does not cover the following services or expenses.
- Unless a cosmetic surgery is considered to be medically necessary, it is not covered by AHCIP. Such procedure might include mammoplasty (breast reductions), vasectomy reversals, abdominoplasty (tummy tuck) and so forth.
- A prescription drug will not be covered by the plan if it is not obtained in a hospital or nursing home.
- Unless it is considered to be medically essential, eye exams for residents above 18 and below 65 will not be covered.
- Routine dental treatment such as cleanings, extractions, and
- Vision care services such as contact lenses, glasses and laser eye surgery.
- Ambulance transportation will not be covered unless it is between medical facilities.
- Mobility devices, medical and surgical appliances, hearing aids, wheelchairs, prosthetics, and so forth.
- Health services offered by professionals that are not physicians are not covered. Such professionals might include chiropractors, massage therapists, physiotherapists, acunpuncturists, nutritionists, naturopaths, homeopaths, nurse practitioners, and psychologists.
- Eye glasses and contact lenses.
- Services offered by clinical psychologists.
- Semi-private hospital rooms and private hospital rooms are also not covered unless they are considered to be medically necessary.
Programs For Prescription Drug Coverage
Below are AHCIP prescription drug programs:
- Outpatient Cancer Drug Benefit Program: This program covers some medications that could be used to treat cancer directly.
- Specialized High Cost Drug Program: This program provides funding for drugs that could be used in specialized procedures such as major heart surgery and organ transplantation.
- Drugs for Disease Control and Prevention: This program provides complete funding for drugs used in treating sexually transmitted diseases (STDs) and tuberculosis (TB).
- Acid Reflux Medications: Since October 1, 2016, this program offers coverage for generic medications used in controlling acid reflux such as proton pump inhibitors.
- Alberta Health Services: This program provides medically essential drugs that are administered in auxiliary hospitals, nursing homes, and
- Retina Anti-Vascular Endothelial Growth Factor Program for Intraocular Disease:
- This program covers drugs for patients suffering from some eye conditions that require treatment with Lucentis, Avastin, or Eylea so as to prevent the loss of sight.
OTHER USEFUL RESOURCES:
- Check it out also here the Best Private Insurance company providers in Canada and North America.
- To know the full details visit the official Alberta’s AHCIP website
- Read more informative Alberta’s articles here
- Read about Alberta Health Care Insurance Plan statistical supplement information
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