27 False
statements
28 Information
for claim
Part 2
Optional Health Services
29 Definitions
30 Regulations
31 Exemption
32 Regulations
Part 3
General
33 Regulations
34,35 Retrospectivity
of regulations
36 Payments
out of General Revenue Fund
37 Benefits
review committees
38 Forms
39 Examination
of practitioners’ records
40 Special
agreements
41 Blue
Cross agreement
42 General
penalty
43 Financial
assistance
44 Residence
requirements
HER MAJESTY, by and with
the advice and consent of the Legislative Assembly of Alberta, enacts as
follows:
Definitions
1 In this Act,
(a) “ABC
Benefits Corporation” means the ABC Benefits Corporation continued under the ABC Benefits Corporation Act;
(b) “basic
health services” means
(i) insured services,
(ii) those services that are provided by a dentist in the field of
oral and maxillofacial surgery and are specified in the regulations but are not
within the definition of insured services,
(iii) optometric services,
(iv) chiropractic services,
(v) services and appliances provided by a podiatrist,
(vi) services classified as basic health services by the regulations;
(c) “benefits”
means the amounts payable by the Minister in respect of the cost of health
services provided to residents;
(d) “Blue
Cross agreement” means an agreement made between the Minister and the ABC
Benefits Corporation pursuant to section 41;
(e) “chiropractic
services” means those services provided by a chiropractor that are specified in
the regulations as chiropractic services for the purposes of the Plan;
(f) “chiropractor”
means,
(i) with reference to services provided in Alberta, a registered
member, registered practitioner or professional corporation under the Chiropractic Profession Act, and
(ii) with reference to services provided in a place outside Alberta, a
person lawfully entitled to practise chiropractic in that place;
(g) “College”
means the College of Physicians and Surgeons of the Province of Alberta;
(h) repealed
RSA 2000 cH‑7 s144;
(i) “dentist”
means,
(i) with reference to goods and services provided in Alberta, a
regulated member of the Alberta Dental Association and College under the Health Professions Act who holds a
practice permit respecting the practice of dentistry, and
(ii) with reference to goods and services provided in a place outside
Alberta, a person lawfully entitled to practise dentistry in that place;
(i.1) “denturist”
means,
(i) with reference to goods and services provided in Alberta, a
person who is a regulated member of the College of Alberta Denturists under the
Health Professions Act who holds a
practice permit respecting the practice of denture construction, and
(ii) with reference to goods and services provided in a place outside
Alberta, a person lawfully entitled to practise denture construction in that
place;
(j) “dependant”
means a dependant as defined in the regulations;
(k) “extended
health services” means those goods and services or classes of goods and
services that are specified in the regulations and provided to a resident or
the resident’s dependants under section 3(2);
(l) “federal
Act” means the Canada Health Act
(Canada);
(m) “health
services” means basic health services, optional health services and extended
health services;
(n) “insured
services” means
(i) all services provided by physicians that are medically required,
(ii) those services that are provided by a dentist in the field of
oral and maxillofacial surgery and are specified in the regulations, and
(iii) any other services that are declared to be insured services
pursuant to section 2,
but does not include any
services that a person is eligible for and entitled to under any Act of the
Parliament of Canada or under the Workers’
Compensation Act or any law of any jurisdiction outside Alberta relating to
workers’ compensation;
(o) “Minister”
means the Minister determined under section 16 of the Government
Organization Act as the Minister responsible for this Act;
(p) “optician”
means
(i) with reference to goods and services provided in Alberta, a
person who is a member of the Alberta Opticians Association and holds a
certificate of registration in the eye glasses dispensing register or a
certificate of registration in the contact lens dispensing register under the Opticians Act, and
(ii) with reference to goods and services provided in a place outside
Alberta, a person lawfully entitled to practise opticianry in that place;
(q) “optional
health services” means those goods and services or classes of goods and
services that are specified in the regulations as optional health services;
(r) “optometric
services” means those services provided by an optometrist that are specified in
the regulations as optometric services for the purposes of the Plan;
(s) “optometrist”
means,
(i) with reference to goods and services provided in Alberta, a
person who is a regulated member of the optometry profession under the Health Professions Act or a
professional corporation registered with the Alberta College of Optometrists
under the Health Professions Act, and
(ii) with reference to goods and services provided in a place outside
Alberta, a person lawfully entitled to practise optometry in that place;
(t) “physician”
means
(i) with reference to medical services provided in Alberta, a person
registered as a medical practitioner or as an osteopathic practitioner under
the Medical Profession Act, and
(ii) with reference to medical services provided in a place outside
Alberta, a person lawfully entitled to practise medicine or osteopathy in that
place;
(u) “Plan”
means the Plan referred to in section 3;
(v) “podiatrist”
means,
(i) with reference to services or appliances provided in Alberta, a
person registered as a member of the Alberta Podiatry Association and lawfully
entitled to practise in Alberta, and
(ii) with reference to services or appliances provided in a place
outside Alberta, a person lawfully entitled to practise podiatry in that place;
(w) “practitioner”
means a chiropractor, denturist, dentist, optician, optometrist, physician or
podiatrist or other person who provides a basic health service or an extended
health service;
(x) “resident”
or “resident of Alberta” means a person lawfully entitled to be or to remain in
Canada, who makes the person’s home and is ordinarily present in Alberta and
any other person deemed by the regulations to be a resident, but does not
include a tourist, transient or visitor to Alberta;
(y) “widow’s pension” means a widow’s pension
under the Widows’ Pension Act.
RSA 2000 cA‑20
s1;RSA 2000 cH‑7 ss144,145,149;
2001 c10 s1;2001 c21 s28;2005 c13 s1
Insured services
2 The Lieutenant Governor in Council may by
regulation declare any basic health services referred to in section 1(b)(ii),
(iii), (iv), (v) or (vi) to be insured services for the purposes of the Plan.
RSA 1980 cA‑24 s2
Part 1
Health Care Insurance
Operation of Plan
3(1) The Minister shall, in accordance with this Act
and the regulations, administer and operate on a non‑profit basis a plan
to provide benefits for basic health services to all residents of Alberta.
(2) The
Minister shall, in accordance with the regulations, provide extended health
services to a resident and the resident’s dependants if
(a) the
resident or the resident’s spouse or adult interdependent partner is 65 years
of age or older, or
(b) the
resident is receiving a widow’s pension.
