info - Alberta Blue Cross

BLUE CHOICE RATES
RATE CHART (Monthly rates for each family member)
PLAN TYPE
4 AND UNDER
AGE
5 - 20 *
21 - 34
35 - 44
45 - 54
55 - 64
PLAN A
$ 12.50
$35.60
$ 57.60
$ 61.70
$ 70.10
$ 80.60
PLAN B
$ 14.60
$ 43.90
$ 76.50
$ 84.70
$ 98.40
$ 117.30
PLAN C
$ 16.70
$ 50.30
$ 90.20
$ 102.40
$ 128.90
$ 151.90
* If all applicants are under 21 years of age then one of the applicants must use the 21 - 34 rates listed above.
INSTRUCTIONS
All individuals covered under the Applicant's
Alberta Health Care Insurance Plan account must
be on the same Blue Choice plan.
1. Select your plan type.
2. Using the Rate Chart above, insert the rate for
each family member into the Rate Calculation
amount column.
RATE CALCULATION
PERSON COVERED
AMOUNT
APPLICANT
SPOUSE
+
DEPENDENTS
+
3. Add the rate(s) within the amount column to
determine your Total Monthly Rate.
+
4. Multiply the total monthly rate by 2 to
determine your initial 2 months’ payment.
+
+
+
+
+
+
MONTHLY RATE
=
0.00
INITIAL 2 MONTHS’
PAYMENT
(Monthly rate x 2)
=
0.00
♦ These rates are subject to change without notice.
♦ Acceptance of the above noted rates does not constitute acceptance of the Agreement.
♦ Rates stated above may change pending medical underwriting.
®* The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of
independent Blue Cross plans. Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan.
® † Blue Shield is a registered trade-mark of the Blue Cross Blue Shield Association. ABC 31479 2016/08
Individual
plans
Individual health plans
for
family
for you
you and your family
Within your reach
Make Alberta Blue Cross
part of your
healthy future
As Alberta’s largest benefits carrier, Alberta Blue Cross provides
supplementary health and dental benefits to meet the needs of over 1.6
million Albertans. Maintaining a high-tech, yet high-touch approach, we
aggressively adopt technology to deliver highly efficient service, but still
maintain a strong commitment to personalized and excellent customer
service. As a best practices organization, Alberta Blue Cross is a repeat
recipient of the Premier’s Award of Distinction, a recipient of the Employer
of Youth Award of Distinction and has been ranked as one of Alberta’s top
employers.
We offer unique value
•Alberta based and Alberta grown. With our head office in Edmonton and
five branch offices across the province, we specialize in serving the Alberta
market. We operate under a mandate with a focus exclusively on the health
of Albertans. We’re just a phone call away, or you can visit us in person at
our Edmonton, Calgary, Lethbridge, Medicine Hat, Red Deer or Grande
Prairie locations.
•Independent and not-for-profit. We are not an insurance company or a
government agency; as an independent, not-for-profit organization we can
deliver unparalleled value.
•Experts in supplementary health care. We keep a close watch on
health care trends and make the most of our health benefit expertise to
consistently bring you affordable coverage.
•We deliver excellent customer service to Albertans (plan members and
service providers) by:
•seamlessly adjudicating tens of millions of claims with a value
exceeding $2 billion,
•offering direct billing, utilizing sophisticated and secure online
technology, and
•responding in-person to just under one million direct inquiries each
year through our call centres and six offices across the province.
•We play an active role in the communities in which we live and work, by
leading and supporting province-wide health and wellness campaigns and
activities, as well as community initiatives.
Designed to meet
your needs
Alberta Blue Cross individual health and dental plans
help you and your family stay healthy by providing
practical benefits you’ll use on a regular basis—
including prescription drugs, vision, dental care, travel
and more.
At the same time, you get affordable protection
against the high cost of unexpected illness, accidents,
ambulance trips and medical conditions.
