Other Medical Services & Supplies

ASEBP provides coverage for a variety of medical services and supplies that complement your provincial health care insurance plan. Here are some things you should know about your Other Medical Services & Supplies coverage:

  • Coverage for Other Medical Services & Supplies is the same for all ASEBP plans, and some of the services and supplies included are also partially covered by your provincial health care insurance plan 
  • While all services and supplies must be medically necessary, a doctor's referral and/or prescription are not required for reimbursement, unless otherwise specified
  • Non-emergency services received outside of Canada are only covered if the health care provider has the proper qualifications (i.e. licensed to practice)—which is the individual’s responsibility to ensure
  • Medical supplies purchased outside of Canada are covered, unless otherwise specified 

Note that the following is an interpretation of the official, legally binding ASEBP insurance policies and plan documents available through your employer or by contacting us.

What's covered?

Accidental Dental

You and your dependants each have a maximum of $1,000 per tooth for dental treatment due to accidental injury (both inside and outside of Canada).

Note that accidental dental claims do not affect your annual or lifetime dental coverage limits. If you receive dental treatment due to accidental injury, please have your dentist complete the “Dental Accident” section of the Dental Care Claim. If the form you’re using does not have a specific section for accidental dental information, please mark the claim “Dental Accident” to prevent expenses from being applied to your annual dental maximum. Please ensure your dentist identifies all injured teeth on the form along with the date and details of the accident.

If services exceed the $1,000 per tooth maximum and you’re inside of Canada, your claim can be submitted under your Dental Care benefits and will be applied to your annual or lifetime dental claim maximums. If services exceed the $1,000 per tooth maximum and you’re outside of Canada, your claim may be covered under your Travel Emergency benefits.

Requirement(s): 

  • Must be necessary for the treatment of either accidental dental injury due to an external blow to the mouth or damage caused from biting on a foreign object inserted in the mouth
  • Treatment must be completed within two years of the accidental injury date
  • Damage must not have existed prior to the accidental injury

Acupuncture

Every calendar year (January to December), you and your dependants can each use up to $700 for acupuncture services. Acupuncture treatments will be covered up to $50 a day per person.
You can track your expenses by viewing the Benefit & Claim Maximums page under the Coverage tab on My ASEBP or on the My ASEBP Mobile App.

Requirement(s): 

  • Must be provided by an acupuncturist registered in the province of practice

Exclusion(s):

  • No more than one treatment per day (per person)
  • Combined acupuncture, chiropractic, massage and physiotherapy expenses cannot exceed more than $1,600 per calendar year (per person)

Ambulance

You and your dependants each have 100 per cent coverage for professional ambulance services (ground and air) at the rates negotiated between ASEBP and Alberta Health Services (AHS). Note that claiming practices may affect the time in which your claim is processed.

Requirement(s): 

  • Must be used for the emergency transport of a patient to the nearest hospital that can provide adequate medical treatment and when no other means of transportation is appropriate

Exclusion(s):

  • Trips that are:
    • not an emergency
    • to a treatment facility that is not active
    • between active treatment facilities (the sending hospital is responsible for this fee)
    • to or from a nursing home
    • pre-arranged or pre-booked
  • Additional fees (e.g. additional fees associated with out-of-province services, non-resident fees, late payment charges, surcharges, escort charges, medications or other charges such as the Jaws of Life, etc.)

Aerochambers

Every calendar year (January to December), you and your dependants each have a maximum of $40 towards the purchase of an aerochamber. Inhalers are covered separately.

Exclusion(s):

  • Repairs

Allergy Testing Materials

Every calendar year (January to December), you and your dependants each have a maximum of $40 towards the purchase of allergy testing materials.

Blood Pressure Monitors

Based on a rolling three-year period, you and your dependants each have a maximum of $150 towards the purchase of a digital blood pressure monitor.

Exclusion(s): 

  • Repairs

Brace

Based on a rolling two-year period, you and your dependants each have a maximum of $500 towards the purchase, repair, replacement and/or rental of a supporting device or appliance for limbs or other body parts (e.g. ankle, knee, wrist, elbow, back, etc.).

