Navigating Insurance

Public Insurance

What is it?

Public health insurance is health coverage that is afforded by your provincial government.

How does it work?

This form of insurance is free and accessible to all citizens and permanent residents of Canada. In Alberta, you will receive an Alberta Health Care card that covers your basic health insurance needs. These include doctor visits for checkups, illnesses that land you in the hospital, public clinic visits, and emergency services.

Need mental health care?

Appointments with a general practitioner (GP) or a psychiatrist is covered by your provincial, public health care plan. You will be required to show your Alberta health card each time you make a visit.

If you are prescribed medications upon completion of the doctor's visit, payment will be required (it is not covered by having an Alberta Health Card).

Private Insurance

What is it?

Private health insurance is health coverage that is seperate from the public insurance you receive when you have an Alberta health card and are a citizen or permanent resident of Canada.

How does it work?

Private insurance is usually afforded by the company that you work for. Often, private insurance will pay for things that your provincial/public insurance won’t cover - called extra coverage or extended health plans.

What does it cover?

The most common types of extra coverage by private insurance are - prescription medications, dental care, physiotherapy, ambulance services, and prescription eyeglasses. Typically, your private insurance will cover a majority of the fee, and you will need to pay the remaining amount. Sometimes your insurance company will pay the full amount and you will pay nothing.

Need mental health care?

If you want to see a private practice with a social worker, psychologist, or counselor, you may need to request private insurance from your employer. Ask your employer what the health benefits are.

Direct Billing

What is it?

Service providers are able to directly send the bill to insurance companies for their clients if the insurance company is one of their partners. Direct billing is very useful for those with health insurance that is recognized in Alberta and Canada as they may not be required to pay the complete fee amount out of pocket.

How does it work?

How much you as a client pay will depend upon your health insurance benefits. If your mental health provider has direct billing services and your insurance company provides direct billing services, then the insurance company will directly be billed for the coverage they provide you with. You may be asked to complete certain forms for the direct billing process.

Reimbursement

What is it?

As a client, your insurance company may ask you to pay out of your own pocket for various services and then submit claims for the money you used. After you submit the claim, your insurance provider will reimburse you for the money you used out of your pocket. The amount of money you are reimbursed for will depend upon your health insurance policies.

Sources

https://mtam.mb.ca/111/direct_billing_101

https://www.irmi.com/term/insurance-definitions/reimbursement-policies