If you’re without employer-sponsored health benefits,
we’ve got an individual health and dental plan to meet
your needs ... and your budget.
• Family protection — Without an Alberta Blue Cross
plan, you could face substantial out-of-pocket costs
for prescription drugs, dental, vision care, ambulance
trips and much more. And without coverage, an
unexpected illness, accident or medical condition
could cost you thousands of dollars.
• Affordable rates — Combine the tax savings of
individual health plan coverage with what you’ll save
on out-of-pocket expenses each year, and you’ll be
surprised how little a plan actually costs.
• Convenience of direct billing — Enjoy the
convenience of direct billing arrangements with
health service providers including pharmacies, vision
care providers and dental offices.
• Online services — Use our desktop and mobilefriendly web sites to access your claims and benefits
information, and submit your claims online anytime,
anywhere. Or, download our new smartphone app
to view your information while on the go!
All from the name you know and trust
At Alberta Blue Cross, your health is our only focus. And
as an Alberta-based, not-for-profit organization, we
deliver the value and affordability you deserve.
You must complete a medical questionnaire to determine eligibility for certain benefits as these plans are medically reviewed
and do not cover pre-existing health conditions or medications.
Blue Choice | Plan A
Blue Choice | Plan B
Extended Health coverage
Extended Health coverage
Ambulance services: Ground and air ambulance to an active
treatment hospital.
Accidental dental care: Up to a maximum of $2,000 per
participant for the repair, extraction or replacement of
natural teeth.
Psychologist: Up to $75 per visit to a maximum of $150 per
participant each benefit year.
Ambulance services: Ground and air ambulance to an active treatment hospital.
Preferred hospital accommodation: Semi-private and private rooms. Up to $100 per
day to a maximum of $2,000 per participant each benefit year.
Hospital cash: $20 per day to a maximum of 20 days per participant each benefit year
when admitted to a hospital.
Physiotherapist/chiropractor/massage therapist: Up to $50 per visit for services
provided by a physiotherapist, $35 per visit for services provided by a chiropractor or
$50 per visit for services provided by a massage therapist to a combined maximum of
$350 per participant each benefit year.
Home nursing: Up to a maximum of $3,000 per participant each benefit year.
Psychologist: Up to $75 per visit to a maximum of $750 per participant each
benefit year.
Podiatrist/chiropodist: Up to $20 per visit to a maximum of $400 per participant each
benefit year for services provided by a podiatrist or chiropodist.
Accidental dental care: Up to a maximum of $2,500 per participant for the repair,
extraction or replacement of natural teeth.
Hearing aids: Up to a maximum of $500 per participant in any four-year period for the
purchase or repair of hearing aids.
Custom made foot orthotics: 70% coverage up to a maximum of $200 per participant
each benefit year.
Custom fitted braces: 70% coverage up to a maximum of $750 per participant in any
two-year period.
Oxygen: Up to a maximum of $2,500 per participant each benefit year for oxygen and
purchase or rental of equipment.
Wheelchair: Up to a maximum of $1,500 once in any three-year period.
Hospital beds: Up to a lifetime maximum of $1,500 per participant.
Medical aids: Crutches, casts, canes, cervical collars, walkers, splints, trusses
and traction kits.
CPAP machines: Sleep apnea appliances up to a combined maximum of $500 per
participant once in any five-year period.
Drug coverage
70% reimbursement for eligible prescription drugs.
Least Cost Alternative (LCA) pricing.
$10,000 maximum per participant each benefit year.
Dental coverage
All dental services paid according to the Alberta Blue Cross Usual and
Customary fee guide.
70% basic dental coverage for standard check-ups,
cleanings, fillings, extractions and root canals to a maximum
of $600 per participant in each benefit year.
(Three month waiting period from enrolment date.)
Travel coverage
10 day travel coverage anywhere in the world outside of
Alberta with up to $5,000,000 in emergency medical benefits.