Requirement(s): 

  • If applicable, your receipt must state the side (left or right) of the body that the brace is intended for

Exclusion(s):

  • Splints
  • No more than one replacement every two years based on the date of service (the date you received the product being claimed—not the date it was paid for) not the calendar year

Canes, Casts, Cervical Collars, Crutches and Walkers

Every calendar year (January to December), you and your dependants each have a combined maximum of $100 towards the purchase and/or rental of canes, casts, cervical collars, crutches and walkers. Canes, casts, cervical collars, crutches and walkers are covered up to $40 per item.

Exclusion(s):

  • Repairs
  • Splints

Chiropractic

Every calendar year (January to December), you and your dependants can each use up to $700 for chiropractic services including X-rays related to treatment. Chiropractic treatments will be covered up to $50 a day per person.
You can track your expenses by viewing the Benefit & Claim Maximums page under the Coverage tab on My ASEBP or on the My ASEBP Mobile App.

Requirement(s): 

  • Must be provided by a chiropractor registered in the province of practice

Exclusion(s):

  • No more than one treatment per day (per person)
  • Combined acupuncture, chiropractic, massage and physiotherapy expenses cannot exceed more than $1,600 per calendar year (per person)

Compression Garments and Support/Surgical Stockings

Every calendar year (January to December), you and your dependants each have a combined maximum of $250 towards the purchase of compression garments (gloves, sleeves, support hosiery and surgical stockings).

Requirement(s): 

  • Compression sleeves must have a minimum pressure gradient of 20 mmHg; minimum of 30 mmHg for all other garments
  • Receipts must include pressure gradient
  • Only gloves, sleeves, support hosiery and surgical stockings are covered

Exclusion(s): 

  • No more than two pairs of each compression garment per calendar year

Diabetic Supplies

Every calendar year (January to December), you and your dependants each have a maximum of $4,000 towards the purchase of alcohol swabs, glucose monitors, lancets, penlets and syringes. Insulin pumps, continuous glucose monitoring receiver/transmitter and insulin are covered separately.

Exclusion(s):

  • Batteries
  • Glucose control solution

Dressings, Bandages and Related Supplies

Every calendar year (January to December), you and your dependants each have a combined maximum of $600 towards the purchase of dressings, bandages and related supplies.

Requirement(s):

  • Must be necessary as a result of a chronic medical condition
  • Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)

Endovenous Laser or Radiofrequency Endovenous Ablation Therapy

You and your dependants each have a lifetime maximum of $4,000 to treat varicose veins by endovenous laser or radiofrequency endovenous ablation therapy.

Requirement(s): 

  • Must be provided by a doctor or other licensed health care provider

Exclusion(s): 

  • Ultrasound-guided therapy

Foot Orthotics

Every calendar year (January to December), you and your dependants each have a maximum of $200 towards the purchase of foot orthotics and/or arch supports.

Requirement(s): 

  • Orthotics and arch supports must be custom made and individually fitted

Exclusion(s):

  • Repairs
  • Heel lifts
  • Off-the-shelf products

Hairpieces and Wigs

Based on a rolling three-year period, you and your dependants each have a maximum of $600 towards the purchase of hairpieces or wigs.

Requirement(s):

  • Only for hair loss due to radiation, chemotherapy or other serious medical conditions
  • Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)

Home Nursing Care

You and your dependants each have a lifetime maximum of 4,000 hours for home nursing care (e.g. private-duty professional nursing services provided in the home) within Canada. Registered nurses and graduate nurses will be covered up to $42 per hour; registered licensed practical nurses will be covered up to $27 per hour.

Requirement(s):

  • Must be provided by a registered nurse, graduate nurse or registered licensed practical nurse 
  • Must be deemed as an appropriate service or course of treatment by your doctor or other licensed health care provider (e.g. occupational therapist)
  • Must be pre-approved by ASEBP prior to service (please contact us for pre-approval requirements)

Exclusion(s): 

  • Homemaker, homecare services and custodial care (e.g. assistance for bathing, house cleaning, meal prep, etc.)

Hospital Beds

You and your dependants each have a lifetime maximum of $3,000 towards the purchase or rental of a hospital bed.

Requirement(s):

  • Must be necessary as a result of a chronic medical condition
  • Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)

Hospital Rooms

You and your dependants each have a daily maximum of $148 for a semi-private hospital room within Canada. 

