ALBERTA HEALTH CARE INSURANCE ACT (RSA 2000 cA-20)

RSA 2000 cA-20

Alberta — Consolidated Statutes

© Published by Alberta King’s Printer Alberta King’s Printer Suite 700, Park Plaza 10611 - 98 Avenue Edmonton, AB T5K 2P7 Phone: 780-427-4952 E-mail: kings-printer@gov.ab.ca Shop on-line at kings-printer.alberta.ca Province of Alberta Office Consolidation Revised Statutes of Alberta 2000

Chapter A-20 Current as of May 14, 2026 ALBERTA HEALTH CARE INSURANCE ACT

Copyright and Permission Statement The Government of Alberta, through the Alberta King’s Printer, holds copyright for all Alberta legislation. Alberta King’s Printer permits any person to reproduce Alberta’s statutes and regulations without seeking permission and without charge, provided due diligence is exercised to ensure the accuracy of the materials produced, and copyright is acknowledged in the following format: © Alberta King’s Printer, 20__.* *The year of first publication of the legal materials is to be completed.

Note All persons making use of this consolidation are reminded that it has no legislative sanction, that amendments have been embodied for convenience of reference only. The official Statutes and Regulations should be consulted for all purposes of interpreting and applying the law. Amendments Not in Force This consolidation incorporates only those amendments in force on the consolidation date shown on the cover. It does not include the following amendments: 2025 c21 s1(8)(

b) amends s4(5). 2025 c21 s1(46) adds

Part 3 (ss74 to 82). 2019 c18 s1 (2021 c25 s5 - effective December 8, 2021; AR 141/2025 s40 - effective June 11, 2025) amends ss1, 6, repeals and substitutes s8 and adds ss8.1 and 8.2, amends ss9, 13, 15, 18, 23, adds

Part 4 ss45 to 52, adds s41.1. 2020 c35 s4 amends s1(a); s9 amends ss11(2) and 22(7)(j). 2021 c25 s1 (AR 217/2022 s215 - effective November 16, 2022) amends ss4(5), 16(1)(p), 22; adds

Part 1.1 ss28.1 to 28.37; amends s41(1)(

a) and (3). 2025 c10 s4 amends s20.3(2)(b). 2025 c21 s1 amends s1; repeals and substitutes s2; repeals and substitutes s6; amends s7; repeals s8 and substitutes ss8 to 8.5; repeals and substitutes ss9(1), 10, 11(1) and 12(1); adds s13.1; repeals and substitutes s15(1); amends s16(1); adds s19.1; repeals and substitutes s20.1(1)(c). 2026 c9 s1 adds the

preamble; amends the enacting clause and ss1, 3 and 4; adds s6.1; amends ss16(1), 17, 18(1) and 26(1); adds s26.1.

Regulations The following is a list of the regulations made under the Alberta Health Care Insurance Act that are filed as Alberta Regulations under the Regulations Act Alta. Reg.

Amendments Alberta Health Care Insurance Act Alberta Health Care Insurance ....................... 76/2006 ........... 128/2006, 136/2009, 170/2012, 4/2016, 136/2017, 193/2019, 20/2020, 148/2020, 106/2021, 218/2022, 158/2025, 199/2025, 289/2025, 291/2025 Blue Cross Agreement ................................... 77/2006 ........... 4/2016, 194/2019, 26/2020 Claims for Benefits ........................................ 81/2006 ........... 15/2016, 159/2017, 67/2020, 142/2021, 291/2025 Insured Hospital Services ............................... 290/2025 Medical Benefits ............................................ 84/2006 ........... 25/2011, 170/2012, 15/2016, 143/2021, 158/2025, 291/2025 Optometric Benefits ....................................... 202/2007 ......... 331/2009, 37/2010, 198/2011, 170/2012, 186/2014, 27/2019, 159/2022, 224/2024, 158/2025, 291/2025 Oral and Maxillofacial Surgery Benefits .................................................... 86/2006 ........... 170/2012, 15/2016, 158/2025, 291/2025 Out-of-Country Health Services ..................... 78/2006 ........... 240/2008, 69/2009, 80/2011, 170/2012, 5/2016, 135/2017, 24/2021, 262/2022, 158/2025, 291/2025 Physician Payment Disclosure ....................... 162/2020 ......... 288/2025 Podiatric Benefits ........................................... 87/2006 ........... 136/2006, 308/2006, 170/2012, 15/2016, 158/2025, 291/2025 Podiatric Surgery Benefits ............................. 137/2006 ......... 170/2012, 15/2016, 158/2025, 199/2025, 214/2025 , 291/2025

