Alberta’s

commitment

to public

health care:

understanding

your public

health care

insurance plan

HEALTH AND WELLNESS

APRIL 1, 2002 –MARCH 31, 2003

Contents

Introduction 1

Progress on health reform 4

Protection, promotion and prevention 5

Accountability to Albertans 6

Public administration of your Alberta Health Care Insurance Plan 7

Comprehensiveness: What is covered by your plan? 8

Universality: Who is covered by the plan? 13

Accessibility: Who has access to insured services? 15

Eligibility: Are you covered when you move to Alberta? 18

Portability: Are you covered when you moveout of Alberta or out of Canada? 18

Sources of more information 20

1

Alberta’s commitment to public health care:understanding your public health care insurance plan

Alberta also provides full and partial

coverage for health care services not

required by the Canada Health Act,

including:

• home care and long-term care

• mental health services

• dental and eyeglass benefits for recipientsof the Alberta Widow’s Pension and theireligible dependents

• palliative care

• immunization programs for children

• allied health services such as optometry(for residents under 19 and over 64 years)and chiropractic and podiatry services

• drug benefits through Alberta Blue Cross.

Alberta has a commitment to

building a better publicly-funded

health care system for Albertans.

The province provides medically necessary

services in a public system that follows the

principles of the Canada Health Act: publicly

administered, comprehensiveness,

universality, portability and accessibility.

Medically necessary services are hospital,

physician and specific services provided by

oral surgeons and other dental

professionals.

2

Our Vision

Citizens of a healthy Alberta

achieve optimal health and

wellness.

The slogan “Healthy Albertans in a healthyAlberta” reflects this vision.

The Government of Alberta wants Albertansto:

• realize their full health potential in a safeenvironment with appropriate income,housing, nutrition and education; and

• play a valued role in family, work andtheir community.

Alberta Health and Wellness contributes tothat effort by ensuring Albertans haveequitable access to affordable, effective andappropriate health and wellness services,when they need them.

The vision also requires individuals to takeresponsibility for their own health.

Our Mission

To maintain and improve the health of

Albertans by leading and working

collaboratively with citizens and

stakeholders.

Two core businesses support this mission:

1. Deliver quality health services toAlbertans.

2. Encourage and support Albertans to lead healthy lives.

3

How are your health care dollars spent?

How is your health care funded?

Contribution from General Revenue Fund – $4,768 (69.7%)

Other Revenue – $38 (0.5%)

Third Party Recoveries – $59 (0.9%)

Lottery Funding – $108 (1.6%)

Premiums – $937 (13.7%)

Canada Health and Social Transfer – $931 (13.6%)

($ Millions)

Health Authorities – $3,850 (56.3%)

Other Programs – $576 (8.4%)

Protection, Promotion, Prevention – $142 (2.1%)

Blue Cross Benefit Program – $413 (6.0%)

Physician Services – $1,442 (21.1%)

Province Wide Health Services – $418 (6.1%)

($ Millions)

TOTAL $6,841 million

Source: Alberta Health and Wellness Annual Report 2002/2003 Highlights.

4

Alberta wait list registry Pilot testing of the Alberta wait list registryhas begun. By fall 2003, the registry will putwait lists for selected procedures on theInternet to help Albertans and theirphysicians plan where they can go forsurgical and diagnostic procedures.

Pharmaceutical Information Network Two Pharmaceutical Information Networkpilot projects were successfully conducted inWestlock and Leduc. The projectsdemonstrated that use of electronicmedication information results in moreeffective decisions about drug prescriptionsfor patients.

Provincial Personal Health Identifier The Provincial Personal Health Identifier(PPHI) identifies each person who receiveshealth services in Alberta. The identifier isunique to each person and remains the sameover the person’s lifetime. The PPHI can beused to collect demographic information andis a key foundation in the development ofAlberta’s electronic health record system.

Rural health strategyAn MLA appointed committee has beenreviewing standards for assessing emergencyand acute care services, primary health careservices, health workforce needs and the useof technology in rural communities.

