AADL – Cost sharing of benefits

Costs paid by clients

Most AADL benefits have a cost-share amount that is paid by clients. Respiratory benefits do not have a cost-share requirement and seniors do not pay cost-share on prosthetic, orthotic, breast prosthesis or ocular prosthesis. For all other benefits, client pay 25% of the cost of program benefits up to a maximum of $500 per family per benefit year (July 1 to June 30).

For some benefits, clients may choose an upgraded item and must pay the additional cost of this item. These additional costs are not included in the $500 cost-share maximum.

Cost-share exemption

Low-income Albertans may be exempt from the $500 cost-share.

Cost-share exemption is available to clients whose taxable income (line 26000 of the most recent income tax return) is:

• $20,970 or less for a single person,
• $33,240 or less for a family with no children, or
• $39,250 or less for a family with children.

Clients receiving income supplement benefits from the following Alberta government programs may be exempt from cost-sharing:

• Income Support Program benefits
• Assured Income for the Severely Handicapped (AISH)
• Alberta Adult Health Benefits (AAHB)
• Child and Youth Support Program
• Children and Family Services (minors in foster care)

Seniors aged 65 or older are not required to cost-share on prosthetic, orthotic, breast prostheses or ocular prostheses benefits.

Clients are not eligible to apply for cost-share exemption if they are:

• A new or returning resident from outside Canada, who has not yet resided in Alberta for 12 consecutive months,
• Exempt from paying income tax for religious, charitable or communal reasons, or
• A foreign student temporarily residing in Canada.

You can apply for a cost-share exemption from AADL directly with the Cost-Share Exemption form.

• Complete the Application for Cost-Share Exemption form

Seniors and their adult dependents requiring hearing aids can apply for cost-share exemption by filling out the Hearing Aid Benefit Cost-Share Exemption Application for Seniors and Their Adult Dependents form.

• Complete the Application for Cost-Share Exemption for Hearing Aid Benefits for Seniors and Their Adult Dependents

If your financial situation has recently changed or you have extraordinary expenses related to your disability, you may be eligible for temporary cost-share exemption. You can apply for temporary cost-share exemption by filling out the Temporary Cost-Share Exemption form.

• Complete the Application for Temporary Cost-Share Exemption form

You need to contact AADL if you receive assistance from:

• Alberta Widows' Pension
• Assured Income for the Severely Handicapped (AISH)
• Alberta Works Health Benefits

Appeal cost-share and benefits

How to appeal cost-share status and benefits received

If you are not exempt from cost sharing and feel that it will cause you financial hardship to share the cost for your benefits with AADL, you can appeal your cost-sharing status using the Cost-Share Exemption Notice of Appeal form.

• Cost-Share Exemption Notice of Appeal form

Quantity and frequency review

A maximum number of each benefit is available each year. However, AADL will review requests for more than the maximum number (referred to as quantity and frequency).

Your authorizer/specialty supplier must complete the Quantity and Frequency Review form and submit it to Alberta Blue Cross through the online health portal within 20 days of your assessment.

The Quantity and Frequency Review form is reviewed by the AADL program manager.

If your request is denied by the AADL program manager, it can be referred to the Quantity and Frequency Review Committee (QFRC) at the request of your authorizer/specialty supplier.

If your request is denied by the QFRC, it can be appealed to the AADL director. Either you or your authorizer/specialty supplier can make this final appeal to the director.

For more information on this process, please speak with your authorizer or specialty supplier, or contact AADL.

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