1 ALBERTA HEALTH CARE INSURANCE ACT

Chapter A-20 Table of Contents

Part 1 Health Care Insurance 1

Definitions 2 Insured services Division 1 Alberta Health Care Insurance Plan 3 Operation of Plan 4 Coverage under Plan 5 Change in residence 6 Payment of benefits 7 Opting in and out by dentists 8 Opting in and out by physicians 9 Extra billing 10 Emergency services 11 Other prohibited fees 12 Prohibition on receiving benefits 12.1 Prohibitions re submission of claims 12.2 Prohibition on causing or contributing to contravention or failure to comply 13 Minister ’s right to recover amounts 14 Offence 15 Duty to advise 16,17 Regulations 18 Reassessment of claims 19 Order reducing future benefits 20 Remuneration of practitioners 20.1 Remuneration to other person 20.2 Minister not liable 20.3 Disclosure re practitioners and publicly funded health services

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 2 20.31 Disclosure re contravention or failure to comply 20.4 Disclosure permitted despite other laws 21 Relationship between practitioner and patient 22 Disclosing health information 23 Protection from action 24 Assignment of benefits 25 Crown ’s right of recovery 26 Prohibitions 27 False statements 28 Information for claim 28.1 Administrative penalties 28.2 Appeal of administrative penalty 28.3 Administrative penalty not stayed 28.4 Enforcement or collection of administrative penalty 28.5 Regulations Division 2 Optional Health Services 29

Definitions 30 Regulations 32 Regulations Division 3 General 33 Regulations 34,35 Retrospectivity of regulations 36 Payments out of General Revenue Fund 37 Benefits review committees 38 Forms 39 Examination of practitioner’s records 39.01 Requirement for information, documents or access to premises 39.1 Disclosure of information to prevent or limit fraud or abuse of health services 40 Special agreements 40.01 Retroactive adjustment of ben efits for purposes of agreement 40.1 AMA representation rights 41 Blue Cross agreement 42 General penalty 43 Financial assistance 44 Residence requirements

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 3

Part 2 Insured Hospital Services Plan 45

Definitions 46 Application of Part Division 1 Insured Hospital Services Plan 47 Establishment, administrat ion and operation of Plan 48 Entitlement to insu red hospital services 49 Residents not entitled to insured hospital services 50 Provision of insured hospital services in emergencies Division 2 Insured and Non-insured Hospital Services 51 Provision of insured hospital services 52 Insured hospital services 53 Payment for insured hospital services 54 Non-insured hospital services 55 No payment for non-insured hospital services Division 3 Charges and Fees 56 Authorized charges for non-insured hospital services 57 Fees for enhanced goods and services 58 Fees charged to non-entitled persons 59 Fees for health services provided by physicians Division 4 Recovery and Payment of Costs by Residents 60 Recovery of costs of providing hospital services 61 Assuming responsibility for cost s of insured hospital services Division 5 Payments to Operators of Other Hospitals and Agencies 62 Hospital services outside Alberta 63 Payments to operators of certain public hospitals 64 Payments to agencies Division 6 General 65 Designation of approved facilities

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 4 66 Operating costs 67 Records, reports and returns 68 Participation in federal programs 69 Group contacts 70 Offences Division 7 Regulations 71 Regulations 72 Transitional regulations 73 Validation of regulation

Part 4 Regulations 83 Deficiency regulations 84 Consequential changes to regulations HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Alberta, enacts as follows:

Part 1 Health Care Insurance

Definitions 1 In this Part, (a) “ABC Benefits Corporation” means the ABC Benefits Corporation continued under the ABC Benefits Corporation Act; (b) “basic health services” means the following classes of goods and services: (

i) insured health services; (ii) those services that are pr ovided by a dentist in the field of oral and maxillofacial surgery and are specified as basic health services in the regulations but are not within the definition of insured health services; (iii) optometric services; (iv) services and appliances provided by a podiatrist; (

v) goods and services classified as basic health services by the regulations under

section 16;

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 5 (c) “benefits” means the amount s payable by the Minister in respect of the cost of health services provided to residents; (d) “Blue Cross agreement” means an agreement made between the Minister and the ABC Benefits Corporation pursuant to

section 41; (

e) and (

f) repealed 2019 c22 s1; (g) “College” means the College of Physicians and Surgeons of Alberta; (

h) repealed RSA 2000 cH-7 s144; (i) “dentist” means, (

i) with reference to goods and services provided in Alberta, a regulated member of the College of Dental Surgeons of Alberta under the Health Professions Act who holds a practice permit respecting the practice of dentistry, and (ii) with reference to goods and services provided in a place outside Alberta, a person lawfully entitled to practise dentistry in that place; (i.1) “denturist” means, (

i) with reference to goods and services provided in Alberta, a person who is a regulated member of the College of Alberta Denturists under the Health Professions Act who holds a practice permit respecting the practice of denture construction, and (ii) with reference to goods and services provided in a place outside Alberta, a person lawfully entitled to practise denture construction in that place; (j) “dependant” means a dependant as defined in the regulations; (k) “extended health services” means those goods and services or classes of goods and services that are specified in the regulations and provided to a resident or the resident’s dependants under

section 3(2); (l) “federal Act” means the Canada Health Act (Canada); (m) “health services” means basic health services, optional health services and extended health services;