(3) The Minister is the public authority
responsible for the administration and operation of the Alberta Health Care
Insurance Plan.
RSA 2000 cA‑20
s3;2002 cA‑4.5 s16
Coverage under Plan
4(1) Subject to this Act and the regulations, the
Minister shall pay benefits in respect of health services provided to
residents.
(2) All
claims for benefits are subject to assessment and approval by the Minister and
the amount of the benefits to be paid and the person to whom the benefits are
to be paid shall be determined in accordance with the regulations.
(3) A
resident is not entitled to the payment of benefits in respect of health
services provided to the resident if the resident is
(a) a
member of the Canadian Forces,
(b) a
member of the Royal Canadian Mounted Police who is appointed to a rank in it,
(c) a
person serving a term of imprisonment in a penitentiary as defined in the Corrections and Conditional Release Act
(Canada), or
(d) a
resident who has not completed the waiting period prescribed by the
regulations.
(4) The
Minister may withhold payment of benefits for health services until the
Minister is satisfied that the person was a resident at the time the services
were provided.
(5) For the purposes of subsection (4), a certificate
of registration under the Health
Insurance Premiums Act is proof, in the absence of evidence to the
contrary, that the person is a resident if the certificate was in effect at the
time the service was provided to that person.
RSA 1980 cA‑24
s4;1984 c26 s1;1994 c23 s49
Change in residence
5(1) Subject to the regulations, a person who ceases
to be a resident of Alberta and becomes a resident of any other place remains
entitled to benefits for health services provided to that person during the
period prescribed in the regulations.
(2) A resident does not cease to be entitled to
benefits by reason of being temporarily absent from Alberta.
RSA 1980 cA‑24
s5;1983 c32 s1;1984 c26 s1
Payment of benefits
6(1) No physician or dentist may receive the payment
of benefits from the Minister for insured services provided in Alberta to a
resident unless the physician or dentist was opted into the Plan when the
insured services were provided.
(2) No
resident may receive the payment of benefits from the Minister for insured
services provided in Alberta to the resident by a physician or dentist unless
the physician or dentist who provided the insured services was opted into the
Plan when the insured services were provided.
(3) Notwithstanding subsections (1) and (2), the
Minister may pay benefits for insured services provided in Alberta to a
resident by a physician or dentist who was opted out of the Plan if the insured
services were provided in an emergency.
1994 c2 s3;1998 c31
s2;1999 c32 s2
Opting in and out by dentists
7(1) Subject to this section, every dentist is
deemed to have opted into the Plan.
(2) A
dentist may opt out of the Plan by
(a) notifying
the Minister in writing indicating the effective date of the opting out,
(b) publishing
a notice of the proposed opting out in a newspaper having general circulation
in the area in which the dentist practises, and
(c) posting
a notice of the proposed opting out in a part of the dentist’s office to which
patients have access
at least 30 days prior
to the effective date of the opting out.
(3) A
dentist who has not previously practised in Alberta may opt out of the Plan
prior to commencing practice by
(a) notifying
the Minister in writing indicating the date on which the dentist will commence
opted‑out practice, and
(b) publishing
a notice of the proposed opting out in a newspaper having general circulation
in the area in which the dentist intends to practise.
(4) A
dentist who has opted out of the Plan shall
(a) post
a notice in a part of the dentist’s office to which patients have access
advising patients of the dentist’s opted‑out status, and
(b) ensure
that each patient is advised in person of the dentist’s opted‑out status
before any service is provided to the patient.
(5) A dentist who has opted out of the Plan may opt
into the Plan by notifying the Minister in writing at least 30 days prior to
the effective date of the opting in.
1986 c3 s2;1994 c2
s4;1998 c31 s2;1999 c32 s2
Opting in and out by
physicians
8(1) Subject to this section, every physician is
deemed to have opted into the Plan.
(2) A
physician may opt out of the Plan by
(a) notifying
the Minister in writing indicating the effective date of the opting out,
(b) publishing
a notice of the proposed opting out in a newspaper having general circulation
in the area in which the physician practises, and
(c) posting
a notice of the proposed opting out in a part of the physician’s office to
which patients have access
at least 180 days
prior to the effective date of the opting out.
(3) A
physician who has not previously practised in Alberta may opt out of the Plan
prior to commencing practice by
(a) notifying
the Minister in writing indicating the date on which the physician will
commence opted‑out practice, and
(b) publishing
a notice of the proposed opting out in a newspaper having general circulation
in the area in which the physician intends to practise.
(4) A
physician who has opted out of the Plan shall
(a) post
a notice in a part of the physician’s office to which patients have access advising
patients of the physician’s opted‑out status, and
(b) ensure
that each patient is advised in person of the physician’s opted‑out
status before any service is provided to the patient.
(5) A
physician who has been opted out of the Plan for a continuous period of at
least one year may opt into the Plan by notifying the Minister in writing at
least 30 days prior to the effective date of the opting in.
(6) A
physician who has been opted out of the Plan for a continuous period of less
than one year may apply to the Minister to opt into the Plan.
(7) An
application under subsection (6) must be in a form acceptable to and contain
the information required by the Minister.
(8) In making a decision on an application under
subsection (6), the Minister shall take into consideration the factors, if any,
that are set out in the regulations.
1998 c31 s2
Extra billing
9(1) No physician or dentist who is opted into the
Plan who provides insured services to a person shall charge or collect from any
person an amount in addition to the benefits payable by the Minister for those
insured services.
(2) If
a physician or dentist contravenes subsection (1), the Minister may,
(a) in
the case of a first or subsequent contravention, send a written warning to the
physician or dentist,
(b) in
the case of a 2nd or subsequent contravention, refer the contravention to the
College or the Alberta Dental Association and College, as the case may be, and
(c) in
the case of a 3rd or subsequent contravention, order that, after a date specified
in the order, the physician or dentist is deemed to have opted out of the Plan
for the period specified in the order.
(3) An order under subsection (2)(c) shall, prior
to the effective date of the order, be served personally or by registered mail
on the physician or dentist affected by the order.
