Which supporting documentation is associated with submission of an insurance claim?

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Services within Canada

Submit a claim to the Alberta Health Care Insurance Plan (AHCIP) for the cost of insured health services received in another Canadian province or territory.

All claims for insured health services from outside Alberta must be submitted within 365 days from the date of the service.

Many services are not covered outside Alberta including:

• 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 1: Find out what you can claim

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

Step 2: Complete the form

Out-of-Province Claim for Physician/Practitioner Services form (PDF, 28 KB).

Step 3: Gather your documents

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

Step 4: Submit completed form

Send your completed forms and supporting documentation to the Out-of-Country unit:

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

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

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.

Effective April 1, 2020, only the cost of insured emergency physician and/or hospital services received outside of Canada are eligible for reimbursement under the Alberta Health Care Insurance Plan. Travel medical insurance is strongly recommended for travellers leaving the country

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.

To submit a claim for reimbursement of the cost of insured emergency health services received outside Canada, complete the Out-of-Country Health Services Claim form and submit it, along with itemized statements and proof of payment. Claims for emergency health costs incurred outside Canada must be submitted within 365 days from the date of service.

Read about health coverage in Canada.

Step 2: Complete the form

Out of Country Health Services Claim form (PDF, 184 KB).

Insurance Claim Consent and Authorization form (PDF, 252 KB) – 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 3: Gather hospital and physician service information

AHCIP needs the following information to process your claim:

Hospital service information

Information you need 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 that was 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 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 that was performed
• the date or dates when the insured person was treated
• the amount being claimed and proof of payment

Step 4: 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) and/or CMS 1500 (physician claim form).

Step 5: Submit your claim

Send your completed forms and supporting documentation to the Out-of-Country unit:

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

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

Contact

Connect with the Out-of-Province/Out-of-Country unit:

Email: [email protected]

Connect with the Alberta Health Care Insurance Plan office.

Which form contains information used to file insurance claims?

What is claim submission?

Which is supporting documentation or information associated with a health care claim?

What are the six important steps to follow before submitting a claim?