ASEBP’s Extended Health Care plan provides coverage for health-care services and supplies which are not covered, or covered only to a limited extent, by the Alberta Health Care Insurance Plan. Benefits excluded from the Alberta Health Care Insurance Plan are not automatically covered by ASEBP’s Extended Health Care plan.

Generally, ASEBP’s Extended Health Care plan covers the following health-related supplies or services:

• prescription medicines
• semi-private hospital accommodation
• a range of services and supplies
• out-of-province coverage
• outside Canada emergency medical treatment

The benefit period runs from January 1 to December 31 of each year.

Depending on which plan you are enrolled in, persons covered under Extended Health Care can include:

• yourself
• your spouse and other dependents - for the purposes of this plan your spouse is considered a dependent

* Direct billing refers to the direct payment to the health service provider (in this case the pharmacist) of the portion of the cost your plan pays. At the time of service, you pay only the amount you are responsible for. Just show your ASEBP identification card.

**Reimbursement means you pay up front for the service or product and then submit a paper claim. See the section How to Submit a Claim.

You are responsible for your own co-payments (if enrolled in a plan not offering 100% coverage or if selecting a higher-cost product) and are responsible for any differences in cost between the dispensing fees charged by the pharmacy and what ASEBP will pay.

Date of service: An expense is considered to be incurred on the date the service or supply was provided. If claiming for a service (e.g. physiotherapy), the date of service refers to the date of the service, and the receipt should reflect this date. If claiming for an item (e.g. foot orthotics), the date of the service refers to the date the member is first in possession of the item, and the receipt should reflect this date.
 

eligible drugs listed in the ASEBP Drug Benefit List

• 80% direct bill* (if there is an LCA) for least cost alternative products; 75% direct bill* (if there is no LCA) and including a maximum dispensing fee of $5.50 per prescription (the dispensing fee is included in the price of the prescription)
• includes legal and conventional prescription and specific over-the-counter drug products where there is a lower cost, interchangeable product with the same active ingredients in the same dosage and form, ASEBP will pay 80% of the LCA cost

diabetic supplies

• 100% direct bill, maximum $4,000 per person per year
• Insulin Pumps: $4,000 per person every four years

semi-private hospital accommodation

• 100% direct bill to a maximum of $24 per day

other eligible health- related expenses

• 100% to specified maximums, reimbursement**

* Direct billing refers to the direct payment to the health service provider (in this case the pharmacist) of the portion of the cost your plan pays. At the time of service, you pay only the amount you are responsible for. Just show your ASEBP identification card.

**Reimbursement means you pay up front for the service or product and then submit a paper claim. See the section How to Submit a Claim.

You are responsible for your own co-payments (if enrolled in a plan not offering 100% coverage or if selecting a higher-cost product) and are responsible for any differences in cost between the dispensing fees charged by the pharmacy and what ASEBP will pay.

Date of service: An expense is considered to be incurred on the date the service or supply was provided. If claiming for a service (e.g. physiotherapy), the date of service refers to the date of the service, and the receipt should reflect this date. If claiming for an item (e.g. foot orthotics), the date of the service refers to the date the member is first in possession of the item, and the receipt should reflect this date.

eligible drugs listed in the ASEBP Drug Benefit List

• 90% direct bill* based on least cost alternative (LCA) pricing and including a maximum dispensing fee of $7.00 per prescription (the dispensing fee is included in the price of the prescription)
• includes legal and conventional prescription and specific over-the-counter drug products where there is a lower cost, interchangeable product with the same active ingredients in the same dosage and form, ASEBP will pay 90% of the LCA cost

diabetic supplies

• 100% direct bill, maximum $4,000 per person per year
• Insulin pumps: $4,000 per person every four years

semi-private hospital accommodation

• 100% direct bill, to a maximum of $24 per day

other eligible health- related expenses

• 100% to specified maximums, reimbursement**

* Direct billing refers to the direct payment to the health service provider (in this case the pharmacist) of the portion of the cost your plan pays. At the time of service, you pay only the amount you are responsible for. Just show your ASEBP identification card.

**Reimbursement means you pay up front for the service or product and then submit a paper claim. See the section How to Submit a Claim.

You are responsible for your own co-payments (if enrolled in a plan not offering 100% coverage or if selecting a higher-cost product) and are responsible for any differences in cost between the dispensing fees charged by the pharmacy and what ASEBP will pay.

Date of service: An expense is considered to be incurred on the date the service or supply was provided. If claiming for a service (e.g. physiotherapy), the date of service refers to the date of the service, and the receipt should reflect this date. If claiming for an item (e.g. foot orthotics), the date of the service refers to the date the member is first in possession of the item, and the receipt should reflect this date.