Collaboration and innovationThe Alberta government accepted 49 of the50 recommendations of the Committee onInnovation and Collaboration report to makeAlberta's regional health authorities morecollaborative, innovative and accountable.New multi-year performance agreements willbe established that will require regionalhealth authorities to improve collaborationand innovation, develop new models of care,create centres of specialization and contractwith a blend of providers to offer a range ofservices.

Accessible, quality careThe Ministry and its partners explored waysto make the best use of health careprofessionals and improve access to healthcare:

• A comprehensive workforce plan is beingdeveloped to attract and retain healthprofessionals.

• A $8.25 million allocation to newalternative funding plans will allow morethan 190 academic physicians to spendmore time teaching students, conductingresearch and caring for patients.

• More than 75 foreign-trained healthprofessionals have been given permanentresident status through the ProvincialNominee Program, a program thatexpedites the immigration process forforeign professionals.

Progress onhealth reformin 2002/2003

Progress onhealth reformin 2002/2003

Progress on health reform in 2002/2003

5

Actions to help Albertans live healthy lives

and avoid injury and disease were a critical

focus this year.

Healthy U campaignA public information and education campaignwas launched to encourage Albertans to leadhealthier lifestyles. The Healthy U campaignincluded television and radio advertisements,a newspaper supplement, and a website thatdirects visitors to reliable health information.

Ten-year health targets and strategiesTargets to lower the rate of chronic diseasesuch as heart disease, cancer, and chronicobstructive pulmonary disease, have beenestablished. Strategies to reach the targetsby 2012 have been identified.

Alberta diabetes strategyA new strategy was developed to providefinancial assistance for low-income Albertans,improve screening for diabetes and addresscomplications for Aboriginal people living offreserve. This plan also proposes preventioninitiatives and new approaches for the careand management of diabetes.

Two new vaccinesTwo new vaccines were added to Alberta’sroutine immunization program for children,starting at age two months. These vaccinesprotect children from meningitis, seriousblood infections and pneumonia at a cost of$20 million annually.

Tobacco reduction strategyThe Alberta Alcohol and Drug AbuseCommission (AADAC) launched aninformation campaign to reduce tobacco usein Alberta. The To Tell the Truth campaignincluded television, radio advertisements anda magazine that carried facts about thedangers of tobacco. A toll-free Smoker’s HelpLine was established to help Albertans quitsmoking.

The Prevention of Youth Tobacco Use Act wasproclaimed to make it illegal for anyoneunder the age of 18 to use or possess tobaccoin a public place.

Protection,promotion and

prevention

Protection,promotion and

prevention

Protection, promotion and prevention

Accountability to Albertans The Canadian Institute for Health Informationconfirmed that Albertans receive high qualitycare in its Health Care in Canada 2002 report.Alberta performed better than the Canadianaverage in several areas, including per-personhealth spending, joint replacement surgeryand heart attack survival rates.

Alberta's Report on Comparable HealthIndicators finds Albertans experience lowerrates of in-hospital mortality rates for heartattacks and strokes, lower potential years oflife lost for lung cancer, colorectal cancer,heart attack and stroke, and lower hospital re-admission rates for heart attacks.

The Annual Health Survey asks Albertans torate how well their health care system isperforming each year. Copies of the annualsurvey and other publications on health caresystem measures can be accessed atwww.health.gov.ab.ca/reading/publications.html.

Health Services Utilization and Outcomes CommissionA survey conducted by the Health ServicesUtilization and Outcomes Commission foundthe majority of Albertans give good marks tothe quality of their health care system.Albertans also said improvement needs to bemade in emergency services, getting accessto specialists, receiving satisfaction in howcomplaints are addressed and managingpatient safety issues.

The commission is studying practice patternsof family physicians and the use of drugs inthe health care system.

6

7

The Alberta Health and Wellness annual

report can be accessed at www.health.gov.

ab.ca/public/document/AR02_02/index.html.