RSA 2000 cA‑20
s9;RSA 2000 cH‑7 s145;2005 c13 s1
Emergency services
10 If a physician or dentist who is opted
out of the Plan provides insured services in Alberta in an emergency to a
resident in respect of whom benefits may be paid and the physician, dentist or
resident is paid benefits with respect to those insured services, the physician
or dentist shall not charge or collect from any person an amount in addition to
those benefits.
1994 c2 s5;1998 c31
s4;1999 c32 s2
Other prohibited fees
11(1) No person shall charge or collect from any
person
(a) an
amount for any goods or services that are provided as a condition to receiving
an insured service provided by a physician or dentist who is opted into the
Plan, or
(b) an
amount the payment of which is a condition to receiving an insured service
provided by a physician or dentist who is opted into the Plan
where the amount is in
addition to the benefits payable by the Minister for the insured service.
(2) Subsection
(1) does not prohibit the charging or collecting of an amount paid for non‑insured
health or pharmaceutical goods or services where the charging or collecting of
that amount is not otherwise prohibited under this Act or the Hospitals Act and a physician or dentist
reasonably determines that it is necessary to provide the non‑insured
health or pharmaceutical goods or services before the insured service is
provided.
(3) If
a person receives an amount in contravention of subsection (1), the Minister
may recover that amount in a civil action in debt as though that amount were a
debt owing from the person to the Crown in right of Alberta.
(4) Where the Minister recovers any amount under
subsection (3), the Minister shall reimburse the person who was charged the
amount.
1998 c31 s5;1999 c32 s2
Prohibition on receiving
benefits
12(1) A physician or dentist who is opted into the
Plan and provides insured services to a person in circumstances where the
physician or dentist knows or ought reasonably to know that the person is being
charged an amount in contravention of section 11 shall not receive the payment
of benefits from the Minister for those insured services.
(2) Section 9(2) applies where a physician or
dentist contravenes subsection (1).
1998 c31 s5;1999 c32 s2
Minister’s right to recover amounts
13(1) If a physician or dentist
(a) in
contravention of section 9 or 10, receives an amount in addition to the
benefits payable by the Minister, or
(b) receives
the payment of benefits in contravention of section 12,
the Minister may act
under subsection (2).
(2) If
subsection (1) applies, the Minister may recover the additional amount and the
benefits in a case referred to in subsection (1)(a), or the benefits in a case
referred to in subsection (1)(b), by one or more of the following means:
(a) by
withholding those amounts from any benefits payable to the physician or
dentist;
(b) by
civil action as though those amounts were a debt owing to the Crown in right of
Alberta;
(c) pursuant
to any agreement between the Minister and the physician or dentist that
provides for the repayment of those amounts.
(3) The Minister shall reimburse a person in
respect of whom benefits may be paid for any amounts recovered under this
section that were paid by the person and
have not been previously reimbursed.
1994 c2 s5;1998 c31
s6;1999 c32 s2
Offence
14 A person who contravenes section 9, 10,
11 or 12 is guilty of an offence and liable to a fine of not more than
(a) $10 000
for the first offence, and
(b) $20 000 for the 2nd and each subsequent
offence.
1998 c31 s7;2000 cH‑3.3
s31
Duty to advise
15(1) Prior to providing insured services in Alberta
to a resident in respect of whom benefits may be paid, a physician or
dentist who is opted out of the Plan
shall advise the resident of that fact and that the resident is not entitled to
be reimbursed from the Plan for the cost of any insured services provided by
the physician or dentist.
(2) This section does not apply when the insured
services are provided in an emergency.
1994 c2 s5;1998 c31
s8;1999 c32 s2
Regulations
16 The Lieutenant Governor in Council may make
regulations
(a) authorizing
or requiring the doing of any act or thing by the Minister, or any other
person, for the purpose of having the Plan meet the criteria prescribed under
the federal Act or to enable the Government of Alberta to receive payment of
contributions by the Government of Canada under the federal Act;
(b) deeming
persons to be residents for the purposes of this Act;
(c) prescribing
classes of goods and services as basic health services or extended health
services;
(d) providing,
in respect of benefits for any or all health services provided outside Alberta
or any specified place outside Alberta, that the benefits may be paid only for
services provided during a specified period of time or that the Minister is
empowered in a particular case to prescribe the period in respect of which
benefits may be paid;
(e) prescribing
the waiting period for a person who is or becomes a resident of Alberta and in
respect of which the costs of any health services provided during that period
to that person are not payable as benefits;
(f) subject
to section 4(2), providing for procedures for the review of any decision or the
settlement of any question pertaining to the determination of
(i) the amount of benefits payable for a particular service,
(ii) whether any service is a health service or not,
(iii) whether any service provided by a physician is medically required
or not, or
(iv) any other matter that affects the entitlement to benefits;
(g) providing,
for the purpose of removing doubt, that
(i) any service is or is not a basic health service, extended health
service or insured service, or
(ii) any particular service that may be provided by a physician is or
is not medically required;
(h) prescribing
the duration of periods for the purposes of section 5(1) and any conditions on
which a person continues to be entitled to benefits by virtue of that
subsection;
(i) providing
the circumstances under which a person is or is not to be considered as
temporarily absent from Alberta for the purposes of section 5(2);
(j) governing
notifications under section 7 or 8;
(k) respecting
the factors to be taken into consideration by the Minister in dealing with
applications under section 8(6);
(l) requiring
practitioners to file with the Minister the kinds of information that the
regulations prescribe for the purpose of facilitating the handling, assessing
and payment of claims for benefits;
(m) prescribing
the times by which or the circumstances under which practitioners are required
to file information pursuant to the regulations under clause (l);
(n) authorizing
the Minister to withhold the payment of benefits to any practitioner until the
practitioner has complied with the regulations under clauses (l) and (m);
(o) prohibiting
a practitioner who submits a claim to the Minister for a benefit on behalf of a
resident from submitting an account to the resident or to a Government
department or agency with respect to the same health services, except when the
account is for an amount in addition to the benefit and is payable under an
agreement or arrangement referred to in section 21(1)(b);
(p) providing,
without limiting the meaning of “residents’ or practitioners’ registration
information” in section 22, that certain information relating to the
registration or enrolment of residents or practitioners obtained under this Act
or the Health Insurance Premiums Act
is included in the meaning of “residents’ or practitioners’ registration
information” in section 22;
(q) designating a person or entity with which
the Minister may enter into an agreement under section 22(15)(b).
