4 Optical
benefits payable
5 Included in
amount of benefits
6 Benefit limits ‑
dental
7 Benefit limits ‑
optical
8 Repeal
9 Expiry
List of Dentist Goods and Services
List of Denturist Goods and Services
List of Optician Goods and Services
List of Optometrist Goods and Services
Definitions
1 In this Regulation,
(a) “Act”
means the Alberta Health Care Insurance Act;
(b) “dental
extended health services” means the goods and services set out in the List of
Dentist Goods and Services and the List of Denturist Goods and Services in this
Regulation;
(c) “dependant”
means a dependant as defined in the Alberta Health Care Insurance Regulation;
(d) “eligible
resident” means
(i) a resident who is receiving a widow’s pension under the Widows’
Pension Act, and
(ii) a person who is a dependant of a person referred to in subclause
(i);
(e) “optical
extended health services” means the goods and services set out in the List of
Optician Goods and Services and the List of Optometrist Goods and Services in
this Regulation;
(f) “Schedule
of Dental Extended Health Benefits” means the Schedule of Dental Extended
Health Benefits prepared and published by the Department of Health and Wellness
and approved by the Minister;
(g) “Schedule
of Optical Extended Health Benefits” means the Schedule of Optical Extended
Health Benefits prepared and published by the Department of Health and Wellness
and approved by the Minister.
Eligibility
2(1) Benefits
are payable to or on behalf of eligible residents for the following extended
health services provided to an eligible resident:
(a) goods
and services in the List of Dentist Goods and Services in this Regulation that
are provided by or under the supervision of a dentist;
(b) goods
and services in the List of Denturist Goods and Services in this Regulation
that are provided by or under the supervision of a denturist;
(c) goods
and services in the List of Optician Goods and Services in this Regulation that
are provided by or under the supervision of an optician;
(d) goods
and services in the List of Optometrist Goods and Services in this Regulation
that are provided by or under the supervision of an optometrist.
(2) Notwithstanding
subsection (1), benefits are not payable for extended health services if a
declaration under section 25 of the Health Insurance Premiums Act is in
effect in respect of the person who receives the services.
Dental benefits
payable
3(1) The benefits payable for dental extended health
services and the descriptions of those services are set out in the Schedule of
Dental Extended Health Benefits.
(2) Notwithstanding
subsection (1), the benefits payable for dental extended health services
provided to an eligible resident by a practitioner are limited to the lesser of
(a) the
amount claimed, and
(b) the
rates established in the Schedule of Dental Extended Health Benefits.
Optical benefits
payable
4(1) The benefits payable for optical extended
health services and the descriptions of those services are set out in the
Schedule of Optical Extended Health Benefits.
(2) Notwithstanding
subsection (1), the benefits payable for optical extended health services
provided to an eligible resident by a practitioner are limited to the lesser of
(a) the
amount claimed, and
(b) the
rates established in the Schedule of Optical Extended Health Benefits.
Included in amount of
benefits
5 The benefits payable for dental extended
health services or optical extended health services provided to an eligible
resident by a practitioner include an amount for the following:
(a) performing
the dental extended health services or optical extended health services;
(b) administration;
(c) recording
of information regarding the services provided unless the recording of the
information is for the purposes of a third party;
(d) completing
and submitting claims;
(e) discussion
or correspondence with a referring health care professional regarding treatment
or a service to be provided to a patient directly related to managing the
patient’s care, unless otherwise provided in this Regulation or the Alberta
Health Care Insurance Regulation.
Benefit limits ‑
dental
6 Benefits payable for dental extended
health services provided to an eligible resident are subject to the following
limitations:
(a) a
benefit for a complete denture for a given arch (upper or lower jaw) will be
paid no more frequently than once every 5 years, and then only if no previous
benefit has been paid for a denture or reset (including rebase) for the arch
during that period;
(b) a
benefit for a partial denture for a given arch will be paid no more frequently
than once every 5 years;
(c) a
benefit for a reline for a denture will be paid no more frequently than once
every 2 years, and then only if no previous benefit has been paid for a reline
or rebase for the denture during that period.
Benefit limits ‑
optical
7(1) The benefits payable for optical extended
health services are limited to one good or service in each 3‑year period
beginning January 1, 1995.
(2) Notwithstanding
subsection (1), benefits may be paid for 2 pairs of glasses, 2 pairs of lenses
or 2 lenses with different corrections, instead of bifocals, but the glasses or
lenses must be purchased at the same time and the benefit to be paid must not
exceed the benefit payable for bifocals.
Repeal
8 The Extended Health Services Benefits
Regulation (AR 383/94) is repealed.
Expiry
9 For the purpose of ensuring that this
Regulation is reviewed for ongoing relevancy and necessity, with the option
that it may be repassed in its present or an amended form following a review,
this Regulation expires on February 15, 2016.
List of Dentist Goods and
Services
(a) examinations;
(b) radiographs;
(c) restorative
services;
(d) endodontics;
(e) periodontics;
(f) dentures;
(g) repairs/additions;
(h) relines;
(i) tissue
conditioning;
(j) oral
and maxillofacial surgery.
List of Denturist Goods
and Services
(a) dentures;
(b) relines;
(c) repairs/additions;
(d) tissue
conditioning;
(e) oral
exams.
List of Optician Goods
and Services
(a) single
vision lens for distance;
(b) single
vision lens for reading;
(c) bifocal
lens;
(d) multifocal
lens;
(e) complete
pair of glasses.
List of Optometrist Goods
and Services
(a) single
vision lens for distance;
(b) single
vision lens for reading;
(c) bifocal
lens;
(d) multifocal
lens;
(e) complete
pair of glasses.