The department also issues an annualstatistical supplement report on data related to the Alberta Health Care Insurance Plan.

The Statistical Supplement report can be

accessed at www.health.gov.ab.ca/reading/

publications.html#4.

Who ensures that reports are accurate?The Auditor General of Alberta audits therecords and financial statements of theMinistry of Health and Wellness.

In addition, each health authority must provideits own audited financial statements to beincluded in the Ministry’s annual report.

How much is spent on the plan each year?In 2002/2003, the Alberta Health Care InsurancePlan issued a total of $1,225,626,637* in fee-for-service payments to Alberta physiciansand a total of $61,714,534* to Alberta alliedhealth practitioners (dental surgeons, dentists,chiropractors, optometrists, podiatrists) forbasic health services.

Publicadministrationof your Alberta

Health Care Insurance

Plan

Publicadministrationof your Alberta

Health Care Insurance

Plan

What is the Alberta Health CareInsurance Plan?Since 1969, the Alberta Health Care InsurancePlan, as defined by the Alberta Health CareInsurance Act, has provided Albertans withmedically necessary hospital services, andmedically necessary services provided byphysicians, oral surgeons and other dentalprofessionals.

Alberta’s health legislation and regulations

can be accessed at www.health.gov.ab.ca/

system/minister/legislation.html.

Who administers and reports on the plan?The Alberta Health Care Insurance Plan isoperated through the Department of Healthand Wellness. The plan is operated on a non-profit basis and is administered by theMinister of Health and Wellness.

Each September, the department issues anannual report that documents the ministry’sactivities and consolidated financialstatements for the previous fiscal year. Theannual report provides information about theactions, key achievements and results for allkey performance measures included in the2002/2003 Business Plan.

Public administration of your Alberta Health Care Insurance Plan

* These figures will be considered preliminary until the release of the Alberta Ministry of Health and Wellness’Alberta Health Care Insurance Plan, Statistical Supplement 2002/2003.

8

What Alberta legislation covershospital services in the province?The Hospitals Act, the Hospitalization BenefitsRegulation (AR244/90), the Health CareProtection Act and Health Care ProtectionRegulation define how insured services areprovided by hospitals or designated surgicalfacilities in Alberta.

Alberta Health Care InsurancePlan StatisticsIn the 2002/2003 fiscal year, there were 5,206*physicians and 1,777* allied healthpractitioners who were registered with andreceived payment from the Alberta HealthCare Insurance Plan. There were 3,124,487*residents registered with the Alberta HealthCare Insurance Plan.

How many facilities are there in Alberta?There are 214 health care facilities in Alberta,excluding psychiatric hospitals and nursinghomes:

Acute Care Facilities (100 hospitals)(facilities that offer health services that areprovided to persons suffering from seriousand sudden health conditions that requireongoing professional nursing care andobservation)

Continuing Care Centres (110 long-term care centres)(facilities that offer health services toresidents who require treatment for long-termor chronic illnesses, diseases or infirmities)

Rehabilitative Facilities (Glenrose Rehabilitative Centre)(facilities that offer health care services forpersons requiring professional assistance torestore physical skills and functionalityfollowing an illness or injury)

Community Care Facilities(three facilities in Alberta: La Crete HealthCentre, Paddle Prairie Community HealthCentre and Rainbow Lake Community HealthCentre).

Are there other types of facilities in Alberta?There are two other types of “non-hospital”facilities:

Non-hospital surgical facilitiesFacilities that offer health care servicesinvolving medical operative procedures thatdo not require an overnight stay in the facilityfor post-operative recovery or observation –including private cataract, abortion, dentaland ophthalmology clinics. According to theCollege of Physicians and Surgeons ofAlberta, there are currently 53 non-hospitalday surgical facilities accredited under thecollege bylaws.

Comprehensiveness:

What iscovered byyour plan?

Comprehensiveness:

What iscovered byyour plan?

* These figures will be considered preliminary until the release of the Alberta Ministry of Health and Wellness’Alberta Health Care Insurance Plan, Statistical Supplement 2002/2003.