RSA 1980 cA‑24
s6;1983 c32 s1;1984 c26 s1;1986 c3 s3;
1994 c2 s6;1994 c34 s3;1998 c31 s10
Regulations
17 The Minister may make regulations
(a) respecting
the rates of benefits in respect of basic health services or extended health
services;
(b) respecting
the manner in which benefits are to be paid and the persons to whom benefits
are to be paid, the conditions of payment and the information required to be
submitted in connection with claims for benefits;
(c) specifying, within the classes prescribed by
the Lieutenant Governor in Council, the goods and services that are basic
health services or extended health services for the purpose of the Plan.
RSA 1980 cA‑24
s7;1984 c26 s1;1992 c21 s1
Reassessment of claims
18(1) The Minister may, with respect to any claim for
benefits that has been assessed under section 4(2), reassess the claim if the
payment or rejection of the claim was made in error or as a result of erroneous
or false information provided by the resident or practitioner concerned or by
any other person acting on behalf of the resident or practitioner concerned.
(2) The
Minister may, with respect to any claim for benefits, reassess the claim when,
in the opinion of the Minister,
(a) the
claim relates to a health service of a kind that the practitioner concerned has
provided to the practitioner’s patients with a frequency that, in the
circumstances, is unjustifiable,
(b) the
total amount of benefits paid for the service was, in the circumstances,
greater compensation to the practitioner for that service than it should have
been,
(c) the
service provided was, in the circumstances, inappropriate or unnecessary,
(d) the
service provided could have been replaced by another professionally acceptable
service for which a lower rate of benefits was payable, or
(e) in
the case of a service provided by a physician, the service was not medically
required.
(3) In
reassessing claims pursuant to subsection (2), the Minister shall have regard
to all the circumstances that, without limitation, shall include
(a) normal
patterns of practice in Alberta of practitioners of the same profession who carry
on similar types of practice in similar circumstances;
(b) accepted
standards of practice in Alberta of the profession of the practitioner
concerned;
(c) in
cases referred to in subsection (2)(b), the amount that would have been
reasonable compensation for the service provided, in view of the time and
degree of skill involved in providing the service.
(4) In
reassessing claims pursuant to subsection (2), the Minister may have regard to
any report or recommendations of:
(a) the
board of directors of the Alberta Medical Association (C.M.A.‑Alberta
Division), when the practitioner concerned is a physician;
(b) the
board of directors of the Alberta Dental Association and College, when the
practitioner concerned is a dentist;
(c) the
council of the Alberta College of Optometrists;
(d) the
Council of The College of Chiropractors of Alberta, when the practitioner
concerned is a chiropractor;
(e) the
Council of Management of the Alberta Podiatry Association, when the
practitioner concerned is a podiatrist;
(f) the
council of the College of Alberta Denturists, when the practitioner concerned
is a denturist;
(g) the
council of the Alberta Opticians Association, when the practitioner concerned
is an optician;
(h) any
committee that
(i) is appointed by the board of directors or council of an
organization referred to in clauses (a) to (g),
(ii) consists of persons who are members of that organization and who
are members of the same profession as the practitioner concerned, and
(iii) is recognized by the Minister as a committee for the purposes of
this section.
(5) When
the Minister reassesses claims pursuant to subsection (1) or (2), the Minister
may make any appropriate adjustment in the amounts paid with respect to the
claim and
(a) if
the amounts paid were in excess of the benefits payable under the adjustment,
recover the excess from the resident or the practitioner, as the case may be,
(i) by withholding from any benefits payable to the resident or the
practitioner, as the case may be, an amount equivalent to the excess,
(ii) by civil action as though the excess were a debt owing to the
Crown in right of Alberta, or
(iii) pursuant to an agreement between the Minister and the resident or
practitioner concerned providing for the payment of the excess;
(b) if
the amounts paid were less than the benefits payable under the adjustment, pay
to the resident or the practitioner to whom the benefits were paid, as the case
may be, the amount of the deficiency.
(6) The
Minister may, with respect to any excess or deficiency referred to in
subsection (5), charge or pay simple interest at a rate the Minister determines
but not exceeding 8% per year.
(7) The
Minister may withhold benefits payable to a practitioner or a resident until
the completion of a reassessment under subsection (1) or (2) of claims relating
to services provided by that practitioner.
(8) The Minister shall notify the resident or
practitioner concerned by mail of any reassessment under this section and the
person so notified may appeal the reassessment to the Court of Queen’s Bench by
way of originating notice if the motion is returnable within 60 days after the
date on which that person was notified.
RSA 2000 cA‑20
s18;RSA 2000 cH‑7 ss144,145,149;
2005 c13 s1
Order reducing future
benefits
19(1) If a practitioner becomes liable under section
18(5) by reason of one or more reassessments of claims pursuant to subsection
(2) of that section, the Minister may, with or without the consent of the
practitioner, make an order directing that, after a date specified in the order
and with respect to any specified kind of health service provided by that
practitioner, the Minister will pay no benefits or only a portion of the
benefits otherwise payable.
(2) An
order under subsection (1)
(a) may
be for a stated period or of indefinite duration;
(b) shall
specify the health services to which it relates;
(c) shall
specify, as to any service referred to in clause (b), whether no benefits are
to be paid by the Minister in respect of it, or the portion of the benefits
that are to be paid.
(3) A
copy of an order under this section shall be served on the practitioner against
whom it is made, and except in the case where it was made with the
practitioner’s consent, the practitioner may, within 30 days after the date on
which the practitioner received the copy of the order, apply to the Court of
Queen’s Bench by originating notice, to have the order rescinded or varied.
(4) After
the hearing of the application, the Court may direct the Minister
(a) to
rescind the Minister’s order, if it considers the Minister had no reasonable
justification for making it, or
(b) to
vary the Minister’s order in the manner specified by the Court.
(5) When an order of the Minister under this
section is of indefinite duration, the Minister shall review the order at least
annually.
RSA 1980 cA‑24 s9
Remuneration of
practitioners
20 The Minister may enter into agreements or
arrangements for the payment of benefits on a basis other than a fee for
service basis.
