Whether it is the navigation, the best coverage, different health expense products, health coverage to save money in taxes, or plans to protect the individual from expensive medical tests or hospital bills. This guide will help individuals understand the medical insurance options that are currently available in Alberta and how to use them. Possession of the right medical test is integral to most people for underwriting purposes, mortgage applications, higher paying jobs, meeting work permit application requirements, or applying for permanent residency. This guide is a comprehensive resource and should be treated with respect. Nevertheless, this document can be the first step in informing readers who are looking for a way to ensure the coverage and benefits that they need. It is both interesting and practical to know the configurations of health insurance in Alberta; there are many topics that owners really care about. This refers to the facts of health insurance coverage in Alberta and how employers help employees with the cost of insurance. All people who need health insurance in Alberta or who are curious about what is happening in the coverage area should take the time to read this guide and get some meaningful information about their Alberta health insurance benefits. The guide has been developed and written in such a way as to suit many different levels of knowledge around insurance, and, as such, the terminology used is at a mid-level, where possible. If particularly complicated terms are introduced, this will be clarified at the time of introduction.
Understanding the Canadian Healthcare System
The Canadian Healthcare System In Canada, publicly funded healthcare services account for most health spending. Traditionally, the term “public healthcare” refers to reliance on government-funded and -controlled healthcare facilities, reversing the previous private ownership of such services. This shift aligned with a growing consensus that everyone should have access to healthcare services funded by the government. This philosophy forms the underpinning of the provincial plans and newly emerging national health programs developed to finance healthcare services. The general principle of these programs is to provide the public with assurance that, regardless of their income levels or place of residence, they will have essential health coverage. Access to healthcare services is a significant determinant in predicting public health, resulting in a plethora of academic literature regarding the subject. The Canadian model of healthcare distribution is rooted in the belief that the capacity of the private sector to provide services is finite. With limited healthcare resources and finite capacity, the ideals that govern the practice of Canadian healthcare should be viewed as accessibility, portability, universality, and public administration. The private sector contributes as well to the provision of health services. In recent years, a series of technological and business advances have led to significant development and expansion of comprehensive health insurance packages. These packages are typically left to individuals or companies to purchase, to supplement the services covered by provincial and territorial public health plans. Furthermore, Canadians living in Alberta have access to a wide range of health benefits thanks to these private and public sector partnerships.
Overview of the Public Healthcare System
The discussion of health insurance in Alberta necessarily begins with an examination of the public healthcare system. Healthcare in Canada is delivered by each province and territory, of which Alberta is one, through government programs that are funded by tax dollars. The federal government contributes financially to these programs through the Canada Health Transfer, which was established through legislation and is tied directly to the state of the economy, as measured by Gross Domestic Product. The Canada Health Act, in turn, guides how cash transfers are to be spent. Its principles dictate that healthcare should be publicly administered and accessible to all, offering insurance plan services payable by the health care insurance plan of the province for the purpose of meeting the reasonable and necessary health care needs of the insured persons. The healthcare insurance plans of each province and territory, including those of Alberta, must be universal, portable, provide coverage for all medically necessary services, and do so without direct financial charges at the point of service.
Each province and territory delivers healthcare benefits to the portion of the population that meets the Canada Health Act definition of insured persons. In Alberta, eligible residents are defined under Schedule A of the Alberta Health Care Insurance Regulation. The majority of residents fall into subsections (a) and (c), which include Canadian citizens and permanent residents. Subsection (b) denotes convention refugees and Protected Persons, who are foreign nationals fleeing persecution due to race, religion, nationality, membership in a particular group, or political opinion. Regardless of status, these individuals receive insurance coverage from the Alberta government as per the principles detailed within the Canada Health Act. However, Schedule A goes on to recognize those individuals who are not eligible for insurance coverage or who are not insured. Residents from the rest of Canada are treated as insured persons, given that they can provide proof of residency as per the Schedule, and as such, many R.O.C. residents also receive public insurance. In addition to R.O.C. insurance, the Alberta government has developed additional care programs that will be discussed further in section two.