Comprehensiveness: What is covered by your plan?

9

Non-hospital diagnostic facilities Non-hospital diagnostic facilities offer healthcare services for procedures that do notrequire an overnight stay and detect anddetermine various diseases or healthconditions. A total of 157 non-hospitaldiagnostic facilities received fee-for-servicepayments from the Alberta Health CareInsurance Plan in 2002/2003.

What Alberta legislation coversthese types of facilities?The Health Care Protection Act defines rulesfor the operation of surgical facilities andprotection of the publicly funded andadministered health care system. UnderSection 7 of this act, surgical facilities areallowed to provide insured surgical serviceswhen they are accredited, have an agreementwith a health authority and the facility isdesignated by the Minister.

Under Section 11, the Minister may designatea surgical facility to provide specified insuredsurgical services where the Minister hasapproved a proposed agreement with ahealth authority, and the Minister is satisfiedthat the surgical facility either is, or will be,accredited to provide those surgical services.

Section 8(3) states that the Minister “shall notapprove an agreement” unless:

• the insured surgical services areconsistent with the principles of theCanada Health Act;

• there is a current and will likely be afuture need for surgical services in thegeographical area to be served;

• the proposed surgical services will nothave a negative impact on the province’spublic health system;

• it is expected the public will benefit fromthe insured surgical services beingprovided;

• the health authority has an acceptablebusiness plan to pay for the services;

• the proposed agreement containsperformance expectations and measures;and

• the physicians providing the services willcomply with conflict of interest and ethicalrequirements within the MedicalProfession Act and bylaws.

10

How are Albertans protected bythe Health Care Protection Act?Under this act:

• operation of private hospitals is prohibited(Section 1)

• operation of non-hospital surgical facilitiesis prohibited unless they are approved(Section 2)

• “queue jumping” is prohibited (Section 3)

• non-hospital surgical facilities cannotcharge facility fees to patients who receiveinsured surgical services (facility fees arepayable by health authorities) (Section 4)

• no person can charge or collect paymentfor enhanced medical goods or servicesabove the actual cost to provide them(Section 5)

• no person can charge or collect paymentfor enhanced medical goods or servicesunless the nature of the goods or servicesoffered and the charges for them are fullyexplained.

How is a hospital approved in Alberta?Acute care hospitals and auxiliary hospitalsmust receive department and ministerialapproval. A new hospital must undergo aregional needs assessment, have a programand service plan developed and conduct ahospital functional programming study.

How is a hospital service insured in Alberta?Section 25(1)(h) of the Health Care ProtectionAct gives Cabinet the authority to determinewhether a particular good or service is astandard or an enhanced good or service. The Health Care Protection Regulation definesmajor surgical services, minor surgicalprocedures, and standard and enhancedmedical goods and services. An amendmentto the regulation must be made to add orremove an insured service.

11

What Alberta legislation coversphysician services?Insured physician services are paid for underthe Alberta Health Care Insurance Plan. Onlyphysicians who meet the requirements statedin the Alberta Health Care Insurance Act areallowed to provide insured physician servicesunder the Alberta Health Care Insurance Plan.

Before being registered with the department,a practitioner must complete the appropriateregistration forms and include a copy ofhis/her licence issued by the appropriategoverning body or association, such as theCollege of Physicians and Surgeons ofAlberta or the Alberta Dental Association andCollege.

Are surgical-dental services insured?The province insures a number of medicallynecessary oral surgical procedures that arelisted in the Schedule of Oral andMaxillofacial Surgery Benefits. A dentist ordental surgeon may perform a small numberof these procedures, but the majority of theprocedures can be billed to the Alberta HealthCare Insurance Plan only when performed byan oral and maxillofacial surgeon.

