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• Ages 0-18: Alberta Health Care covers one complete eye exam per year. Additional exams and/or treatments may be covered based on medical needs. Ask your doctor of optometry for information about coverage and potential costs for specific visual conditions. Alberta Health Care covers medically necessary services.
• Ages 19-64: Alberta Health Care does not cover eye exams, however many Albertans have insurance coverage through their employer or their own medical plan. We offer convenient direct-billing to most majory health benefits plans. Alberta Health Care does cover medically necessary services.
• Age 65+: Alberta Health Care covers one complete eye exam per year. Additional exams and/or treatments may be covered based on medical needs, such as glaucoma, diabetes or cataract follow-up or monitoring. Ask your doctor of optometry for information about coverage and potential costs for specific visual conditions. Alberta Health Care covers medically necessary services.
• Medically Necessary/Urgent Care: includes eye infections or injuries, foreign objects in the eyes, sudden change in vision, monitoring for diabetes issues, glaucoma, and retinal disease, and post-operative care for cataract patients.

Yes, we have the ability to direct-bill most major health benefits plans.

Please be mindful that every health benefits plan is unique and that some may not permit eye care providers, like us, to bill directly on behalf of the plan holder (i.e., the patient). Due to privacy laws, eye care providers do not have access to plan details prior to the act of requesting payment. Accordingly, it is the responsibility of the patient to be aware of any billing limitations associated with their benefits plan(s). It is also the responsibility of the patient to be aware of the amount of coverage they have and the date on which their benefits are renewed or replenished (i.e., annually).

Health benefits plan providers can sometimes limit the ability to direct bill plans based on the following:

• Benefit Plan. For example, the benefits plans held by many federal public servants do not permit eye care providers to direct-bill. Therefore, patients must provide payment and then personally submit their claim to their benefits plan provider for reimbursement.
• Day of Service. For example, some benefits plan providers manually review, adjudicate and/or audit claims for direct-billing. Their capacity to review, adjudicate, and/or audit claims can sometimes fluctuate throughout the week, especially on weekends. Therefore, patients must provide payment and be reimbursed by their benefits provider
• Balance Billing. For example, in cases where the patient would like to direct-bill two or more benefit plans, the secondary plan provider may require documentation of the amount covered by the primary plan. Therefore, patients must provide (partial) payment and then personally submit their claim to their secondary benefit plan provider for reimbursement.

• Contact Information (name, address, phone number, email, etc.);
• Date of birth;
• Gender;
• Alberta Health Card;
• List of current prescription medicine(s);
• Medical history;
• Family Physician;
• Date of laser corrective eye surgery (if applicable);
• Ophthalmologist (if applicable);
• Health benefits/Health Insurance policy and group information;
• If applicable, your current prescription eyeglasses;
• If applicable, your current contact lens brand/type (i.e., packaging);
• The location of your most recent eye exam.