Alberta Health Care

Out-of-country out-patient hospital services are paid at a daily maximum of $50 Canadian. Only one out-patient visit is payable each day. In-patient hospitalization services are paid at a daily rate of $100 Canadian. These fees include ALL the services provided to a patient by the hospital such as bed, nursing services, in-hospital medications, laboratory services, x-ray services, etc.  However, if you have this surgery done in a private facility/surgical suite setting, there are no benefits under your AHCIP for facility fees and their associated costs.

Insured physician services received out-of-country are paid at the same rate than an Alberta physician would be paid for the same or similar service. You have one year from the date of service to submit your claim to the AHCIP for consideration. On this basis, the maximum reimbursement to Albertans obtaining this service outside of Alberta (whether in Canada or outside of Canada), is approximately $1200.00 Canadian.  This reimbursement is at the Alberta rate for the

 
1. surgeon  
2. anesthetic  
3. surgical assistant

Alberta Health and Wellness

Out-of Country Claims

PO Box 1360 Stn Main

Edmonton, Alberta T5J 2N3

Ensure that your documentation provides the physicians name, location of service, diagnosis, date of service and fee for each service. Currently, claims are being processed in a 12 week timeframe. You will receive a cheque and payment detail report from Alberta Health and Wellness. Once this is received they should be mailed to your secondary insurance, if applicable, so they can consider paying any outstanding expenses.