AHCIP Alberta Coverage Summary
Alberta Health Care Insurance Plan (AHCIP)
Alberta’s provincial healthcare plan, or the AHCIP coverage summary, stands for Alberta Health Care Insurance Plan. The following is a summary of AHCIP benefits and coverage
Coverage Summary
All residents of Alberta must register themselves and their dependents with AHCIP in order to qualify for benefits
Services deemed medically necessary by a qualified physician (applies to all services listed below).
Standard hospital wards (semi-private and private rooms ONLY if medically required, which is rare).
Medically necessary nursing services.
One eye examination for seniors (aged 65 and up) and children aged 18 and under per year.
Laboratory and diagnostic procedures.
Medications that are administered in a hospital.
Partial coverage is provided for some oral, dental, and maxillofacial surgeries.
Ambulance transportation from one medical facility to another.
Vasectomies (but not vasectomy reversal).
Bariatric surgery for residents who qualify via the Alberta Weight Wise program.
Psychiatrists (psychologists not covered).
Services Covered by AHCIP
Generally speaking, any service that is deemed medically necessary is covered by AHCIP
Cosmetic surgery unless deemed medically necessary. Examples are vasectomy reversals, abdominoplasty (tummy tuck) and breast reductions (mammoplasty).
Prescription drugs obtained outside of a hospital or nursing home (however, there are specialty programs, see below for more information).
Eye exams for residents aged 19-64 UNLESS deemed medically necessary as a result of some trauma.
Routine dental treatment (e.g. cleanings, fillings and extractions).
Ambulance transportation (except between medical facilities).
Vision care including glasses, laser eye surgery, and contact lenses.
Health services provided by people who are not physicians (e.g. massage therapists, chiropractors, acupuncturists, physiotherapists, naturopaths, nutritionists, psychologists, homeopaths and nurse practitioners). Note: services such as physiotherapy may be covered if performed in a hospital and deemed medically necessary.
Hearing aids.
Surgical and medical appliances, prosthetics, wheelchairs and other mobility devices. Note that basic medical equipment MAY be covered via the Alberta Aids to Daily Living program.
Publicly funded services (e.g. funded by Alberta Health Services) performed OUTSIDE of Alberta. For example, midwifery, physiotherapy, cancer and homecare services, optometry and podiatry services, etc.
Clinical psychologist services.
Contact lenses and eyeglasses.
Semi-private and private hospital rooms UNLESS medically necessary.
Medical advice obtained over the telephone.
Dentures.
Services Not Covered by AHCIP
Services That Are Partially Covered
Podiatry: some, although not all, podiatry services are covered up to a maximum of $250 per year. Contact the Alberta government for further details.
Some dental, oral and maxillofacial surgical services if deemed medically necessary.
Some dental benefits for seniors with low to moderate incomes (see the Dental and Optical Assistance for Seniors Program).
Partial or full coverage for some optometry costs if treatment is required as a result of specific medical conditions. Contact the Alberta government for further details.
Prescription Drug Coverage Programs
Specialized High Cost Drug Program
Some funding is available for drugs used in specialized procedures such as organ transplants and major heart surgery.
Insulin Pump Therapy Program
Designed for Albertans who have Type 1 or Type 3 diabetes. Covers the cost of an insulin pump and associated supplies.
For full details, go to the Alberta government’s health plan web site
Outpatient Cancer Drug Benefit Program
Certain medications used to directly treat cancer are covered.
Retina Anti-Vascular Endothelial Growth Factor Program For Intraocular Disease
The RAPD program offers coverage for Avastin, Lucentis and Eylea, drugs which are used to slow down loss of vision.