RSA 1980 cA‑24 s11
Relationship between
practitioner and patient
21(1) Nothing in this Act or the regulations
(a) interferes
with the right of any person to the person’s own choice of practitioner,
(b) except
sections 9 and 10, interferes with the right of any practitioner to make an
agreement or arrangement with any person to collect from that person an amount
in addition to the benefits payable by the Minister with respect to goods or
services provided by the practitioner, if the agreement or arrangement is made
before the goods or services are provided,
(c) except
sections 9 and 10, affects the right of any resident to receive any health
services or benefits in respect of them by reason of the resident’s choice of
practitioner, or
(d) interferes
with the right of a practitioner to accept or refuse to accept a patient who is
a resident, subject to humanitarian considerations and the traditions and
ethics of the profession of which the practitioner is a member.
(2) Nothing in this Act or the regulations is to be
construed to prevent any resident who does not desire to claim or receive
benefits for health services provided to the resident or resident’s dependants
from assuming the responsibility for the payment of those costs.
RSA 1980 cA‑24
s12;1984 c26 s1;1986 c3 s5;1994 c2 s7
Disclosing health
information
22(1) Except as permitted or required under this Act,
the Minister or a person employed in the administration of this Act and
authorized by the Minister may disclose health information acquired under this
Act or the Health Insurance Premiums Act
only in accordance with the Health
Information Act.
(1.1) If there is an inconsistency or
conflict between subsection (6.1) or (7) and the Health Information Act, subsection (6.1) or (7), as the case may
be, prevails.
(2) The
Minister or any person authorized by the Minister may, for the purpose of
enforcing the Crown’s right of recovery under Part 5 of the Hospitals Act, disclose information
acquired under this Act.
(3) The
Minister or a person employed in the administration of this Act and authorized
by the Minister may disclose information pertaining to the date on which health
services were provided, a description of those services, any diagnosis given by
a person who provided the services, the name and address of the person who
provided the services, the benefits paid for those services and the person to
whom they were paid, the name and address of the person to whom the services
were provided and any other information pertaining to the nature of the health
services provided to any committee established to advise the Minister in
respect of matters under section 18.
(4) The
Minister or a person employed in the administration of this Act and authorized
by the Minister may, in connection with the administration of the Criminal Code (Canada), disclose to the
Minister of Justice and Attorney General, or a person designated by the
Minister of Justice and Attorney General, information pertaining to the date on
which health services were provided, a description of those services, any
diagnosis given by a person who provided the services, the name and address of
the person who provided the services, the benefits paid for those services and
the person to whom they were paid, the name and address of the person to whom
the services were provided and any other information coming to the knowledge of
any person employed in the administration of this Act in the course of that
person’s employment.
(5) The
Minister or a person employed in the administration of this Act and authorized
by the Minister may disclose information pertaining to the date on which health
services were provided and a description of those services, the name and
address of the person who provided the services, the benefits paid for those
services and the person to whom they were paid, the name and address of the
person to whom the services were provided and any other information pertaining
to the nature of the health services provided, to the Alberta Cancer Board, The
Workers’ Compensation Board, a director under the Child, Youth and Family
Enhancement Act, the Sexually
Transmitted Disease Control Unit of the Department of Health and Wellness, or
the Director of Medical Services appointed under the Occupational Health and Safety Act, if
(a) a
member or officers of the Board, a director under the Child, Youth and
Family Enhancement Act, or an
officer of the Unit, or the Director of Medical Services, as the case may be,
makes a written request for it, and
(b) the
information required is necessary and relevant to a matter being dealt with by
the Board, a director under the Child, Youth and Family Enhancement Act, an officer of the Unit or the
Director of Medical Services.
(6) Notwithstanding
subsection (5), the Minister or a person employed in the administration of this
Act and authorized by the Minister may disclose to the Director of Medical
Services for The Workers’ Compensation Board or the Director of Medical
Services appointed under the Occupational
Health and Safety Act any diagnosis given by a person who has provided health
services to another person if
(a) the
Director makes a written request for the diagnosis, and
(b) the
health services provided relate to or likely relate to the occupation or former
occupation of the person for whom the health services were provided or to a
disease that is related to that person’s occupation or former occupation.
(6.1) The
Minister or a person employed in the administration of this Act and authorized
by the Minister may disclose individually identifying health information, other
than a diagnosis given by a person who has provided health services, acquired
under this Act
(a) to
the individual who is the subject of the information,
(b) to
a person referred to in section 104(1)(c) to (i) of the Health Information Act who is acting on behalf of the individual
who is the subject of the information, or
(c) to
a person other than the individual who is the subject of the information if the
individual has consented to the disclosure in accordance with section 34 of the
Health Information Act.
(7) The
Minister or a person employed in the administration of this Act and authorized
by the Minister may disclose information pertaining to the date on which health
services were provided and a description of those services, the name and address
of the person who provided the services, the registration number of the person
who received the services, the benefits paid for those services and the person
to whom they were paid, but the information may be disclosed only
(a) in
connection with the administration of this Act, the regulations or the federal
Act,
(b) in
proceedings under this Act or the regulations,
(c) in
connection with the administration of the Financial
Administration Act or regulations, orders or directives under that Act,
(d) to
the person who provided that service, the person’s solicitor or personal
representative, the committee of the person’s estate, the person’s trustee in
bankruptcy or other legal representative,
(e) - (g) repealed
RSA 2000 cH‑5 s110,
(h) to
a board of directors, council or committee of an organization referred to in
section 18(4) for purposes in connection with that section,
(i) to
a medical examiner appointed under the Fatality
Inquiries Act for the purposes of an investigation under that Act,
(j) to
the Hospital Privileges Appeal Board established under the Hospitals Act for the purposes of an appeal to that Board, or
(k) to
the Health Disciplines Board, a health discipline association or a Committee
under the Health Disciplines Act, if
the information is furnished in compliance with a notice under section 38(1) of
the Health Disciplines Act, or
(l) to
a hearings director of a college under the Health
Professions Act, if the information is furnished in compliance with a
notice under section 73 or 74 of the Health
Professions Act.
(8) The
Minister or a person employed in the administration of this Act and authorized
by the Minister may disclose information, other than information related to
health services, about a person, but the information may only be disclosed in
connection with the administration of the Seniors
Benefit Act.