Role of Private Health Insurance
Beyond our public healthcare system, many Canadians choose private health insurance for different reasons: – To access services not covered by the public system, or that have limited coverage. – To pay for the part of the cost of a service that is not covered by the public system. – To get more value for what the government and taxpayers are already spending on healthcare. – To get health services faster, such as tests, specialists, and private or semi-private hospital rooms. – To match the coverage from where they previously lived in Canada. – To get help with out-of-pocket medical expenses, such as prescription drugs or medical supplies. – To protect against being part of a triaged surgery list where the government decides who does and does not receive timely care. Private health insurance plans will cover different services, have different benefits and premiums, cover pre-existing conditions, and require different underwriting before approval. There are three main types of private health insurance products to consider: – Employment-based group private health plans. – Association group private health plans. – Individual private health plans. Sometimes these are sold as a basic supplemental plan. This kind of plan usually only covers a few areas of healthcare. For a more comprehensive plan, premiums can be increased over a basic supplemental plan. With private health insurance, there are some misconceptions. Private health insurance is not meant to replace public healthcare. For almost all residents, the public system is the first payer for insurable services. A comprehensive private health insurance program is to be a complement to the public system. The idea is that an individual can tailor the right mix of healthcare through a combination of public coverage and privately insured services to meet their personal health needs and their capacity for out-of-pocket healthcare costs.
Health Insurance in Alberta
Alberta is renowned for its comprehensive and proactive approach to health care. This section provides pertinent information covering the regulatory environment and associated coverage options. Moving forward, we’ll begin with an account of Alberta’s regulatory system, including the Alberta Health Care Insurance Plan.
Alberta’s Regulatory System
Strategic insurance enrollment begins in a study of one’s rights under the law. Consideration of these rights will aid in the determination of whether your insurance policies are consistent with the unique organizational functions of insurance. In Canada, public health care is a multi-level government-administered program, and medical malpractice insurance is at the federal level. In Alberta, the AHCIP is provided by the Alberta Ministry of Health and Wellness and administered by the Alberta Treasury, with central service and registry data maintained by Alberta Blue Cross. As the province’s only health insurance provider, AHCIP guarantees that the majority of medical services provided in Alberta hospitals are covered by the government, and, in return, the government compensates the hospitals in accordance with the Canada Health Act. The AHCIP is mandatory for almost every Albertan. A majority must register with AHCIP, while a few, including children under 18, members of the Canadian Forces, inactive reservists, or veteran members of the Royal Canadian Mounted Police, do not need to register because they are already enrolled.
To summarize, an understanding of the requisite core competency of the pertinent functions of health insurance is important. Further, policyholders must recognize the rights and responsibilities they have under the law and the associated regulations that are in place. The principal health liability insurance in Alberta is the provincial AHCIP. There are also private health insurance plans. Both are discussed in this section. This section will start with coverage under the AHCIP in Alberta, then examine the other health care insurance available to Albertans.
Mandatory Coverage: Alberta Health Care Insurance Plan (AHCIP)
Canadian citizens and permanent residents residing in Alberta are legally required to enroll in the Alberta Health Care Insurance Plan. The AHCIP is mandated to administer funding and management of the health system that provides health care services to residents of the province. In essence, it is the way that most Albertans access their right to health care—a right that is not guaranteed to those without Canadian long-term residency. The primary exceptions to this requirement are those covered by a private health care insurance plan held by their employer, including international students who may hold private insurance plans. The first subsection in this chapter describes AHCIP and what it covers. The next section provides an overview of care funded through the AHCIP, in addition to necessary information for maintaining coverage.
The AHCIP is the first stop for those looking to understand the health insurance coverage available to them in Alberta. It covers almost all medically necessary hospital and physician services, including those deemed inpatient or outpatient, diagnostic imaging, and surgical procedures, as part of its fee-for-service programs. The plan also includes coverage of mental health and addiction services by community clinics, helplines, and other auxiliary advanced care or ambulatory services, and most services provided by licensed midwives. Inpatient pharmaceuticals (with specific limitations), immunizations, and palliative or continuing care are also covered. Eligibility for AHCIP coverage is relatively broad; a resident of Alberta is any Canadian citizen or permanent resident whose primary place of residence currently and objectively is within the province, whose primary address shown on their driver’s license or similar personal information card is within Alberta, and is committed to being physically present in the province most of the time across 12 months. Some additional flexibility is given to seasonal laborers or those temporarily based outside of the province for work. Coverage typically begins on the first day of the third month after the resident arrives in Alberta. Coverage is continued until the last day of the second month following their move out of the province.
