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Common Questions - Extended Health Care

1 Does my Extended Health Care cover services such as chiropractic treatment, massage therapy, and physiotherapy?
 

Your Extended Health Care plan covers the cost of several health services and supplies that are not covered by Alberta Health Care Plan, including chiropractic treatments, massage therapy, and physiotherapy, among many others. 

For a full list of covered services and supplies, go the Other Health Benefits section of the Extended Health Care Benefit Guide.

2 What if my prescription cannot be processed at the pharmacy?
 

If your claim can't be processed at the pharmacy and you require the medication immediately, you will have to pay for the prescription then submit the expense for reimbursement, provided the drug is eligible under your EHC plan.

Please ask your pharmacist what the response code was when he/she tried to process your prescription. Contact a Benefit Specialist with this response code for more information about the error.

3 Am I covered for Psychology or family counselling services?
 

If you have Extended Health Care (EHC) coverage, then you also have a psychology benefit. Refer to the psychology benefit section of the Extended Health Care Benefit Guide for information about the coverage.

To confirm that you hold EHC coverage, refer to your ASEBP ID card.

You may also be eligible for counselling services through the Employee & Family Assistance Program (EFAP) ASEBP offers through Homewood Health, if your employer has chosen to enrol your employee group in this program. Homewood Health's EFAP is a proactive health program which provides support services—healthy lifestyle coaching, counselling and advice—to covered members and their families. These services offer assistance when a covered member has identified an area for which they could use extra support and are prepared to actively engage with a professional to gain perspective and work toward positive results.

4 Does my EHC cover eyeglasses and eye examinations?
 

No. Eyeglasses and eye exams are covered by ASEBP's Vision Care benefit. To confirm that you have Vision Care, refer to your ASEBP ID card.

For information about Vision Care coverage, refer to the Vision Care Benefit Guide.

5 How do I find out if a drug is covered?
 

In general, most medications prescribed by an appropriate health care provider, dispensed by a licensed pharmacist, and approved by Health Canada are covered under ASEBP's Extended Health Care benefit.

If you have questions about the eligibility of a specific drug, there are a number of ways to determine if it's covered by your ASEBP benefits:

    1. Look up the drug using ASEBP's Drug Inquiry Tool found on My ASEBP under the Coverage tab. This tool will let you know if the drug is covered by your ASEBP benefits, if there are generic or alternative medications available, if step therapy rules apply and if the drug requires special authorization.
    2. Contact your pharmacist. They should have access to ASEBP's Drug Benefit List which details all eligible medications.
    3. Contact an ASEBP Benefit Specialist. When calling, please have the Drug Identification Number (DIN) available.
6 What is a "special authorization" drug?
 

Certain prescription drugs require special authorization before coverage under ASEBP's Extended Health Care plan is granted. These are high-cost drugs used to treat potentially catastrophic conditions (e.g., cancer, multiple sclerosis, rheumatoid arthritis, etc.) that can become more severe over time. These drugs may also have special handling or administration requirements, such as being refrigerated or delivered via injection. To determine if a prescription medication requires special authorization, please refer to ASEBP's Drug Inquiry Tool, which can be found under the Coverage tab on My ASEBP.

Your physician must submit a request for special authorization following the process described in the ASEBP Drug Benefit List. The special authorization process considers information provided on your behalf by your physician (note: medical specialists are very familiar with the authorization process).

Approval for coverage is provided if your medical condition meets the clinical criteria defined for the drug involved. You and your physician will be advised in writing of the decision following a request for special authorization.

On September 1, 2015, ASEBP introduced an enhanced special authorization process for five key health conditions: rheumatoid arthritis, multiple sclerosis, Crohn's disease/colitis, severe psoriasis and chronic hepatitis C. You can find out more about the enhanced special authorization process in the Rx Benefits section of our website.

7 Am I covered for vaccines?
 

Yes, ASEBP's Extended Health Care benefit does cover some preventative vaccines, such as the hepatitis B and shingles vaccines. To determine if a vaccine is covered by your ASEBP benefits, you can use our Drug Inquiry Tool, available under the Coverage tab on My ASEBP.

For more details on vaccine coverage, please visit the Prescription Benefits Medication page in the online Extended Health Care guide.

8 Am I covered for hearing aids and tests?
 

If you have Extended Health Care coverage, you are covered for hearing aids, but not for tests. For more information about what is covered under you hearing aid benefit, refer to the "Medical Appliances, Equipment, and Supplies" section of the Extended Health Care Benefit Guide.