This coverage can be used for any number of trips lasting
up to 10 days each. A 10% discount offered on purchase of
additional coverage.
Accidental Death benefit
$15,000 in the event of an accidental death of a participant.
Accidental Death Benefit underwritten by the Blue Cross Life
Insurance Company of Canada.
Drug coverage
70% direct bill for eligible prescription drugs.
Least Cost Alternative (LCA) Pricing.
$10,000 maximum per participant each benefit year.
Dental coverage
All dental services paid according to the Alberta Blue Cross Usual and Customary fee guide
75% basic dental coverage for standard check-ups, cleanings, fillings, extractions and
root canals to a maximum of $600 per participant in each benefit year.
(Three month waiting period from enrolment date.)
50% extensive dental for periodontics and dentures in the second year to a combined
basic and extensive maximum of $1,250 per participant in the second and each
subsequent benefit year.
(12 month waiting period from enrolment date.)
Vision care coverage
Combined maximum of $200 per participant towards an eye examination (maximum
of $85) and the purchase or repair of eyeglasses, contact lenses and intraocular lenses
in any two-year period.
Travel coverage
Now is the time to assess your health coverage
needs. Whether you’re self-employed, working
without group benefits or an early retiree,
Alberta Blue Cross individual health plans are a
smart choice for you and your family.
Please review the plan choices and select one
today.
17 day travel coverage anywhere in the world outside of Alberta with up to $5,000,000
in emergency medical benefits. This coverage can be used for any number of trips
lasting up to 17 days each. A 10% discount offered on purchase of additional coverage.
Accidental Death benefit
$20,000 in the event of an accidental death of a participant.
Accidental Death Benefit underwritten by the Blue Cross Life Insurance Company of Canada.
Blue Choice | Plan C
Extended Health coverage
Ambulance services: Ground and air ambulance to an active treatment hospital.
Preferred hospital accommodation: Semi-private and private rooms. Up to $100 per day to a
maximum of $3,000 per participant each benefit year.
Hospital cash: $20 per day to a maximum of 30 days per participant each benefit year when
admitted to a hospital.
Physiotherapist/chiropractor/massage therapist: Up to $50 per visit for services provided
by a physiotherapist, $35 per visit for services provided by a chiropractor or $50 per visit for services
provided by a massage therapist to a combined maximum of $350 per participant each benefit year.
Acupuncture/homeopath/osteopath/naturopath: Up to $50 per visit to a licensed practitioner in
acupuncture, homeopathy, osteopathy or naturopathic medicine, to a combined maximum of $350
per participant each benefit year.
Home nursing: Up to a maximum of $5,000 per participant each benefit year.
Psychologist: Up to $75 per visit to a maximum of $750 per participant each benefit year.
Podiatrist/chiropodist: Up to $20 per visit to a maximum of $400 per participant each benefit year
for services provided by a podiatrist or chiropodist.
Accidental dental care: Up to a maximum of $3,000 per participant for the repair, extraction or
replacement of natural teeth.
Hearing aids: Up to a maximum of $750 per participant in any four-year period for the purchase or
repair of hearing aids.
Auxiliary care: Up to a maximum of $1,000 per participant each benefit year.
Custom made foot orthotics: 70% coverage up to a maximum of $200 per participant each
benefit year.
Custom fitted braces: 70% coverage up to a maximum of $750 per participant in any
two-year period.
Oxygen: Up to a maximum of $2,500 per participant each benefit year for oxygen and purchase or
rental of equipment.
Wheelchair: Up to a maximum of $1,500 once in any three-year period.
Hospital beds: Up to a lifetime maximum of $1,500 per participant.
Medical aids: Crutches, casts, canes, cervical collars, walkers, splints, trusses and traction kits.
CPAP machines: Sleep apnea appliances up to a combined maximum of $500 per participant once
in any five-year period.
Blue Choice |
Portability
In the future, you may have an opportunity to
acquire group benefits through an employer.