Total payments to oral surgeons and dentistsfor insured surgical-dental services were$2,394,458.*

234*oral surgeons and dentists wereregistered with theAlberta Health CareInsurance Plan andbilled the plan forinsured dentalservices

Number of oral surgeonsand dentists in AlbertaAs of March 31, 2003

2,841*general practitioners

5,206*total physiciansregistered with

and receivedpayment from

the AlbertaHealth Care

Insurance Plan

2,365*specialists

Number of physicians in AlbertaAs of March 31, 2003

Can physicians opt out of the plan?Yes, under section 8 of the Alberta HealthCare Insurance Act, physicians may opt out ofthe Alberta Health Care Insurance Plan. As ofMarch 31, 2003, there were no opted-outmedical practitioners in the province.

Can dentists and oral surgeons opt out of the plan?Under section 7 of the Alberta Health CareInsurance Act, dentists and oral surgeons mayopt out of the Alberta Health Care InsurancePlan. As of March 31, 2003, there were no opted-out dentists or oral surgeons in Alberta.

* These figures will be considered preliminary until the release of the Alberta Ministry of Health and Wellness’Alberta Health Care Insurance Plan, Statistical Supplement 2002/2003.

12

What medical benefits are insured?The Medical Benefits Regulation defineswhich medical services are insured. Theseservices are documented in the Schedule of Medical Benefits, which isprepared and published by the departmentand approved by the Minister.

A complete list of medical benefits can be

accessed at www.health.gov.ab.ca/

professionals/somb.htm.

How are changes to the list made?Insured physician services and any changesto the Schedule of Medical Benefits arediscussed between the department and theAlberta Medical Association (AMA). Allchanges to the Schedule of Medical Benefitsrequire ministerial approval after jointnegotiations between the department and theAMA have concluded.

What is not insured?Section 4(1) of the Hospitalization BenefitsRegulation provides a list of uninsuredhospital services. Uninsured services includedrugs, services and products that have beendeemed medically unnecessary and servicesprovided by a facility outside of Canada,unless prior approval of the Minister isobtained.

The Minister of Health and Wellnessdetermines what services the Alberta HealthCare Insurance Plan covers. The departmentreviews scientific literature, consults expertadvice and assesses policy, funding andtraining in considering medical products,services or devices for insured coverage.

Section 21 of the Alberta Health CareInsurance Regulation defines what servicesare not considered insured services.

Can Albertans be billed for any services?Physicians may bill a patient for services thatare not medically required and not includedin the Schedule of Medical Benefits. Thedepartment does not regulate physicians’billings for uninsured services. The College ofPhysicians and Surgeons of Alberta hasdeveloped and enforces a policy on this issueentitled Charging for Uninsured Services, andthe Alberta Medical Association provides theGuide to Direct Billing for Uninsured Servicesto physicians.

No de-listed servicesThere were no medical services de-insured or de-listed in 2002/2003.

13

Who is eligible for coverage in Alberta?Under the terms of the Alberta Health CareInsurance Act, all Alberta “residents” areeligible to receive publicly funded health careservices under the Alberta Health CareInsurance Plan. A “resident” is defined as aperson lawfully entitled to be or to remain inCanada who makes the province his or herhome and is ordinarily present in Alberta.The term “resident” does not include atourist, transient or visitor to Alberta.

Number of Albertans coveredAs of March 31, 2003

Who is not eligible for coveragein Alberta?Residents who are not eligible for coverageunder the Alberta Health Care Insurance Planare:

• members of the Canadian Forces;

• members of the Royal Canadian MountedPolice (RCMP) who are appointed to arank; and

• persons serving a term in a federalpenitentiary.

(However, family members are eligible for coverage.)

Are people who have moved to Alberta from other countries covered?People from outside Canada who move toAlberta to establish permanent residence areeligible for coverage if they are landedimmigrants, returning landed immigrants orreturning Canadian citizens. Temporaryresidents arriving from outside Canada, whomay be deemed residents, include persons onVisitor Records, Student or EmploymentAuthorizations and Minister’s Permits. As ofMarch 2003, there were 17,107 peoplecovered under these conditions.