Requirement(s):

  • Service must be from an institution regarded as an accredited hospital. To be recognized as a hospital, the institution must:
    • be accredited as a hospital by the Canadian Council on Hospital Accreditation,
    • be approved for resident in-patient care under a provincial hospital services program,
    • be primarily engaged in the in-patient medical care and treatment of sick and injured persons,
    • provide medical, diagnostic and major surgical facilities, and
    • provide 24-hour-a-day nursing service.

Exclusion(s):

  • Services from an institution not regarded as an accredited hospital, including:
    • an institution which is primarily a home for the aged, rest home or nursing home,
    • a facility solely dedicated to addiction treatment,
    • a facility that operates under the Mental Health Act, and
    • an institution operating primarily as a school or furnishing custodial care (e.g. auxiliary hospital, palliative care or respite room).

Hearing Aids and Related Supplies

Based on a rolling three-year period, you and your dependants each have a maximum of $3,000 towards the purchase, repair and/or replacement of hearing aids and related supplies. You and your dependants each have a lifetime maximum of $3,000 for expenses related to the damage to hearing caused by an accident.

Exclusion(s):

  • Batteries
  • Hearing tests
  • Cochlear implants

Ileostomy, Colostomy and Urinary Incontinence Supplies

Every calendar year (from January to December), you and your dependants each have a maximum of $1,000 towards the purchase of ileostomy, colostomy and urinary incontinence supplies.

Requirement(s): 

Exclusion(s):

  • Tubing
  • Skin care products

Insulin Pumps and Continuous Glucose Monitoring Receiver/Transmitter

Based on a rolling four-year period, you and your dependants each have a combined maximum of $5,000 towards the purchase of insulin pumps and continuous glucose monitoring receiver/transmitter. Other diabetic supplies and insulin are covered separately.

Exclusion(s):

  • Batteries
  • Glucose control solution

Intravenous Supplies

Every calendar year (January to December), you and your dependants each have a maximum of $150 towards the purchase of intravenous supplies (e.g. hep-locks, IV solutions, IV tubing, needles and swabs).

Joint Injectable Materials

For joint injectable material details, please see Drugs.

Massage Therapy

Every calendar year (January to December), you and your dependants can each use up to $700 for massage therapy services. Massage therapy treatments will be covered up to $50 a day per person.

You can track your expenses by viewing the Benefit & Claim Maximums page under the Coverage tab on My ASEBP or on the My ASEBP Mobile App.

Requirement(s):

  • Must be provided by a massage therapist registered in the province of practice (all of Canada) and have a minimum of 2,200 hours of training or equivalent competency (Alberta only)

Exclusion(s):

  • No more than one treatment per day (per person)
  • Combined acupuncture, chiropractic, massage and physiotherapy expenses cannot exceed more than $1,600 per calendar year (per person)
  • Services provided by massage therapy students—even if they’re registered with a professional college or association

Naturopathy

Every calendar year (January to December), you and your dependants each have a maximum of $200 for naturopathy services. Naturopathy treatments will be covered up to $20 a day per person.

Requirement(s):

  • Must be provided by a naturopathic practitioner registered in the province of practice or a member of the Canadian Naturopathic Association (for those provinces where there is no licensing body)

Exclusion(s):

  • No more than one treatment per day (per person)
  • Naturopathic medicines

Orthopedic Shoes

Every two calendar years (January to December), you and your dependants each have a maximum of $1,500 towards the purchase of orthopedic shoes.

Requirement(s):

  • Must be necessary because of an anatomical deformity, and a physician's letter/prescription stating the anatomical deformity is required with claim submission
  • Shoes must be custom made and individually fitted—if a brace is attached to the shoe, the brace must extend partway up the leg

Exclusion(s): 

  • Repairs

Out-of-Province Treatment

Coverage for out-of-province specialized treatment expenses for you and your eligible dependants are only considered if not available in your province of residence.

Requirement(s):

  • Specialized treatment you seek is available within Canada but outside your province of residence
  • The Alberta Health Care Insurance Plan acknowledges the treatment and accepts the expense for reimbursement
  • Must be pre-approved by ASEBP prior to treatment (please contact us for pre-approval requirements)

Exclusions:

  • Outside of Canada treatment

Oxygen and Supplies Required for Its Use

Every calendar year (January to December), you and your dependants each have a maximum of $1,000 towards the purchase, repair, rental and/or shipment of oxygen and supplies required for its use.

Phototherapy Light

You and your dependants each have a lifetime maximum of $300 towards the purchase of one phototherapy light.