(9) Notwithstanding
subsection (7), the Minister or a person authorized by the Minister may
disclose residents’ or practitioners’ registration information obtained under
this Act or the Health Insurance Premiums
Act
(a) for
the purpose of the administration of this Act or the Health Insurance Premiums Act, the regulations under those Acts,
the federal Act or any program that receives funds directly or indirectly from
the Department of Health and Wellness, or
(b) in
proceedings under this Act, the Health
Insurance Premiums Act or the regulations under those Acts.
(10) to (14) Repealed RSA 2000 cH‑5 s110.
(15) The
Minister may enter into an agreement respecting the disclosure of practitioners’
registration information obtained under this Act or the Health Insurance Premiums Act with
(a) any
Minister or government, or
(b) a
person or entity designated in the regulations.
(16) The
Minister may, in accordance with an agreement made under subsection (15),
disclose practitioners’ registration information obtained under this Act or the
Health Insurance Premiums Act.
(17) A
government, person or entity that receives information under an agreement
referred to in subsection (15) shall use the information only for the purposes
specified in the agreement.
(18) With
the consent of the Minister or an employee of the Government authorized by the
Minister to do so, information of the kind referred to in subsection (5) and
any other information pertaining to the nature of the health services provided
and any diagnosis given by a person who provided the services may be disclosed
or communicated to a disciplinary body of the organization of which that person
is a member if an officer of that organization makes a written request for the
information and states that the information is required for the purposes of
investigating a complaint against one of its members or for use in disciplinary
proceedings involving that member.
(19) The
Minister may disclose to a disciplinary body of an organization any information
referred to in subsection (7) and any other information pertaining to health
services provided by a member of that organization if the Minister considers
that it is in the interests of the public and of the organization that the
information be so disclosed.
(20) In
subsections (18) and (19), “disciplinary body” means
(a) the
council of the College or a discipline committee under the Medical Profession Act,
(b) the
council or a hearing tribunal of the Alberta Dental Association and College,
(c) the
council or a hearing tribunal of the Alberta College of Optometrists,
(d) the
Council of The College of Chiropractors of Alberta or a discipline committee
under the Chiropractic Profession Act,
(e) the
Council of Management of the Alberta Podiatry Association,
(f) the
council or a hearing tribunal of the College of Alberta Denturists,
(g) the
council of the Alberta Opticians Association or the discipline committee of
that Association,
(h) the
Council of The College of Physical Therapists of Alberta or the Discipline
Committee under the Physical Therapy
Profession Act, or
(i) the
council or a hearing tribunal of the College and Association of Registered
Nurses of Alberta.
(21) The
Minister or a person authorized by the Minister may disclose information
obtained under the Blue Cross agreement to the Council or Investigating
Committee of the Alberta College of Pharmacists for the College’s use in
investigating a complaint against a member of the College or in disciplinary
proceedings involving that member if
(a) an
officer of the College makes a written request for the information, or
(b) the
Minister considers that it is in the interests of the public and of the College
that the information be so disclosed.
(22) A
person who contravenes this section is guilty of an offence.
(23) No
report, form or return prescribed by or required for the purposes of this Act
or the regulations shall be admitted in evidence in any judicial proceeding,
other than a judicial proceeding under this Act, to adversely affect the
interest of the person making the report, form or return.
(24) Notwithstanding subsection (23), the provincial
judge presiding at a public inquiry under the Fatality Inquiries Act may
admit in evidence information obtained by a medical examiner under subsection
(7)(i), but all proceedings related to that information shall be held in
private.
(25) In
this section,
(a) “health
information” means health information as defined in the Health Information Act;
(b) “individually
identifying”, when used to describe health information, means that the identity
of the individual who is the subject of the information can be readily
ascertained from the information.
RSA 2000 cA‑20
s22;RSA 2000 cH‑5 s110;
RSA 2000 cH‑7 ss144,145,147,149,155;AR 49/2002 s3;
2002 c30 s11;2003 c16 s117;2003 c39 s8;2005 c13 s1
Protection from action
23 If a practitioner or an agent or employee of a
practitioner discloses information to the Minister or to a person employed in
the administration of this Act, no action lies against the practitioner or the
agent or employee in respect of the disclosure of that information.
RSA 2000 cA‑20 s23;RSA 2000 cH‑5 s110
Assignment of benefits
24 Subject to the regulations, the right of any person
to receive payment of benefits is not assignable and no sum owing by the
Minister as benefits is liable to be charged or to be attached in any
proceedings or subject to an order for equitable execution against the person
entitled to receive payment of benefits.
RSA 1980 cA‑24 s15
Crown’s right of recovery
25 The Crown in right of Alberta is entitled to
recover the Crown’s cost of health services under Part 5 of the Hospitals Act.
RSA 1980 cA‑24
s16;1994 c37 s5
Prohibitions
26(1) In this section,
(a) “carrier”
means
(i) an insurer licensed under the Insurance
Act, or
(ii) the Provincial Health Authorities of Alberta;
(b) “insurer”
means
(i) a carrier, or
(ii) an employer, corporation or unincorporated group of persons that
administers a self‑insurance plan;
(c) “self‑insurance
plan” means a contract, plan or arrangement entered into, established,
maintained in force or renewed under which coverage is provided
(i) by an employer for all or some of the employer’s employees who
are residents of Alberta,
(ii) by a corporation for all or some of its members who are residents
of Alberta, or
(iii) by an unincorporated group of persons for all or some of its
members who are residents of Alberta.
(2) An
insurer shall not enter into, issue, maintain in force or renew a contract or
initiate or renew a self‑insurance plan under which any resident or group
of residents is provided with any prepaid basic health services or extended
health services or indemnification for all or part of the cost of any basic
health services or extended health services.
(3) An
insurer that contravenes subsection (2) is guilty of an offence.
(4) Notwithstanding
subsection (2), an insurer may enter into, issue, maintain in force or renew a
contract or initiate or renew a self‑insurance plan under which a
resident is indemnified
(a) for
the cost of any basic health service or extended health service provided
outside Alberta that is over and above the benefits payable by the Minister for
that service, or
(b) to
the extent prescribed by the regulations and in those cases specified in the
regulations, for the cost of any basic health services or extended health
services other than insured services over and above the benefits payable by the
Minister for those services.