3,124,487*residents registered with

the Alberta Health CareInsurance Plan

Universality:Who is

covered by the plan?

Universality:Who is

covered by the plan?

Universality: Who is covered by the plan?

* These figures will be considered preliminary until the release of the Alberta Ministry of Health andWellness’ Alberta Health Care Insurance Plan, Statistical Supplement 2002/2003.

14

How do people new to Albertaapply for health coverage?

All new Alberta residents are required toregister themselves and their eligibledependents with the Alberta Health CareInsurance Plan. New residents to Albertashould apply for coverage within threemonths of arrival. Family members areregistered on the same account for billingpurposes and to ensure that benefits, such asnon-group Blue Cross, can be provided to allmembers of the family unit.

Who is required to pay premiumsfor health care in Alberta?All Alberta residents, except dependents andindividuals excluded from registration, arerequired to pay premiums. Exceptionsinclude individuals enrolled in special groups(such as Alberta Widows’ Pension or Supportfor Independence), or people entitled to fullpremium assistance.

937 millionraised through premiums covered

only 14 per cent of the total

Can Albertans be deniedcoverage if they are unable to pay their premiums?No. Although Albertans are required to paypremiums, no resident is denied coveragedue to an inability to pay.

Money raisedthroughpremiumsin 2002/2003

Two programs assist lower-income, non-senior Albertans with the cost of theirpremiums: the Premium Subsidy Programand the Waiver of Premiums Program.

Seniors are required to pay premiums at thesame rates as non-seniors, although seniorsmay be eligible for premium assistance asdetermined through the Alberta SeniorsBenefit Program.

$6.8 billionspent onhealth carecosts byAlberta in2002/2003

Accessibility:Who hasaccess toinsured

services?

Accessibility:Who hasaccess toinsured

services?

Who has access to insured health services?All Alberta residents have access to insuredhealth services in Alberta.

How is Alberta increasing accessto insured hospital services in Alberta?The 2002/2003 budget included:

• an increase of 7.3 per cent or $468 million,with total Alberta Health and Wellnessspending in 2002/2003 of $6.837 billion.

• an increase of $247 million or 6.9 per centto regional health authorities andprovincial boards.

• an increase of approximately $21 millionfor province-wide services for key life-saving procedures primarily done in Edmonton and Calgary.

• an increase of $177 million for physiciancompensation, as part of the agreementnegotiated with the Alberta MedicalAssociation.

How is Alberta increasing access to insured physician and dental-surgical services in Alberta?The Alberta International Medical Graduate(AIMG) Program and the Alberta Rural FamilyMedicine Network (ARFMN) continued tohave funding extended during this period.There are currently 17 residents training inthe AIMG Program. The ARFMN Program has a total of 40 family medicine residents.As well, $920,000 was provided to theUniversity of Alberta to support thecontinuance of the School of Dentistry.

15

Accessibility: Who has access to insured services?

16

31 Opticians50 Podiatrists

102 Denturists340 Optometrists453 Oral Surgeons/Dentists801 Chiropractors

5,206 Physicians

6,983* TOTAL

Number ofpractitioners who were registeredwith and receivedpayment from theAlberta Health CareInsurance Plan as of March 31, 2003

How many health carepractitioners are there in Alberta?

* The number of physicians,dentists and oral surgeons,services provided and amounts paid for insuredhospital/medical services are to be considered preliminaryuntil the release of the AlbertaMinistry of Health and Wellness’Alberta Health Care PlanStatistical Supplement,2002/2003.

What other initiatives aimed atincreasing access are underway?In response to the Premier’s Advisory Councilon Health report, the Alberta government hascommitted to the following:

• launch a website posting information onwait times for selected procedures

• establish a centralized booking system forselected procedures to allow patients tofind a surgeon and facility that matchestheir needs

• increase the use of care groups, whichinvolve a range of health professionalsand new approaches to care for peoplewith chronic diseases

• work with physicians and healthauthorities to identify appropriate accessstandards for selected health services.

