The Core Plan is a competitively priced extended health care and dental plan administered by Alberta Blue Cross (ABC). The plan also provides emergency out-of-province/country travel coverage.

To be eligible for the Core Plan, a participant must be:

• An eligible member in good standing of the AMA or NWTMA.
• An employee of a participating member who is working a minimum of 21 hours per week, not working temporarily or seasonally.
• A resident of Canada.

As of September 1, 2020, Core Plan monthly premiums are:

Please note: The Core Plan is mandatory while the Cost-Plus Plan is optional.

The Cost-Plus Plan is an optional self-insured plan to cover eligible health expenses not included in the Core Plan. As a self-insured plan, there are no premiums.

The Cost-Plus Plan uses current income tax rules that allow employers to provide health benefits and use the payments as a tax deduction for their incorporated or unincorporated business.

When can you join?

Enrolling in the plans is limited to the 60 days:

• After September 1 each year.
• After termination from another group insurance plan.
• After becoming a new practicing physician member of the Alberta Medical Association.

Step-by-step process

• Each eligible participant (physician and/or employees) completes the Core Plan Application:
  • Complete the Core Plan Application
• The physician completes the Participation Agreement specifying who will be covered by the Core Plan and Cost-Plus Plan:
  • Complete the Participation Agreement
  • Setting your Cost-Plus Plan Annual Dollar Liability Limit

Mail, fax or email the Core Plan Application(s) and Participation Agreement to:
AMA Health Benefits Trust Fund
c/o ADIUM Insurance Services Inc.
CMA Alberta House
12230 106 AVE NW
Edmonton AB T5N 3Z1
F 780.488.7558
Toll-free fax 1.877.302.3486
Email ADIUM Insurance Services Inc.

Core Plan

Please note: Submit Core Plan claims to Alberta Blue Cross.

After enrolling in the AMA HBTF, we will provide you with the Core Plan Benefits Booklet as well as information for submitting claims.

• Submit your claim online. Register for online service here:
  Access the Alberta Blue Cross login page

OR

• Download the claim form here:
  Complete the Alberta Blue Cross Health Services Claim Form
• Out of Province Emergency Medical Travel coverage and claims
  What to do when you have a medical emergency while traveling outside Alberta

If you have a problem with your claim, contact Alberta Blue Cross customer service:

• Edmonton 780.498.8000
• Calgary 403.234.9666
• Toll-free 1.800.661.6995

Cost-Plus Plan

Please review the Instructions & Tips section below prior to completing the claim form.

You have two options to complete your Cost-Plus Plan claim:

Option 1: Submit your claim ONLINE.

(For members only. Claims for physician's clinic employees must be submitted using Option 2 below.)

Complete and submit an online claim

Option 2: Complete the Cost-Plus Plan Claim Form (PDF)

Step 1

• Complete the Cost-Plus Plan Claim Form (PDF)

Step 2

• On page one, complete the
  • Participant Information
  • Participant Declaration and Authorization
  • Payor Authorization
• On page two, Claim Listing section, please:
  • Enter all medical expenses (receipts) for each family member (see Tips below).
  • Sub-total the medical expenses and then add the $25 administration fee for the claim total.

Step 3

• Either fax, scan and email, or mail your claim form to:
  • Fax: 780.488.7558 or 1.877.302.3486
  • Email: adium@albertadoctors.org
  • Mail:
    AMA Health Benefits Trust Fund
    12230 106 Avenue NW
    Edmonton AB T5N 3Z1