(5) Subject
to the regulations, if
(a) a
carrier carries on a business of
(i) providing for the prepayment of the cost of health services other
than basic health services by way of group contracts and individual contracts,
or
(ii) selling insurance in respect of the cost of any health services
other than basic health services by way of group contracts and individual
contracts,
(b) the
carrier has entered into such a group contract with an employer in respect of
some or all of the employer’s employees who are residents of Alberta,
(c) an
employee who is a resident of Alberta and is covered by that group contract
retires from the employment of that employer in accordance with the employer’s
retirement plan or policy, and
(d) that
employee applies to the carrier, not later than 30 days after the date of the
employee’s retirement, for an individual contract that is then being offered by
the carrier to the public, and the employee pays the required initial premium
or subscription,
the carrier shall
issue the individual contract to that resident to provide coverage for that
resident and any of that resident’s dependants included in the application,
regardless of the age or state of health of the resident or any of the
resident’s dependants.
(6) A
carrier that contravenes subsection (5) is guilty of an offence.
(7) This section applies notwithstanding anything
in the Insurance Act or any other
Act.
RSA 1980 cA‑24
s17;1996 c6 s13
False statements
27(1) A person providing health services to a
resident who wilfully makes a false statement in any report, form or return
required to be submitted to the Minister to enable benefits to be paid to the
resident or to any other person is guilty of an offence and liable to a fine of
not less than $100 and not more than $1000.
(2) A person, other than a person providing health
services to a resident, who wilfully makes a false statement in any report,
form or return prescribed by or required for the purposes of this Act or the
regulations is guilty of an offence and liable to a fine of not less than $100
and not more than $1000.
RSA 1980 cA‑24 s18
Information for claim
28(1) A person who provides health services but does
not claim payment from the Minister of the benefits in respect of them shall
provide to any other person authorized by the regulations to make the claim all
information required for the purpose of making the claim and obtaining payment
from the Minister.
(2) When
a person provides information under subsection (1), the person shall do so in
the form prescribed by the Minister.
(3) A person who contravenes this section is guilty
of an offence.
RSA 1980 cA‑24 s19
Part 2
Optional Health Services
Definitions
29 In this Part,
(a) “optional
contract” means a contract issued by the Minister to a resident pursuant to the
regulations under this Part;
(b) “subscriber”
means a person who is the holder of an optional contract;
(c) “subscription”
means an amount payable to the Minister by a subscriber under an optional
contract;
(d) “subsidy” means the amount prescribed in the
regulations by which a subscription is reduced.
RSA 1980 cA‑24 s26
Regulations
30 The Lieutenant Governor in Council may make
regulations
(a) authorizing
the Minister to issue contracts to residents of Alberta providing insurance in
respect of the cost of optional health services provided to the subscribers
under it and their dependants;
(b) prescribing
the classes of goods and services that are optional health services for the
purposes of optional contracts;
(c) governing
applications for optional contracts and the requirements to be met by
applicants for those contracts;
(d) prescribing
any terms or conditions of optional contracts;
(e) fixing
subscription rates under optional contracts;
(f) authorizing
the Minister to grant subsidies prescribing the amounts of the basis for
calculating subsidies and prescribing the conditions as to eligibility of
persons for subsidies;
(g) authorizing
and empowering the Minister and a carrier as defined in section 26 to enter
into an agreement providing for
(i) the allocation of optional contracts by the Minister to the
carrier for the purposes of administration,
(ii) the fees to be paid to the carrier for its services,
(iii) the powers and duties of the carrier under the agreement in
respect of the administration of the contracts, and
(iv) any other matters incidental to the allocation of the contracts
or their administration;
(h) generally, providing for any other matter
considered necessary for the purpose of administration and operation of this
Part or to meet cases that may arise and for which no provision is made by this
Act.
RSA 1980 cA‑24 s27
Exemption
31(1) No subscription is payable under an optional
contract if the subscriber is receiving a widow’s pension.
(2) Subsection
(1) applies to an optional contract
(a) if
the subscriber is receiving the widow’s pension at the time the contract is
issued, or
(b) on
the date the subscriber is first paid a widow’s pension, if that date occurs
after the contract is issued.
(3) The
exemption from liability for the payment of subscriptions under subsection (1)
ceases at the end of the 2nd month following the month in which
(a) the
death of the subscriber who was receiving the widow’s pension occurs, or
(b) the
subscriber becomes ineligible for the widow’s pension,
whichever occurs first.
1983 cW‑7.5 s11
Regulations
32 The Minister may make regulations
(a) prescribing
the rates of benefits payable for optional health services under optional
contracts;
(b) specifying, within the classes prescribed by
the Lieutenant Governor in Council, the goods and services that are optional health services for the
purposes of optional contracts.
RSA 1980 cA‑24 s29
Part 3
General
Regulations
33 The Lieutenant Governor in Council may make
regulations
(a) defining
“dependant” for the purposes of the Plan, this Act and the regulations;
(b) providing
for the establishment of committees in connection with the Plan and prescribing
their powers and duties;
(c) prescribing
the remuneration and expenses to be paid to committees appointed under clause
(b);
(d) providing,
as to any provision of the regulations, that its contravention is an offence;
(e) respecting
and authorizing the types of recoverable payments that may be made under the
Plan;
(f) respecting
and authorizing the programs the costs of which may be paid under the Plan;
(g) generally, providing for any other matter
considered necessary for the purpose of administration and operation of this
Act or to meet cases that may arise and for which no provision is made by this
Act.
RSA 1980 cA‑24
s30;1983 c32 s1;1984 c26 s1;1985 c32 s1;
1994 c31 s1
Retrospectivity of
regulations
34 A regulation made under section 33(e) may be
effective as of any date not earlier than November 1, 1981 and may validate
recoverable payments referred to in the regulation that were made under the
Plan since that effective date.
1983 c32 s1;1994 c31 s1
Retrospectivity of
regulations
35 A regulation made under section 33(f) may be
effective as of any date not earlier than January 1, 1985 and may validate the
payment of the costs of the programs referred to in the regulation that were
made under the Plan since that effective date.
1985 c32 s1;1994 c31 s1
Payments out of General
Revenue Fund
36 The following may be paid out of the General
Revenue Fund:
(a) recoverable
payments pursuant to regulations under section 33(e);
(b) payments
required to be made by the Minister pursuant to an arrangement made pursuant to
section 88 of the Workers’ Compensation
Act;
(c) any payment required to be made under the
Plan pursuant to this or any other Act that is not paid under the authority of
a supply vote.