But there’s no need to leave your Blue Choice
individual health plan behind. You can maintain
the option to resume your coverage sometime
in the future, without a medical review. This
guarantees you and your family will always
have access to an Alberta Blue Cross individual
health plan, regardless what medical conditions
may develop. Some restrictions will apply.
Secure online services for
plan members
Access your claim and benefit information
anytime, anywhere by using our desktop
web site, our mobile-friendly web site, or
our new smartphone app.
To access secure online services for plan
members, go to www.ab.bluecross.ca,
and click the “Sign-in” button located in
the top right hand corner of the page to
select “Plan members.”
Drug coverage
80% direct bill for eligible prescription drugs.
Least Cost Alternative (LCA) Pricing.
$10,000 maximum per participant each benefit year.
Dental coverage
All dental services paid according to the Alberta Blue Cross Usual and Customary fee guide.
80% basic dental coverage for standard check-ups, cleanings, fillings, extractions and root canals to
a maximum of $600 per participant in each benefit year.
(Three month waiting period from enrolment date.)
50% extensive dental for periodontics and dentures in the second year to a combined basic and
extensive maximum of $1,250 per participant in the second and each subsequent benefit year.
(12 month waiting period from enrolment date.)
50% extensive dental for crowns, bridges and implants in the third year to a combined basic and
extensive maximum of $1,250 per participant in the third and each subsequent benefit year.
(24 month waiting period from enrolment date.)
50% for orthodontics in the third year up to a lifetime maximum of $2,000 per participant.
(24 month waiting period from enrolment date.)
•Submit claims.
•View a summary of completed claims.
•Check claim reimbursement status.
•View claim statements for the past 24
months.
•Check coverage levels and when you
are next eligible for vision and dental
services.
•Print claim forms.
•Update your mailing address.
Combined maximum of $250 per participant towards an eye examination (maximum of $85) and
the purchase or repair of eyeglasses, contact lenses and intraocular lenses in any two-year period.
•Arrange to have your claim payments
deposited directly into your bank
account and access your statements
online.
Travel coverage
•Print or order additional ID cards.
17 day travel coverage anywhere in the world outside of Alberta with up to $5,000,000 in
emergency medical benefits. This coverage can be used for any number of trips lasting up to 17
days each. A 10% discount offered on purchase of additional coverage.
•And much more.
Vision care coverage
Accidental Death benefit
$25,000 in the event of an accidental death of a participant.
Accidental Death benefit underwritten by the Blue Cross Life Insurance Company of Canada.
This brochure provides an overview of Blue Choice
plans offered by Alberta Blue Cross. It is not a contract
or complete listing of all benefits.
It’s easy to apply
1. Select the plan that suits your needs.
2. Refer to the Rate Chart that accompanies this brochure.
3. Complete all parts of the application form, or contact a
representative to find out how to apply online.
• Be sure to sign and date the application.
• Incomplete information will cause delays.
4. Forward your fully completed application.
Your application will be medically reviewed and you will be notified
whether you have been accepted or declined. If you are accepted,
coverage will begin the first day of the month following the
acceptance of your application. Dental coverage waiting periods apply.
Don’t delay—you never know when an illness or accident may occur.
If you have any questions, just call us!
There’s an Alberta Blue Cross representative ready to help you.
Enjoy the benefits of a Blue Choice individual health plan—apply today.
1-800-394-1965
780-498-8008 in Edmonton
403-294-4032 in Calgary
www.ab.bluecross.ca
The Blue Cross symbol and name are registered marks of the Canadian
Association of Blue Cross Plans, an association of independent Blue Cross plans.
Licensed to ABC Benefits Corporation for use in operating the Alberta Blue
Cross Plan. ® † Blue Shield is a registered trade-mark of the Blue Cross Blue Shield
Association. ABC 83143 2016/01
®*
Alberta Blue Cross
Individual Health Plans
10009 - 108 Street
Edmonton, AB T5J 3C5