Supplementary Coverage: Private Health Insurance Plans
In Alberta, you have some supplementary coverage options by way of private health insurance plans. While the AHCIP offers a degree of basic, essential coverage, private health insurance plans provide additional benefits intended to complement your basic coverage by covering some of the costs for healthcare services or products not funded by medically necessary health insurance. Such “gaps” in publicly funded healthcare are intended by some policies; for individuals requiring care not funded by AHCIP to any extent—such as prescription medication, dental and vision care, or physiotherapy—supplementary coverage will make treatment more affordable. Policies vary extensively, including monthly premiums, dollar limits, and annual deductibles and co-pays, but most provide more or less coverage for prescription drugs, dental care, and vision care, plus some additional benefits. The purpose of this chapter is to outline both the general types of supplementary coverage available through private health insurance in Alberta and the specific products available in today’s marketplace.
At its simplest, obtaining supplementary health insurance—when it is in fact necessary—is a sound economic investment: you are paying smaller monthly premiums today to stash cash aside in cases of unexpected, substantial health-related expenses. As options are reviewed, it is important to assess one’s personal healthcare needs and compare these with the benefits and features of all plans currently available. Although many supplementary health insurance policies are available to individuals directly from insurance companies, some employers offer group insurance plans to their employees and their employees’ dependants. Members of professional organizations or unions may also be eligible for preferred rates on group policies.
Coverage Options and Benefits
Hospital and Medical Services
Prescription Drugs and Pharmacies
Dental Care
Vision Care
Mental Health Services
Navigating the Health Insurance Marketplace
The health insurance marketplace can be extremely daunting to navigate, and many people feel overwhelmed when it comes to choosing an insurance plan. There are many things to consider when selecting an insurance plan, and it is important to take stock of your personal financial situation and healthcare needs. Taking an active role in the exploration of insurance options can help you make more informed decisions about your healthcare coverage. If you are selecting a plan for yourself, consider your medical history and existing conditions, any prescription drugs you take, and the current state of your health. If you have or are thinking about starting a family, be sure to consider coverage for prenatal care, maternity care, and coverage for dependent children. The marketplace is full of insurance options, and it is imperative you fine-tune the plans based on what works best for you. There are a few types of insurance plans, including health managed organizations, exclusive provider organizations, preferred provider organizations, and consumer-directed or high-deductible plans. Depending on the type of plan you get, the amount you pay will differ, as well as the doctors you can see, the routine services you require, and the costs of co-payments, co-insurance, deductibles, and premiums. It is very important to take your own budget into consideration when purchasing insurance, and the best plan for you may not have the lowest monthly premium. A premium is the amount you will pay the insurance company each month for health coverage, even if you don’t use any medical services. The deductible is the amount you pay for covered health insurance services before your insurance plan starts to pay. Once you have paid your deductible, you usually pay only a co-payment or co-insurance for covered services. Co-payments and co-insurance are both ways you pay for healthcare services. Co-payments are usually a fixed amount you pay for covered services. Co-insurance is usually a percentage you pay for covered services. The amount you will pay monthly for premiums may be lower if you plan to pay a higher deductible or co-payments out of your pocket. If you go to the doctor frequently, you should look at how much you will have to pay out of pocket for office visits and other routine services. Some plans may not pay for some services until you pay for a part of them, such as diagnostic tests and prescription drugs. Knowing these terms and what costs you will be required to pay as a member of the health insurance plan is an important tool for your selection process.
Choosing the Right Plan for Your Needs
When selecting a health insurance plan in Alberta, it’s important to understand that one size does not fit all. Each person’s healthcare needs and priorities will be unique to them. For example, people on the younger end of the spectrum who seldom, if ever, get sick may want to sign into a less expensive health insurance plan than families with young children whose illness risk is higher. Start by determining how much healthcare and what type of healthcare coverage you think will suit you best. Some other things to consider include:
– How many people will need to be covered by your plan? – What are yours, your partner’s, and your children’s ages? – Does anyone in your immediate family have known health issues? – Do you participate in risky activities or have a job that’s more prone to injury? – Do you travel frequently?
