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Alberta Adult Health Benefits Brochure

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Alberta Adult Health Benefits Brochure Powered By Docstoc
					                                                       Health Benefits
Contact Us:                                            Review Committee
For more information on Alberta Works Health           What does the Review Committee do?                    What happens next?
Benefit Programs you can contact the following         • This committee provides a fair review of            • Your doctor may need to complete a
offices or go to the websites listed below:              health benefit decisions, and ensures that            Request for Drugs and Nutritional Products
                                                         Albertans with low income who have unique             form if you need medication or over-the-
Income Support Health Benefits
                                                         medical needs can access the health supports          counter products that are not covered on
Contact your Income Support worker at the office         they need.                                            the Health Benefits Card. This form is also
where your file is held.                                                                                       available from your worker or on our website
                                                       • If you need a health benefit not covered
                                                         on the Health Benefits Card, you can request          employment.alberta.ca/hb-drugs. Attach
Learner Health Benefits                                  a review by the Health Benefits Review                the completed form when you submit your
                                                         Committee.                                            request to your worker.
Alberta Employment and Immigration
Student Funding Contact Centre                         • The Health Benefits Review Committee will           • The office handling your request will review
   PO Box 28000, STN Main                                review requests for drugs, optical, dental,           all information you submit, answer your
   Edmonton, AB T5J 4R4                                  ambulance services and diabetic supplies that         questions, and submit your documents along
                                                         are not covered on your Health Benefits Card.         with a Supervisory Summary to the Health
Phone: Toll-free 1-800-222-6485                                                                                Benefits Review Committee.
       or 780-427-3722 in Edmonton                     • If one of the above benefits is not covered
                                                         and you want to appeal the decision, refer to       • Each case submitted to the Health Benefits
Fax: Toll-free 310-0000, then enter 780-415-9947                                                               Review Committee is reviewed and researched
     or 780-415-9947 in Edmonton                         the Contact Us section of the brochure for the
                                                         office to contact.                                    on an individual basis.
                                                                                                             • Staff working for the committee may contact
Alberta Adult Health Benefit, and                      How do I request a review?                              your medical practitioners if more information
Alberta Child Health Benefit
                                                       • Obtain a Request for Review of Decision               is needed.
Alberta Employment and Immigration                       form from your worker or from our website           • The committee makes decisions based on
Health Benefits Contact Centre                           employment.alberta.ca/hb-review                       health benefits policy and the information
   PO Box 2222
                                                       • Complete the form explaining what decision            you submit to support your request.


                                                                                                                                                                Health Benefits
   Edmonton, AB T5J 5H3
                                                         you want reviewed, who will provide the             • The committee’s written decision is mailed to
Phone: Toll-free 1-877-469-5437                          medical services you need, and the cost.              you and includes the reasons for the decision.
       or 780-427-6848 in Edmonton
                                                       • Attach any information related to your request
Fax: Toll-free 310-0000, then enter 780-415-8386,        that your health care provider can provide.                                                            Under Alberta Works, eligible individuals and
     or 780-415-8386 in Edmonton                                                                                                                                families with limited incomes can access free
                                                       • Submit the completed form to the appropriate
                                                                                                                                                                health benefits.
Alberta Works Online Policies on Health Benefits         office listed in the Contact Us section of this
and the Health Benefits Review Committee                 brochure. This office can also provide additional                                                      Knowing your family’s health is cared for will
employment.alberta.ca/hb-policy                          information and answer any questions you                                                               bring you peace of mind.
                                                         may have. If you need assistance filling out
General info on Alberta Works Health Benefits            the form, please ask.
                                                                                                                                                                For more detailed information please go to the
employment.alberta.ca/hb                                                                                                                                        Contact Us section on the back of this brochure.


                                 AEHB 1634 (2008/08)
How do I know if I qualify for                                                                             What does the                                          How do I use the
a Health Benefits Card?                                                                                    Health Benefits Card cover?                            Health Benefits Card?

