Health care coverage outside Canada

Overview

Before choosing to have elective (non-emergency) surgery outside Canada, know what is covered and what is not covered.

Only the cost of insured emergency physician and hospital services received outside of Canada will be eligible for reimbursement under the Alberta Health Care Insurance Plan (AHCIP). Travel medical insurance is strongly recommended for travellers leaving the country.

Services and rates paid to Alberta physicians are listed in the Schedule of Medical Benefits.

Emergency services consist of insured services rendered in relation to an illness, disease or condition that is acute and unexpected, arose outside of Canada, and requires treatment without delay outside Canada.

After reading through this content and you still have questions, contact the AHCIP Out-of-Country unit by email: [email protected].

Haemodialysis

Effective April 1, 2023, when submitting an Out-of-Country Health Services Claim form for Haemodialysis,  indicate the following:

• type of Haemodialysis
• prescribed days per week in Alberta
• prescribed days per week out of country
• date of service
• total charges
• currency
• exchange rate
• country where services were provided

Note: you need to attach your prescription provided by an Alberta Nephrologist when submitting a claims form for Haemodialysis.

What is covered

Limited coverage

The AHCIP covers only limited physician and hospital costs outside of Canada.

If you get medical or hospital care when outside of Canada, you will be responsible for paying the difference between the amount charged and the amount the AHCIP reimburses you.

If you claim coverage under the AHCIP, you still have to pay the health service provider. You can then submit a claim to the AHCIP office to request reimbursement for eligible out-of-country health expenses. Reimbursement is issued in Canadian funds only.

Physician services outside Canada

If you get insured services from a physician outside Canada you will be reimbursed either the amount you claimed for the physician’s services, or the rate an Alberta physician is paid for that service, whichever amount is less.

Hospital services outside Canada

A hospital is defined as a place that provides diagnostic services and facilities for medical and surgical treatment for urgent medical conditions and short-term treatment for a severe injury or episode of illness.

Hospital services must be services that would normally be covered by the AHCIP and must be provided in a general or auxiliary hospital.

Hospital-services rates are the maximum that is reimbursed for all services provided to a patient, such as room and board, nursing, laboratory and X-ray services, medical supplies, and prescription drugs.

The rate for in-patient hospital services is $100 (Canadian) per day, not including the day of discharge. The rate for outpatient services is $50 (Canadian) per day, with a limit of one visit per day.

Private facilities

Payment for hospital services provided in a private health facility will not be reimbursed.

What is not covered

Services and expenses that the AHCIP does not cover include (but are not limited to):

• elective (non-emergency) treatment and surgery
• routine lab services received outside a hospital
• food, lodging, transportation, or other costs related to obtaining health services outside Alberta
• health services provided by health care providers other than physicians including:
  • chiropractor
  • acupuncturist
  • massage therapist
  • homeopath
  • nutritionist
  • psychologist
  • podiatrist
  • optometrist
  • physician assistant
  • nurse practitioner
• air or ground ambulance services
• mental health services not provided in a general hospital
• publicly funded services (through Alberta Health Services) such as:
  • home care
  • behavioural disorders
  • addiction treatment
• prescription medication
• medical and surgical appliances, prosthetics
• experimental or research procedures, for example, clinical trials

Submit a claim

Learn how to submit a claim for insured health services.