After considering your needs, research your insurance company of choice for different plan options. Make note of what is covered by the plan and if it aligns with the needs of you and your family. Also, consider the plan’s costs before any services are even used, including premiums, deductibles, and co-pays. Value how much each service is going to cost you in relation to other plans. Research how the plan networks with healthcare providers, specialists, and hospitals in your area. Can you get the care you need at conveniently located clinics and hospitals? Lastly, don’t forget to read the fine print! Clearly understand your policy. Otherwise, you may inadvertently be responsible for covering certain medical services and prescriptions due to coverage policy restrictions. Simple due diligence can alleviate accidental costs.
Understanding Premiums, Deductibles, and Co-payments
A premium is a regular payment made to health insurance providers in exchange for and just to maintain your coverage. This can often be paid weekly, biweekly, monthly, or annually. A deductible is a predetermined amount of money that you must pay out of pocket each year for health services before insurance covers more of the associated costs. Co-payments, also known as co-pays, are fixed amounts that you pay at the time when you access health services. These cannot be accumulated into a larger sum and may be paid at the point of service. As a general rule of thumb, a health insurance plan with lower premiums will have higher deductibles and co-payments, ultimately translating to higher out-of-pocket costs at the time of receiving health services. Example: Both of the following plans have annual deductibles of $1,000: • Plan A: Costs $90 per month with a $40 co-payment; health services have a cap at out-of-pocket costs of $5,000 per year. • Plan B: Costs $150 per month, with a $10 co-payment; health services have a cap at out-of-pocket costs of $2,000 per year. This means that if you visit health care services an average of once a month or less per month in a year, Plan A may save you more since you are $60 per month from the lower premium and $10 every time you visit the doctor. However, if you visit health care services two or more times per month, you could be saving more with Plan B. Budgeting Tips: It is key to keep in mind that on top of regular preventive medical checks, minor accidents, and usual symptoms, unaccounted health emergencies also lead to medical costs. It is strongly advised to add up all the expenses and calculate both the anticipated number of visits to health care services during an average month for you and the additional periodical services that are needed to get an estimate of what you will finally be paying with either of the health insurance plans. In addition to this, consider the following tips when dealing with health insurance deductibles and co-payments. Compare Plans: Different health insurance plans can include the same services at different amounts for premiums, deductibles, and co-pays. Look at these monthly costs, the annual deductibles, and co-pays of the services you normally seek and adjust them to your personal healthcare regularity to compare them and see which ones you can afford. Look at What Is Important: At the end of the day, your health is worth more than any amount of money, so plan accordingly. Do you want to pay more now, at an affordable rate, or after paying a higher amount on a monthly basis? This should help you determine what plan is better for you. Plan Long-Term: Your health premiums and deductible should fall within your financial capability and should not interfere with your long-term financial planning despite a health emergency.
Navigating the health insurance system in Alberta requires individuals to understand the complex range of services that are available to them. While public health insurance provides financial protection for many healthcare services, provincial residents must also anticipate out-of-pocket costs or additional private or select services they may require. There are many private health insurance options available to help cover these costs, but it is important that people research what their options are, who might be eligible for coverage, and for what. The goal of navigating health insurance in Alberta is to help guide individuals in making informed decisions about their coverage needs. We hope that this document allows readers to begin to see the interconnectedness between coverage and benefits, and anticipate what it might mean to have a mix of public and private health insurance options for the province.
We encourage those interested in private health insurance to become familiar with the range of choices available to them, and also to stay up to date on the latest insurance plans, policies, and options as they evolve. When it comes to public health insurance, changes related to waiting periods for temporary residents, government reimbursement, or new eligibility will depend on changes in legislation. We strive to give readers an understanding of the health insurance options that exist in Alberta. We think it is important for people to stay informed about all of the options, benefits, costs, and challenges to make a proactive decision about their complete healthcare needs. It is always good for someone to shop around at the beginning, periodically review and make any necessary adjustments in coverage that are unique to their personal health, lifestyle, and budgetary needs. There are many factors that affect a person’s health. Try to ensure that your choices are helping you to get, or keep, as healthy as possible.
