MLA frequently asked questions

Who decides how government-sponsored benefits programs work?

Alberta Blue Cross^® and the Government of Alberta are separate entities.

The government-sponsored benefits programs that Alberta Blue Cross^® administers were created by and are led by the Government of Alberta. Therefore, the Government of Alberta is responsible for deciding the following:

• How programs are designed.
• Program eligibility criteria.
• What is and is not covered by a program.
• The amount of coverage provided by a program.

We will help your constituents to the best of our ability, including by working with them directly to give them expert advice and assistance. However, Alberta Blue Cross^® has no authority to change eligibility criteria, alter coverage levels or decide what is and is not covered.

The ultimate authority on government-sponsored benefit policies and procedures rests with the Government of Alberta. Where necessary, we refer constituency offices and Albertans to Alberta Health or other government offices.

What can Alberta Blue Cross^® help constituency offices with?

Our MLA Inquiry team is a single point of contact for all constituency offices’ questions and concerns relating to Alberta Blue Cross^®‘s work with the Government of Alberta.

We enlist the help of Alberta Blue Cross^®’s Customer Service team, which aids all Albertans who are enrolled in government-sponsored programs.

In most cases, we can assist with questions related to the following:

• Helping constituents understand the government-sponsored benefit programs available to them.
• Connecting constituents to our Customer Service team to assist with questions about claims, coverage and eligibility.
• Referring constituents and constituency offices to the appropriate Government of Alberta departments.

What information does Alberta Blue Cross^® need to resolve my inquiry?

Providing complete and accurate information is the best way to expedite the MLA Inquiry line process.

At minimum, we need to be able to identify the constituent or constituents who are the subject of the inquiry. In addition to the member’s full name, an Alberta Blue Cross^® member ID number and home address will expedite your inquiry.

Additional information about your inquiry is always helpful, including details about the situation and any earlier attempts to resolve the issue.

How does a constituent enroll in the Coverage for Seniors program?

To be eligible for the Coverage for Seniors program, Albertans must verify their age with Alberta Health.

The Alberta Health Care Insurance Plan (AHCIP) office will send Albertans a package shortly before they turn 65. Among other information and forms, this package includes instructions for how to submit proof of age documents.

Unfortunately, Alberta Health may not always have the most current addresses on file. Sometimes this means Albertans don’t receive this package. If this occurs, the Albertan must fill out a proof of age declaration form and attach a proof of age document. The following documents are accepted as proof of age:

• Canadian driver’s license,
• Alberta identification (ID) card,
• birth certificate,
• old-age pension entitlement form,
• passport or immigration record, or
• Canadian citizenship certificate.

The Albertan can then submit the form 1 of 2 ways:

• take the completed form to an AHCIP-authorized registry agent for processing, or
• mail the completed form and a copy (both sides) of the proof of age document to the AHCIP office.

Does Alberta Blue Cross^® administer seniors’ dental coverage?

As of June 3, 2024, Alberta Blue Cross administers the Dental Assistance for Seniors Program (DASP).  Please direct all DASP dental inquiries to Alberta Blue Cross^® at 1-800-661-6995.

What drugs are covered on government-sponsored benefits programs?

The Alberta Drug Benefit List outlines the drugs and diabetic supplies covered by major government-sponsored drug plans in Alberta, including Non-Group Coverage, Coverage for Seniors and low-income programs.

While Alberta Blue Cross^® provides scientific and administrative support to the Alberta Drug Benefit List, the choice of whether to cover a specific drug rests with the Government of Alberta.

Most items on the Alberta Drug Benefit List are open benefits, meaning they can be claimed by anyone with coverage. A minority of drugs are covered only when a special authorization is granted (see below).

How do special authorizations work?

Some drugs on the Alberta Drug Benefit List are only covered on a special authorization basis. Once a special authorization is approved, the drug may be claimed and covered as normal.

This means that in addition to having coverage, the Albertan must have been specially authorized to receive that specific drug. The Albertan must work with their physician to apply for a special authorization.

Alberta Blue Cross^® approves or denies special authorizations based on objective clinical criteria set by Alberta Health. These criteria are specific to a given drug or class of drugs, and often involve laboratory testing.

Questions about special authorizations can be highly technical and specific. In these cases, it is best to contact us directly to discuss your inquiry.

My constituent has 2 or more health benefit plans. How do they interact?

Many Albertans receive both public and private health coverage simultaneously.

In these situations, plans can interact to the Albertan’s advantage. For example, an Albertan may obtain public coverage so they have access to prescription drugs and buy private vision and dental coverage.

When an Albertan with multiple plans makes a claim, the way that claim is paid is determined by the coordination of benefits rules.

The coordination of benefits rules are highly technical and often specific to a given situation. If you are asking about how a specific claim would be processed in a specific situation, it is best to contact us directly to discuss your constituent’s inquiry.

Please note we can only speak to coordination of benefits when at least 1 of the benefit plans involved is administered by Alberta Blue Cross^® (such as a private plan we offer or a government-sponsored benefits plan we administer).