Palliative care health benefits

Overview

The Palliative Coverage Program provides subsidized benefits to Albertans who are:

diagnosed as palliative
remain in their home or in a hospice where access to publicly funded drugs, diabetes supplies and ambulance services may not be included

Palliative refers to patients who:

have been diagnosed by a physician or nurse practitioner as being in the end stage of a terminal illness or disease
are aware of their diagnosis
have made a voluntary informed decision related to resuscitation, and the focus of care is palliation and not treatment aimed at a cure

Albertans who are palliative have access to extra health benefits that cover health-related services not covered by the Alberta Health Care Insurance Plan (AHCIP).

By subsidizing the cost of care in the home or community, a major financial burden is removed for the patient and the family.

Alberta Blue Cross administers Palliative Coverage. There are no premiums to pay.

Eligibility

The program is open to Albertans registered with the AHCIP and who have been diagnosed as being palliative.

The program excludes patients who live in residences that provide publicly funded drugs, diabetes supplies and ambulance services. These residences include:

type A continuing care homes (formerly known as long-term care facilities)
acute care hospitals
psychiatric hospitals

Apply for the program

Step 1. Complete the form

Download and complete the Palliative Coverage Program application form.

You can also get the application form from:

Alberta Blue Cross
your physician or nurse practitioner
the palliative care program
home care offices in your area

The application form must be completed and signed by both the patient, or guardian, and physician or nurse practitioner.

Step 2. Submit the form

You can mail or fax the form.

Mail:

Alberta Health
Attn: Alberta Palliative Coverage Program
PO Box 1360 Station Main
Edmonton, Alberta T5J 2N3

Fax: 780-422-0102

The patient or guardian will receive written notification from the Ministry of Health regarding acceptance into the program. Alberta Blue Cross will mail an ID card to the patient or guardian.

When coverage begins

The physician or nurse practitioner determines the effective date of coverage. This date must not be more than 30 days prior to the date the program office receives the application. The coverage will continue as long as the patient is diagnosed as being palliative.

Benefits provided

Prescription drugs

Prescription medications, specific laxatives and solutions for hydration therapy are covered if listed in the Alberta Drug Benefit List or Palliative Care Drug Benefit Supplement.

Effective March 1, 2020, there is no co-payment for eligible prescriptions.

A patient will be responsible for additional costs if:

your drug is not listed in the Alberta Drug Benefit List, or the Palliative Coverage Drug Benefit Supplement
you want a more expensive brand of drug than the least cost alternative, maximum allowable cost product or generic product
the brand of drug you want costs more than the maximum cost set by the Alberta government for that drug

To avoid surprises, ask your pharmacist about the cost of your prescription before it is filled.

Diabetes coverage

Plan members with diabetes will receive coverage for eligible diabetes supplies purchased from a licensed pharmacy, up to a maximum of $2,400 per eligible person depending on the method of diabetes management. (Read the Coverage Maximums for Diabetes Supplies fact sheet). This benefit will be for each benefit year (July 1 to June 30).

Eligible diabetes supplies include:

test strips
needles
syringes
lancets

Continuous Glucose Monitors (CGMs)

Continuous Glucose Monitors (CGMs) are available to Albertans under 18 years old who are living with diabetes. A prescription from an endocrinologist or pediatrician is required for coverage. Learn more about the eligibility criteria.

These devices are not included in the $2,400 annual maximum for diabetes supplies.

Ambulance services

Ambulance services are covered to the maximum rate established by the Alberta government for treatment, and transportation to and from a general, active treatment hospital in the event of illness or injury.

Transportation must be provided in a ground vehicle approved under the Emergency Health Services Act and regulations. It does not include interfacility transfer by ambulance.

For more information, see:

What is not covered

Supplies or expenses not covered include:

infusion equipment and supplies
claims for benefit expenses incurred prior to the effective date of coverage
claims for benefit expenses received by Alberta Blue Cross more than 12 months after the service was provided
services covered by the AHCIP
charges for drugs supplied directly and charged for by a physician, with the exception of allergy serums
registration, admission or user fees charged by a hospital
drug products not listed in the Alberta Drug Benefit List – ask your pharmacist or physician if your prescribed medication is on this list
semi-private or private hospital room
travel insurance for emergency hospital and medical expenses outside of the province or country

How to get benefits

After you get a notification stating you are accepted into the Palliative Coverage program, you will get an Alberta Blue Cross ID card mailed to you.

With the Alberta Blue Cross ID card, you can get:

eligible prescription drugs and diabetic supplies at your local pharmacy
ambulance services

If you are covered by more than one supplementary health benefit plan, eligible expenses may be coordinated between plans to maximize your benefits.

Reimbursement

To claim reimbursement for eligible benefits, submit your claim using the Alberta Blue Cross claim form. This form is also available at any Alberta Blue Cross office or pharmacy.

To be eligible for reimbursement, claims must be received by Alberta Blue Cross within 12 months of the service date.

If you have more questions, contact Alberta Blue Cross.

How to access continuing care

Notifications

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