Requirement(s): 

  • Must be required to treat seasonal affective disorder, and a physician's letter/prescription stating the diagnosis must be included with the claim submission

Exclusion(s):

  • Batteries
  • Repairs
  • Replacement bulbs

Physical Rehabilitation Equipment

You and your dependants each have a lifetime maximum of $300 towards the purchase or rental of physical rehabilitation equipment.

Exclusion(s): 

  • Repairs

Physiotherapy

Every calendar year (January to December), you and your dependants can each use up to $700 for physiotherapy services. Physiotherapy treatments will be covered up to $50 a day per person.

You can track your expenses by viewing the Benefit & Claim Maximums page under the Coverage tab on My ASEBP or on the My ASEBP Mobile App.

Requirement(s): 

  • Must be provided by a physiotherapist registered in the province of practice

Exclusion(s):

  • No more than one treatment per day (per person)
  • Combined acupuncture, chiropractic, massage and physiotherapy expenses cannot exceed more than $1,600 per calendar year (per person)

Podiatry

Every calendar year (January to December), you and your dependants each have a maximum of $700 for podiatric services including X-rays related to treatment. Podiatry treatments will be covered up to $50 a day per person.

Requirement(s):

  • Must be provided by a doctor or other licensed health care provider

Exclusion(s):

  • No more than one treatment per day (per person)
  • Facility fees

Prosthetics

Breast Prostheses

Every calendar year (January to December), you and your dependants each have a maximum of $400 per breast towards the purchase of breast prostheses.

Exclusion(s):

  • Repairs
  • Bras

Eye Prostheses

Based on a rolling three-year period, you and your dependants each have a maximum of $500 towards the purchase and/or repair of an eye prostheses.

Larynx Prostheses

Based on a rolling three-year period, you and your dependants each have a maximum of $2,000 towards the purchase and/or repair of a larynx prostheses.

Limb Prostheses

Based on a rolling three-year period, you and your dependants each have a combined maximum of $15,000 per limb towards the purchase, repair and/or replacement of prosthetic limbs, myoelectric limbs and stockings.

Exclusion(s): 

  • No more than one replacement per limb every three years based on the date of service (the date you received the product being claimed—not the date it was paid for) not the calendar year

Psychology

Every calendar year (January to December), you and your dependants each have a maximum of $1,200 for psychology services including telephone and video call sessions. Psychology sessions will be covered up to $100 for the first hour and a maximum of $50 for each additional half hour.

For sessions less than one hour, the coverage will be prorated based on the length of the session. Group/family counselling is covered and prorated based on both the length of the session and the number of patients attending.

Requirement(s):

  • Must be for the diagnosis and treatment of mental, nervous or emotional disorders
  • Must be provided by a chartered psychologist, a provisional psychologist who is under the supervision of a chartered psychologist or a person holding a Master of Social Work degree 
  • Receipts for claim submissions must include:
  • the provider's name, address and credentials,
  • the length of each session,
  • the amount being charged for each session, and
  • each patient's name if more than one person is attending a session.

Exclusion(s):

  • No more than one session per day (per person)
  • Psycho-educational assessment and/or testing
  • Services provided by counsellors

Respiratory Equipment

Based on a rolling five-year period, you and your dependants each have a combined maximum of $2,500 toward the purchase, repair and/or rental of respiratory equipment (e.g. nebulizers, sleep apnea dental appliances, peak flow meters and continuous positive airway pressure (CPAP) machines, etc.).

You can track your expenses by viewing the Benefit & Claim Maximums page under the Coverage tab on My ASEBP or on the My ASEBP Mobile App.

Requirement(s): 

  • Sleep apnea dental appliances must be purchased—not repaired or rented

Exclusion(s):

  • Batteries
  • Sleep studies, testing and dental examination fees

Sclerotherapy

For sclerotherapy details, please see Drugs.

Ultraviolet Light

You and your dependants each have a lifetime maximum of $300 towards the purchase of one ultraviolet light.

Requirement(s): 

  • Must be required to treat psoriasis, and a physician's letter/prescription stating the diagnosis must be included with the claim submission

Exclusion(s):

  • Batteries
  • Repairs
  • Replacement bulbs

Wheelchairs or Scooters

Based on a rolling four-year period, you and your dependants each have a combined maximum of $4,000 toward the purchase, repair, replacement and/or rental of wheelchairs or scooters.

