AMA Health Benefits Trust Fund

Core Plan

The Core Plan is a basic* extended health care and dental plan specifically designed for AMA HBTF and administered by Alberta Blue Cross (ABC). The plan also provides emergency out-of-province/country travel coverage.

Who is eligible?

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.

How much are the premiums?

As of January 1, 2024, Core Plan monthly premiums are:

*AMA HBTF’s Core Plan is subject to co-insurance and annual plan maximums. Specifically, the prescription drug and basic dental plans are each capped at $750/year per person. Medical expenses in excess of these amounts may be submitted through the Cost-Plus Plan or for those with significant prescription drug expenses you should consider supplementing Core Plan coverage with the “Non-Group Coverage” offered by Alberta Health that offers prescription drug and other extended health care coverage. Non-Group Coverage does not require proof of good health and will not exclude coverage for pre-existing conditions. For more information on Non-Group Coverage please see the Alberta Health website Non-Group Coverage | Alberta.ca. Premiums paid for Non-Group Coverage are an eligible expense under the Cost-Plus Plan.

Core Plan tax receipt

A self-service feature for physicians, resident physicians and medical students

Get a receipt for your AMA HBTF Core Plan payments that you can use for tax purposes: Your AMA HBTF Core Plan tax receipt

You will need to login to the website to access this feature. Need help logging in? Visit Login help.

Cost-Plus Plan

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.

For more information on the Cost-Plus Plan, please review the AMA Health Benefits Trust Fund brochure.

When can you join?

Enrolling in the plans is limited to the 60 days after:

• January 1 each year.
• Termination from another group insurance plan.
• Becoming a new practicing physician member of the Alberta Medical Association.

Step-by-step process

1. Each eligible participant (physician or employees) completes a Core Plan Application:

Complete the Core Plan Application

Mac users: Please ensure to fill out the form using Adobe reader.

2. The physician will complete the Participation Agreement to specify who will be covered by the Core Plan and by the Cost-Plus Plan:

Complete the Participation Agreement

3. Submit the Core Plan Application and Participation Agreement to us:

• By email: adium@albertadoctors.org
• By secure upload through our member portal
• By fax: 780-488-7558 or 1-877-302-3486
• Mail:

AMA Health Benefits Trust Fund
c/o ADIUM Insurance Services Inc.
CMA Alberta House
12230 106 Avenue NW
Edmonton AB T5N 3Z1

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)

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

• 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.

• You may submit your claim in the following ways:
  
  • By email: adium@albertadoctors.org
  • By secure upload through our member portal: www.albertadoctors.org/dashboard
  • By fax: 780-488-7558 or 1-877-302-3486
  • Mail:
    AMA Health Benefits Trust Fund
    c/o ADIUM Insurance Services Inc.
    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. The funds are withdrawn by electronic funds transfer, from your account on file for premiums.
• 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 (beginning at paragraph 1.12)
• If possible, please organize expenses by calendar year.

When will my claim be processed?

• Claims received by the 15 of each month are processed on or around the 18 of the month at which time the funds are withdrawn from your account.
• Approximately ten days is required for bank confirmation of deposit.
• If electronic reimbursement has been chosen, your reimbursement will be deposited by Electronic Funds Transfer to your bank account, the first week of the following month.

Core Plan

• Complete the Core Plan Benefit Change Form (mail 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.

For retired members, the Core Plan may not provide sufficient coverage for your needs.

AMA members are entitled to move to one of two plans without proof of good health, provided you transfer your coverage within 60 days of cancelling your Core Plan coverage:

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 and older.
   
   
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.

View ARTA's April 26, 2022 webinar for AMA members.

Contact ADIUM Insurance Services

• Learn more about the plan and to enrol.
• Add or delete dependants from your Core Plan coverage.
• Change bank accounts for your Core Plan pre-authorized monthly payments.
• Questions about claiming through the Cost-Plus Plan.
  • Email: adium@albertadoctors.org
  • Phone: 780-482-0692

Contact Alberta Blue Cross

• Enquire about a Core Plan claim that has been adjudicated.
• Check if a prescription drug is covered by the Core Plan.
  • Edmonton 780-498-8000
  • Calgary 403-234-9666
  • Toll-free 1-800-661-6995

Contact CanAssistance – Out of province/country emergency travel benefit

• Report a medical emergency while travelling.
• Information about coverage prior to your departure.
• Submit a claim or enquire into the status of your claim.
• Any other enquiry about your coverage.

Hours of operation

• Travel Assistance (emergency contact number - 24/7).
• Other enquiries – Monday to Friday 6:30 a.m. to 6 p.m. MST.
  • 1-888-772-2583
  • 1-403-225-4289 collect