Income Support                                                                                             Prescription Drugs and Nutritional Products            Whether you fill a prescription at a pharmacy,
                                                                                       Maximum
If you are receiving Income Support (including        Family Type                      Income (effective   • Many, but not all prescription drugs are paid        have an eye exam, request eyeglasses or have
Learners) you will receive a Health Benefits Card                                      August 1, 2008)       for. Some over-the-counter products, such as         dental work done, you must always present your
that provides health benefits coverage for you                                                               prenatal vitamins and children’s vitamins are        Health Benefits Card. That way the medical office
                                                      Single Individual                $15,545                                                                    can tell you up front if the service you need is
and your family.                                                                                             also covered. Your pharmacist has a list of
                                                      Single Parent with 1 Child       $24,397               what is free with the Health Benefits Card.          covered by the card.
Alberta Adult Health Benefit
                                                      Single Parent with 2 Children    $29,073                                                                    For example, if a prescription you need is
You and your family may qualify for a Health                                                               Optical Care
                                                      Single Parent with 3 Children    $34,056                                                                    covered by the Health Benefits Card, the
Benefits Card, under the Alberta Adult Health                                                              • Adults receive a free eye exam and eyeglasses        pharmacist will provide it to you free of charge.
Benefit program, if:                                  Single Parent with 4 Children*   $39,336               every 24 months if needed.                           The pharmacist then submits a claim to Alberta
• You have high ongoing prescription drug needs,                                                           • Children receive free eyeglasses every 12 months     Blue Cross, and they pay the pharmacist on
                                                      Couple with no Children          $21,763
  and limited income.                                                                                        if needed (their annual eye exams are covered        behalf of our department.
                                                      Couple with 1 Child              $29,285               by Alberta Health and Wellness).
• You are pregnant and have limited income.
                                                                                                                                                                  The Drug Benefit Lists and the Agreements that
• You leave Income Support (Expected to Work,         Couple with 2 Children           $34,346
                                                                                                           Dental Care                                            our department has with optometrists, opticians,
  Not Expected to Work) and you have income           Couple with 3 Children           $38,997                                                                    dentists and denturists will cover most of the
                                                                                                           • Basic services such as extractions and fillings
  from employment, self-employment, or the                                                                                                                        medical services that you and your family need.
                                                      Couple with 4 Children*          $44,000               are covered, in order to alleviate pain and
  Canada Pension Plan Disability program.
                                                                                                             infection.
• You leave the Assured Income for the Severely      * Add $4663.00 for each additional child                                                                     Other Health Plans
                                                                                                           • In some cases additional services such as cleaning
  Handicapped (AISH) program and you have                                                                                                                         If your family gets services through another
                                                     How do I figure out my income?                          and annual examinations are also covered.
  income from employment, self-employment,                                                                                                                        health plan, you must use that plan first. The
                                                     You can calculate your income by looking at             Ask your dentist about your coverage.
  or the Canada Pension Plan Disability program.                                                                                                                  Alberta Works Health Benefits Card can cover
                                                     your last income tax return.                                                                                 your remaining costs. Talk to your doctor, dentist,
                                                     • Look at Line 236 to find out your                   Ambulance Services
Alberta Child Health Benefit                                                                                                                                      optician or pharmacist about how this works.
                                                        net income.                                        • Emergency ambulance trips to the nearest
Children in families with limited income can
                                                     • Add any child support you receive,                    hospital are covered.                                IMPORTANT: Always present your Health
receive coverage under the Alberta Child Health
                                                        which is on Line 156.                                                                                     Benefits Card before you receive the service.
Benefit program. Families qualify based on income.
                                                     • Subtract the amount you were taxed,                 Diabetic Supplies                                      If the service is covered by the card then it is
                                                        which is on Line 128.                                                                                     provided free of charge. If the service is not
The following chart provides income thresholds                                                             • Diabetic supplies such as injection supplies,
                                                     The amount left is your income. If you have                                                                  covered then you should ask the health care
for the Alberta Adult Health Benefit and the                                                                 testing strips, lancets and penlets are covered.
                                                     trouble calculating your income, call us.                                                                    provider or your worker about alternatives.
Alberta Child Health Benefit programs.

                                                                                                                                                                  On the other side of this brochure, you will find
                                                                                                                                                                  information about the Health Benefits Review
                                                                                                                                                                  Committee. This committee meets weekly and
                                                                                                                                                                  reviews requests for unique needs that are not
                                                                                                                                                                  covered by the Health Benefits Card.