RSA 1980 cA‑24
s31;1983 c32 s1;1985 c32 s1;
1987 c29 s2;1994 c31 s1
Benefits review
committees
37(1) The Minister may establish one or more benefits
review committees.
(2) The
Minister may, with respect to a benefits review committee established under
subsection (1),
(a) appoint
or provide for the appointment of its members,
(b) prescribe
the term of office of any members,
(c) designate
a chair, vice‑chair and secretary, and
(d) authorize,
fix and provide for the payment of remuneration and expenses to its members.
(3) A
benefits review committee shall, when directed to do so by the Minister,
conduct a review of the rates of benefits payable in respect of
(a) basic
health services or any class of basic health services,
(b) extended
health services or any class of extended health services, or
(c) optional
health services or any class of optional health services,
whichever are
specified in the direction.
(4) If
a benefits review committee is directed to conduct a review under subsection
(3), the Minister may direct the committee to conduct the review in
consultation with representatives of an association of persons who provide the
services concerned.
(5) After conducting a review, a benefits review
committee shall make recommendations to the Minister with regard to the rates
of benefits it has reviewed.
RSA 1980 cA‑24 s32
Forms
38 The Minister may prescribe any forms to be used
under this Act or the regulations that the Minister considers necessary.
RSA 1980 cA‑24 s33
Examination of
practitioners’ records
39(1) A person employed in the administration of this
Act who is expressly authorized to do so by the Minister
(a) may,
with the consent of the practitioner or group of practitioners concerned,
examine and audit any books, accounts or records, other than patient records,
maintained by or on behalf of a practitioner or group of practitioners with
respect to claims for or payments of benefits relating to health services
provided by that practitioner or members of that group of practitioners, and
(b) in
the course of an examination and audit made with such consent, may take
extracts from or make copies of all or any part of those books, accounts and
records.
(2) If any practitioner does not give or refuses to
give a consent under subsection (1) after the Minister has requested that
consent, the Minister, after consultation with the council of the College or
the board of directors or council of the organization that represents the
practitioner’s profession, may withhold the payment of benefits to that
practitioner in respect of claims made by that practitioner on behalf of
residents until the consent is given.
RSA 1980 cA‑24
s34;1990 c6 s4
Special agreements
40(1) The Minister may enter into agreements with any
government, person or unincorporated group of persons
(a) respecting
any matter relating to the administration or operation of the Plan, or
(b) providing
for any matter for which no provision is made elsewhere in this Act or in the
regulations that the Minister considers necessary,
and the Minister may
implement any agreement so made.
(2) An
agreement under subsection (1) between the Minister and the Alberta Medical
Association may provide for the submission of differences to arbitration.
(3) If
an agreement between the Minister and the Alberta Medical Association provides
for arbitration,
(a) the
arbitration is final and binding on the Crown and the Alberta Medical
Association, and
(b) the Arbitration
Act does not apply to the arbitration.
RSA 1980 cA‑24
s35;1986 c3 s8
Blue Cross agreement
41(1) Subject to the approval of the Lieutenant
Governor in Council, the Minister and the ABC Benefits Corporation may enter
into an agreement, referred to as the Blue Cross agreement, providing for the
following:
(a) programs
to provide goods and services to residents and their dependants by the ABC
Benefits Corporation on payment of the premiums prescribed in respect of the
programs under the regulations made pursuant to the Health Insurance
Premiums Act;
(b) the
payments to be made by the Minister to the ABC Benefits Corporation with
respect to goods and services provided to residents and their dependants under
the Blue Cross agreement;
(c) the
goods and services that are to be provided under the Blue Cross agreement with
respect to residents and their dependants;
(d) generally,
any matter in connection with or incidental to the matters referred to in
clauses (a), (b) and (c).
(2) Only
goods and services that are not basic health services or extended health
services may be provided under the Blue Cross agreement.
(3) If
a resident is in arrears of premiums under the Health Insurance Premiums Act, the resident and the resident’s
dependants are not entitled to receive goods and services under the Blue Cross
agreement.
(4) Subsection
(3) does not apply if
(a) the
resident or the resident’s spouse or adult interdependent partner is 65 years
of age or over, or
(b) the
resident is receiving a widow’s pension.
(5) The
Lieutenant Governor in Council may make regulations not inconsistent with the
Blue Cross agreement governing any matter in connection with or incidental to
matters provided for in the agreement.
RSA 2000 cA‑20
s41;2002 cA‑4.5 s16;2004 c5 s3
General penalty
42 A person who is guilty of an offence under the
regulations or under this Act and for which no penalty is specifically
provided, is liable
(a) for
a first offence, to a fine of not more than $500 and in default of payment to
imprisonment for a term of not more than 30 days,
(b) for
a 2nd offence, to a fine of not more than $1000 and in default of payment to
imprisonment for a term of not more than 60 days, and
(c) for a 3rd or subsequent offence, to
imprisonment for a term of not more than 6 months without the option of a fine.
RSA 1980 cA‑24 s38
Financial assistance
43(1) The Lieutenant Governor in Council may
establish a program to provide financial assistance in cases where, because of
the sickness or disability of a resident or dependant, the resident is faced
with expenses that could not reasonably be foreseen and guarded against and
that place an undue burden on the financial resources of the resident.
(2) The program may specify the types of expenses
in respect of which assistance may be given and the portion of the expense that
is to be borne by the resident.
RSA 1980 cA‑24
s39;1983 c81 s1;1984 c26 s1
Residence requirements
44(1) A resident who is entitled to benefits under
this Act is also entitled to receive, without charge, insured services that are
provided under
(a) the
Cancer Programs Act;
(b) the
Mental Health Act;
(c) the
Public Health Act;
(d) any
other Act under which insured services are provided,
notwithstanding any
provision of those Acts or the regulations under them that provide requirements
as to residence in Alberta that are inconsistent with or more onerous than the
requirements as to residence under the Plan.
(2) Subsection (1) does not affect any provision in
any Act referred to in that subsection or in any regulations under such an Act
that pertain to requirements as to residence in Alberta in relation to the
provision of any services that are not insured services.
RSA 1980 cA‑24
s40;1982 c10 s7;1984 cP‑27.1 s87