17

How are physicians paid?Most physicians in Alberta are paid on a fee-for-service basis for providing insuredservices. The department and the AlbertaMedical Association are working with healthauthorities, facilities and physicians todevelop a number of new alternate paymentplan projects as alternatives to fee-for-servicepayment.

These alternate payment plans and alternatefunding plans were expanded in 2002/2003with approximately 225 physicians involvedin such arrangements. A number of otherplans, involving approximately 1,000 primarycare specialist and academic physicians, arein development.

Who determines what physicians are paid?Alberta Health and Wellness (AHW)negotiates payment agreements with theAlberta Medical Association (AMA), theprofessional association representingphysicians and surgeons in Alberta.Negotiations are currently underway toestablish a new agreement between AHWand the AMA. Regional health authorities(RHAs) are represented in these negotiationsfor the first time. AHW, RHAs and the AMAwill sign this new agreement.

In 2002/2003, total fee-for-service payments tophysicians for insured physician serviceswere $1,225,626,637* (for generalpractitioners and specialists).

What role do regional health authorities play?The Regional Health Authorities Act definesthe roles and responsibilities for regionalhealth authorities in delivering hospital andhealth services.

Alberta Health and Wellness uses apopulation-based funding formula to fundregional health authorities. The formulacalculates the total population, age, genderand socio-economic composition of theregion, as well as the services provided toresidents, to determine how much funding isprovided to each region.

In 2002/2003, $3.9 billion in population-basedfunding was provided to the regional healthauthorities.

Edmonton and Calgary health authorities alsoreceive funding to provide specialized tertiaryservices (province-wide services) to allAlbertans. Province-wide services received$418 million in 2002/2003, an increase ofapproximately six per cent over the previousyear.

* These figures will be considered preliminary until the release of the Alberta Ministry of Health and Wellness’Alberta Health Care Insurance Plan, Statistical Supplement 2002/2003.

18

Are out-of-province residentsinsured when they move toAlberta?Persons moving permanently to Alberta fromanother part of Canada are eligible forcoverage on the first day of the third monthfollowing their arrival, provided they registerwithin three months of arrival.

Eligibility: Are you covered when you move to Alberta?

Are people from outside ofCanada insured when they move to Alberta?Persons moving permanently to Alberta fromoutside Canada are eligible for coverage ifthey are landed immigrants, returning landedimmigrants or returning Canadian citizens.Temporary residents may also be eligible forcoverage, provided their Canada entrydocuments are valid for at least 12 months.

Portability: Are you covered when you move out of Alberta or out of Canada?

Is there coverage for Albertansliving temporarily in anotherprovince?The Alberta Health Care Insurance Planprovides the following coverage:

• Visit/Vacation = up to 24 months coverage

• Work/Business/Missionary Work = up to 48 months

• Post Secondary Education = no limit.Covered until studies are completed.

Extension requests for longer than 24 monthswill be reviewed on a case-by-case basis.

Individuals who are routinely absent fromAlberta every year will need to spend acumulative total of 183 days in a 12-monthperiod in Alberta to maintain continuouscoverage.

If individuals will not be present in Alberta forthe required 183 days, they may beconsidered residents of Alberta if they satisfyAlberta Health and Wellness that Alberta istheir permanent and principle place ofresidence.

More information on coverage during

temporary absences outside of Canada or

Alberta is accessible at www.health.gov.ab.

ca/coverage/ahcip/travel.html.

19

$546,853*Total amount paidfor in-patient and

out-patient insuredhospital services

provided to Albertaresidents

(7,437* services)

$976,232*Amount paid forinsured physicianservices providedto Albertaresidents(21,289* services)

Out-of-countrypaymentsin 2002/2003

Is there coverage for peopleliving temporarily outsideCanada?The Alberta Health Care Insurance Planprovides coverage for the first six consecutivemonths of absence outside Canada. Residentswho wish to maintain coverage for a longerperiod may request an extension of coveragefor a maximum of 24 consecutive monthsfrom the month of departure.