Instructions & Tips

• Ensure that you have first claimed any medical expenses that are covered under the Core Plan through Alberta Blue Cross. You are paying premiums for this plan so you should get the most from it. See “Make a claim – Core Plan” above for more information.
• Please do NOT submit receipts or Explanation of Benefits statements with your claim. Retain them on file for four years in case they are required in an audit. We return all receipts mailed in with a claim, so let’s both save on postage!
• Participant Information – this is the physician or employee whose medical expenses are being claimed.
• Participant Declaration and Authorization:
  • If you are the physician and are claiming for your family, sign both the Participation Declaration and Authorization and the Payor Authorization sections.
  • An employee of a physician or clinic completes the Participant Information and signs the Participation Declaration and Authorization.
  • If you employ your spouse, he or she is claimed as a family member on your claim and not as an employee.
• Payor Authorization – the physician or clinic officer signs the Payor Authorization. We strongly encourage you to use our electronic funds transfer process (i.e., don’t mail a cheque). This ensures exact amounts are withdrawn (from the same account you are paying Core Plan premiums from) and we avoid issues that can occur with cheques. If you choose to submit a cheque, it must be from the same account that we are withdrawing Core Plan premiums and it is payable to AMA Health Benefits Trust Fund.
• Claims Listing:
  • You may list medical expenses for both the current year and the previous year.
  • Rather than manually listing your expenses, you may create your own Excel spreadsheet with the same headings from the claim form. Include the $25 administration fee in your total claim amount. Submit the spreadsheet with page one of the claim form. Please note that ineligible expenses submitted to ABC are not automatically eligible under the Cost-Plus Plan. Please review the list of eligible expenses link below to ensure your expense is eligible.
  • Rather than listing every expense, you may create an account on the Alberta Blue Cross website and then pull claims reports by calendar year. Use the “Your portion” on this report for each family member by claim type (e.g., Rx, Dental). In the event of audit, we will accept these statements in-lieu of receipts.
  • It is your responsibility to determine if your medical expenses are allowable by Canada Revenue Agency. Please refer to the below resources for more information:
    • Quick glance list of eligible and ineligible medical expenses
    • CRA's Income Tax Folio S1-F1-C1: Medical Expense Tax Credit
  • If possible, please organize expenses by calendar year.

When will my claim be processed?

• Claims received by the 15th of each month are processed on or around the 18th of the month at which time the funds are withdrawn from your account. If you have provided a cheque to fund your claim, it is deposited to our trust bank account.
• Approximately ten days is required for bank confirmation of deposit.
• Your reimbursement cheque will be mailed the first week of the following month.

Core Plan

• Complete the Core Plan Benefit Change Form (mail, fax or email the form to ADIUM Insurance Services Inc.).
• Complete the Over-age Dependant Declaration from Blue Cross (if applicable).

Cost-Plus Plan

• Complete the Cost-Plus Plan Benefit Change Form (mail, fax or email the form to ADIUM Insurance Services Inc.).

The AMA Health Benefits Trust Fund offers two plans:

• Core Plan – administered by Alberta Blue Cross, the Core Plan is a basic extended health care and dental plan with no upper age limit to participate. You can remain on this plan as long as you want, even in retirement. The Out of Province/Canada Emergency Travel Benefit terminates upon the member’s 75th birthday. You pay a monthly premium for this coverage.
• Cost-Plus Plan – administered by ADIUM Insurance Services, the Cost-Plus Plan uses current income tax rules that allow employers to provide health benefits and use the payments as a tax deduction for their incorporated or unincorporated business. Upon full retirement, the Cost-Plus Plan is generally no longer available as it only benefits you if you have business revenue to deduct the Cost-Plus Plan claim against.

1. Alberta Blue Cross – Retiree plan
   
   For information on the Alberta Blue Cross – Retiree plan, please visit their website, where you can obtain full information on the plan, get a quote and apply for coverage. AMA HBTF qualifies as an “employer sponsored plan” when asked in the application.
   
   The eligible ages for enrollment are 50 to 75.
    
2. Alberta Retired Teachers Association – ARTA Retiree Benefits Plan
   
   For information on the ARTA Retiree Benefits Plan, please visit their website, where you can get full information on the plan, including premium rates, and complete the enrollment form.
   
   The eligible ages for enrollment are age 55 and older.

Note: Neither the Alberta Medical Association or ADIUM Insurance Services endorses these programs. Questions about the coverage offered and the enrollment process must be directed to the respective provider.