Health Insurance and Coverage in Canada

The health care system in Canada covers basic services, but many health services are not covered, or are only partially covered. Possible services that may be partially covered include dental services, optometry, physiotherapy, chiropractic services, and prescription medications. For more information, review the guidelines, conditions and limitations under the AHCIP.

Paying Out-of-Pocket for Health Services

If the treatment you want to receive is not covered or only partially covered under the UAHIP and/or the AHCIP, you will be responsible to pay out of your own pocket for the remaining portion (balance) of the service and/or treatment. To ensure you can pay for the the treatments and/or services you need, ask your healthcare professional about your coverage and insurance plan before receiving treatment.

Coverage

Depending on your health insurance plan, you may receive full, partial, or no coverage for health services you access. For more details about your coverage, speak with a health professional and/or refer to your insurance plan.

The following provides a breakdown of coverage based on the health insurance plans listed:

Full Coverage (under AHCIP and UAHIP)

  • Includes necessary medical visits to a physician or psychiatrist, required medical laboratory and/or other diagnostic procedures, oral surgery services, and hospital visits and stays.

Partial Coverage (under AHCIP and UAHIP)

  • Includes prescription medications, optometry, dental services (e.g., cleaning, filling, and extraction of wisdom tooth), podiatry (foot care), and medications.

No Coverage (under AHCIP)

  • Includes non-medically required surgery (e.g., cosmetic procedures), vision care (if between 19 and 64 years of age), medical forms and notes, and clinical psychologist services.

Glossary
Drop-in/walk-in clinic
If you have a medical concern, you can visit medical centres without booking appointments (e.g., University Health Centre in SUB 2-200).
Registered nurse
A nurse who is licensed to practice after receiving 4 years of university-level training.
Triaged
This terms refers to health professionals who assess patients and determine who should be treated first. The priority in this case is not first-come, first-serve. Instead, priority is based on the severity of the medical situation.
Additional prescribing authority
Alberta pharmacists have a unique ability to obtain this type of authority. This authority allows them to write prescriptions for certain medications (e.g., antibiotics, antidepressants, inhalers, birth control drugs, heart medications, and diabetes medications) as a way to provide ongoing patient care.
Referral health care system
This means there is more than one level of health care service where, upon assessment from a health provider, you may be referred to additional medical services. In Canada, there is primary, secondary, and tertiary levels of health care services.
Ongoing medical care
Receiving ongoing medical care means that you are receiving continuous care, and/or coming back to the same doctor as other medical issues come up. This term can also indicate that you have a designated family doctor.
Private practice
Canada's health care system is publicly funded. However, some health practitioners offer services that are either partially covered or not covered at all (as outlined in your insurance plan) because they are not "medically necessary" services (e.g., cosmetic surgery). These health practitioners have a private practice.