Extention requests for longer than 24 monthswill be reviewed on a case-by-case basis andwill be responded to the same as for Albertansliving temporarily in another province.

The maximum amount payable for out-of-country in-patient hospital services is$100 (Canadian) per day, (not including day ofdischarge). The maximum hospital out-patientper visit rate is $50 (Canadian), with a limit ofone visit per day. The only exception ishaemodialysis, which is paid at a maximum of$220 per visit, with a limit of one visit per day.Physician and allied health practitionerservices are paid according to Alberta rates.

Is approval needed to receiveservices outside Alberta?Prior approval is not required for electiveservices received outside Alberta, except forthe treatment of alcohol and substance abuse,eating disorders and similar addictive orbehavioural disorders. Approval by theMinister must be received before theseservices can be covered.

Is there coverage for peoplereceiving medical attention in another province?Alberta participates in the Hospital ReciprocalAgreement with other provinces andterritories, which allows for the processing ofhospital costs provided by the host province.

Alberta also participates in the MedicalReciprocal Billing Agreement with provincesand territories (except Quebec), which allowsfor the processing of medical costs providedby practitioners in the host province.Payments are paid at the host province orterritorial rates.

$23,707,079*Total amount paidfor in-patient and

out-patient insuredhospital services

provided to Alberta residents(72,250* services)

$13,880,981*Amount paid forinsured physicianservices providedto Alberta residents(559,503* services)

Out-of-provincepaymentsin 2002/2003Within Canada

Portability:Are you

covered whenyou move

out of Albertaor out ofCanada?

Portability:Are you

covered whenyou move

out of Albertaor out ofCanada?

* These figures will be considered preliminary until the releaseof the Alberta Ministry of Health and Wellness’ AlbertaHealth Care Insurance Plan, Statistical Supplement2002/2003.

20

Sources of more

information

Sources of more

information

Office consolidations of all health care

insurance legislation, together with all

relevant regulations:

• Alberta Health Care Insurance Act

• Alberta Health Care Insurance Regulation • Government Accountability Act

• Health Care Protection Act

• Health Care Protection Regulation • Health Insurance Premiums Act

• Health Insurance Premiums Regulation• Hospitalization Benefits Regulation• Hospitals Act

• Hospital Foundation Regulation • Medical Benefits Regulation • Medical Profession Act

• Nursing Homes Act

• Nursing Homes General Regulation• Regional Health Authorities Act

• Regional Health Authorities Regulation.

Note: All Alberta Statutes and Regulations

are available on line at http://qpsource.

gov.ab.ca.

• Schedule of Medical Benefits, April 1, 2003.

• Schedule of Oral and MaxillofacialSurgery Benefits, August 1, 2001.

• Reports of the Auditor General of Albertafor 2002/2003.

• Alberta Ministry of Health and WellnessAnnual Report, 2002/2003.

• Ministry of Health and Wellness Three-Year Business Plan, 2003-2006.

• Alberta Budget, 2002/2003.

• Alberta Ministry of Health and Wellness’Alberta Health Care Insurance Plan,Statistical Supplement 2002/2003.

Note: These publications are available on our

website at http://www.health.gov.ab.ca/

reading/publications.html.

Sources of more information

Ministry and Commission ContactsMinister of Health and Wellness

Gary G. Mar, Q.C.MLA, Calgary Nose Creek427-3665

Deputy Minister

Dr. Roger Palmer422-0747

Health Facilities Review

Committee Chair

Bob MaskellMLA, Edmonton-Meadowlark427-3101

Alberta Alcohol and Drug Abuse

Commission Chair

LeRoy JohnsonMLA, Wetaskiwin-Camrose427-2837

Mental Health Patient Advocate

Jay McPhail422-1812

Alberta Health and Wellness10025 – Jasper Avenue

Edmonton, Alberta

T5J 2N3

(780) 427-7164

310-4455 (toll free anywhere in Alberta)

www.health.gov.ab.ca

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HEALTH AND WELLNESS