Submit a claim for insured health services

Services within Canada

You can submit a claim for reimbursement if you paid for insured health services outside of Alberta. The Alberta Health Care Insurance Plan (AHCIP) will reimburse the cost of insured health services received in another Canadian province or territory.

Step 1: Find out what you can claim

Learn about what AHCIP covers if you need health services in another province or territory.

Many services are not covered outside Alberta. These include:

• vision care
• mental health and addiction services
• physiotherapy
• midwifery services
• some cancer services
• home care services
• podiatry and optometry services
• dentistry services except for medically required oral surgery

Step 2: Gather your documents

Gather all your documents and receipts. Make clear photocopies of all itemized statements and proof of payment. Do not send original documents, as we cannot guarantee their safe return.

Step 3: Complete the form

For reimbursement of insured health services expenses outside of Alberta, complete the form.

Out-of-Province Claim for Physician/Practitioner Services form.

Step 4: Submit completed form

Send us your completed form and supporting documentation.

Services outside Canada

To submit a claim to AHCIP for health services from outside Canada:

Step 1: Find out what you can claim

AHCIP only provides limited coverage for health services received outside Canada.

Read about health coverage outside Canada.

Step 2: Gather hospital and physician service information

AHCIP needs the following information to process your claim:

Hospital service information

Information you need to provide for hospital services includes:

• facility name and address
• the day the insured person was admitted
• the date of discharge
• the Current Procedural Terminology (CPT) billing codes and diagnosis of the condition for which the insured person was admitted
• the nature of any treatment, procedure or surgery performed
• the kind and number of any laboratory, radiological or other diagnostic tests performed
• the amount being claimed and proof of payment

Physician service information

Information you need to provide for physician services includes:

• physicians name and specialty
• the current CPT billing codes and diagnosis of the condition for which the insured person was treated
• the nature of any treatment, procedure or surgery performed
• the date or dates when the insured person was treated
• the amount being claimed and proof of payment

Step 3: Gather your documents

Make copies of all itemized statements and proof of payment for your records.

All documents must be on an official statement or letterhead of the facility or physician providing the service.

All supporting documents in a foreign language must be translated into English. A copy of the original statement and the English translation must be included in your claim submission.

For services provided in the United States of America, you need to submit the UB04 hospital claim form, or the CMS 1500 physician claim form, or both.

Step 4: Complete the form

Out of Country Health Services Claim form.

Insurance Claim Consent and Authorization form – Application for third-party requests for reimbursement of insured physician and hospital services paid on behalf of Alberta residents who obtained emergency medical services outside Canada.

Step 5: Submit your claim

Send us your completed forms and supporting documentation.

Contact

Connect with the Out-of-Province and Out-of-Country unit, or submit your claim:

Email: [email protected]
Fax: 780-422-1958

Mail:
Alberta Health
Attention: Out-of-Province and Out-of-Country Claims
PO Box 1360, Station Main
Edmonton, Alberta  T5J 2N3

Connect with AHCIP.