Requirement(s):

  • Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)

Exclusion(s):

  • Batteries
  • Knee scooters/walkers

What's not covered?

Only expenses specifically listed as covered may be reimbursed and are subject to any limitations, maximums or exclusions as indicated. Here are a number of items not covered under the plan. Note that this list is not exhaustive. 

  • Magnetic Resonance Imaging (MRI)
  • Check-ups (including screening, routine physical examinations and research studies) not necessary for treatment
  • X-rays (unless related to chiropractic or podiatry treatments)
  • Speech therapy
  • Hearing tests
  • Splints
  • Surgical implants (e.g. breast, testicular, cochlear)
  • Medical services and supplies (including hospital confinement) provided in association with cosmetic surgery or procedures
  • Expenses that are not considered medically necessary for the care of the patient’s injury or illness
  • Treatment that is experimental, educational or for the purpose of research
  • Extra billing charges by your doctor or other licensed health care provider (e.g. missed appointment fees, fees to complete medical forms, late fees, etc.)
  • Additional costs for medical supplies purchased from providers inside and outside Canada (e.g. shipping, duty)—unless related to oxygen and supplies required for its use
  • Treatment and/or supplies provided free of charge
  • Services or supplies that should be free-of-charge under legislation (e.g. charges made by doctors which are in excess of fees allowed by Health Canada)
  • Expenses covered through a government program, whether or not you or your dependants choose to participate in the program
  • Expenses acquired because of active participation in a war or act of war (declared or not)
  • Expenses incurred while on active duty in any military or peacekeeping force
  • Services that are self-performed or supplies that are self-prescribed by a covered member or dependant that is a health care provider (e.g. a doctor writes him/herself a prescription)
  • Dental services other than those described under the Accidental Dental benefit
  • All expenses incurred as a result of conduct that would constitute an indictable offence within Canada

Additional Information

Best Practices for Ambulance Claims

In order to direct-bill ASEBP for ambulance services you must provide AHS with your ASEBP ID number during pick-up and transport. If you’ve provided AHS with your ID number and receive an invoice from AHS, please contact them to bill ASEBP directly instead.

If you do not provide your ID number during pick-up and transport and pay AHS for the service directly, you must request a refund from AHS and have them bill ASEBP directly using your ID number in order to be reimbursed. If you do not request a refund and you submit the claim to ASEBP for reimbursement, ASEBP will only reimburse at the rates negotiated between ASEBP and AHS.

Prorated

Benefit coverage that is prorated refers to a maximum being divided proportionally.

Example 1:

Psychology sessions are covered up to $100 per hour (for the first hour) and are prorated for sessions under one hour. Examples of shorter sessions are included below:

  • A 30-minute session will be paid out at a total of $50.
  • A 45-minute session will be paid out at a total of $75.
  • A 50-minute session will be paid out at a total of $83.33.

 

Example 2:

Group/family counselling is prorated based on both the length of the session and the number of patients attending. Please note that covered members and their dependants are not charged for other individuals in attendance. Examples of prorated group sessions are included below:

  • One person with ASEBP benefits attends a one-hour session with someone without ASEBP benefits. The person with ASEBP benefits will be subject to a maximum coverage of $50 (i.e. 50 per cent of $100) for this one-hour session. 
  • Two people with ASEBP benefits attend a one-hour session. Both people will be subject to a maximum coverage of $50 each (i.e. 50 per cent of $100) for this one-hour session.
  • One person with ASEBP benefits attends a one-hour session with two people without ASEBP benefits. The person with ASEBP benefits will be subject to a maximum coverage of $33.33 (i.e. 33.33 per cent of $100) for this one-hour session.

Rolling Period

Your plan maximum is based on a rolling-year period (e.g. two years for a rolling two-year period, three years for a rolling three-year period, etc.) by service date (the date you received the treatment, service or product being claimed—not the date it was paid for)—not calendar year.

Example:

  • If you make a respiratory claim (which has a rolling five-year period) for $100 on May 15, 2015, that $100 will be added back to your respiratory coverage balance on May 15, 2020.

You can track your expenses by viewing the Benefit & Claim Maximums page under the Coverage tab on My ASEBP or on the My ASEBP Mobile App.

NOTE: This information is only current as of Sep 15, 2017. Please visit asebp.ca for the most up-to-date information.

Benefit Inquiries

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