Are Eye Exams Covered By Alberta Health

The Alberta Health Care Insurance Plan (AHCIP) provides residents of Alberta with full coverage for medically necessary physician and some specific Dental and Oral surgical health services. A physician will, by using his professional judgement determine whether it is medically necessary. Some optometric services may also be covered by the Alberta Health Care Insurance Plan for some residents, refer to the schedule of benefits.

Who is covered

To be eligible former residents must register when returning to the Province.  For Alberta children under 18 (1 to 18 years) and seniors 65 years and older eye examinations are covered if received in Alberta. Optometry services received outside Alberta are not covered by the Alberta Health Care Insurance Plan.

Applying for coverage

Once your application is processed the effective date of your coverage will be determined based on the following:

a)    If you move to Alberta from within Canada your coverage begins on the first day of the third month following the date when permanent residency began in Alberta. Coverage does vary from province to province.

b)    Should you move to Alberta from outside Canada your coverage begins on the date of arrival in Alberta once all registration validation requirements are met.

If the AHCIP application is not received within 3 months of when you arrive and establish permanent residency in Alberta the effective date of your coverage will be determined upon application. A medical card will be issued upon acceptance into the medical plan and you should always carry your card and photo ID with you at all times to receive medical services in Alberta.

Restrictions

Each person is allowed one complete exam, one partial exam and one diagnostic procedure per benefit year, from July 1 to June 30.

There are some Optometric benefits available to other Albertans of all ages for specific medical conditions treated by Alberta Optometrists. A Calgary Optometrist cannot charge their patients for services covered by AHCIP. The patient or secondary insurer (if applicable) is responsible for any additional costs not covered under the Alberta Health Care Insurance Plan. Also, residents 19 to 64 who require an eye examination for a medical condition, episode of illness or trauma, for example, if you are involved in an accident, you may be eligible for an eye examination. For further information contact your health care professional regarding services covered by the Health Care Plan.