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 6 (n) “insured health services” means (

i) all services provided by physicians that are medically required, (ii) those services that are pr ovided by a dentist in the field of oral and maxillofacial surgery and are specified in the regulations, and (iii) any other services that are declared to be insured health services pursuant to

section 2, but does not include any services that a person is eligible for and entitled to under any Act of the Parliament of Canada or under the Workers’ Compensation Act or any law of any jurisdiction outside Alberta relating to workers’ compensation; (o) “Minister” means the Minister determined under

section 16 of the Government Organization Act as the Minister responsible for this Act; (p) “optician” means (

i) with reference to goods and services provided in Alberta, a person who is a regulated member of the College of Opticians of Alberta and who holds a practice permit respecting the practice of dispensing of eye glasses or contact lenses, and (ii) with reference to goods and services provided in a place outside Alberta, a person lawfully entitled to practise opticianry in that place; (q) “optional health services” means those goods and services or classes of goods and services that are specified in the regulations as optional health services; (r) “optometric services” means those services provided by an optometrist that are specified in the regulations as optometric services for the purposes of the Plan; (s) “optometrist” means, (

i) with reference to goods and services provided in Alberta, a person who is a regulated member of the optometry profession under the Health Professions Act or a professional corporation registered with the Alberta College of Optometrists under the Health Professions Act, and

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 7 (ii) with reference to goods and services provided in a place outside Alberta, a person lawfully entitled to practise optometry in that place; (t) “physician” means (

i) with reference to medical se rvices provided in Alberta, a regulated member of the College of Physicians and Surgeons of Alberta under the Health Professions Act authorized to use the title “physician” who holds a practice permit issued under that Act, or a professional corporation registered with the College of Physicians and Surgeons of Alberta, and (ii) with reference to medical services provided in a place outside Alberta, a person lawfully entitled to practise medicine or osteopathy in that place; (u) “Plan” means the Plan referred to in

section 3; (v) “podiatrist” means, (

i) with reference to services or appliances provided in Alberta, a regulated member of the College of Podiatric Physicians of Alberta who holds a practice permit issued under the Health Professions Act, and (ii) with reference to services or appliances provided in a place outside Alberta, a person lawfully entitled to practise podiatry in that place; (w) “practitioner” means a denturist, dentist, optician, optometrist, physician or podiatrist or other person who provides a basic health service or an extended health service; (w.1) “regulations” means the re gulations made under this Part, unless the context otherwise requires; (x) “resident” means a person who is (

i) lawfully entitled to be or remain in Canada and makes the person’s home and is ordinarily present in Alberta, or (ii) deemed by the regulations to be a resident, but does not include a tourist, transient or visitor to Alberta or a person assumed under the Health Insurance Premiums Act no longer to be a resident.

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 8 (

y) repealed 2 003 cI-0.5 s52. RSA 2000 cA-20 s1;RSA 2000 cH-7 ss143,144,145,146,148,149,152; 2001 c10 s1;2001 c21 ss27,28;2003 cI-0.5 s52;2005 c13 ss1,4(4); 2007 c32 s1(41);2008 c34 s18;2016 c9 s24;2019 c22 s1;2022 c4 s2; 2025 c10 s4;2025 c21 s1(3) Insured services 2 The Lieutenant Governor in Council may by regulation declare any basic health services referred to in

section 1(b)(ii), (iii), (iv) or (

v) to be insured health services for the purposes of the Plan. RSA 2000 cA-20 s2;2019 c22 s1;2022 c4 s2;2025 c21 s1(4) Division 1 Alberta Health Care Insurance Plan Operation of Plan 3(1) The Minister shall, in accordance with this Part and the regulations, administer and operate on a non-profit basis a plan to provide benefits for basic health services to all residents.

(2) The Minister shall, in accordance with the regulations, provide extended health services to a resident and the resident’s dependants if (

a) the resident or the resident’s spouse or adult interdependent partner is 65 years of age or older, or (

b) repealed 2 003 cI-0.5 s52.

(3) The Minister is the public authority responsible for the administration and operation of the Alberta Health Care Insurance Plan. RSA 2000 cA-20 s3;2002 cA-4.5 s16;2003 cI-0.5 s52;2025 c21 s1(7) Coverage under Plan 4(1) Subject to this Part and the regulations, the Minister shall pay benefits in respect of health services provided to residents.

(2) All claims for benefits are subject to assessment and approval by the Minister and the amount of the benefits to be paid and the person to whom the benefits are to be paid shall be determined in accordance with this Part and the regulations.

(2.1) The Minister is not bound by a claim for benefits submitted, or by information provided in respect of a claim for benefits, by or on behalf of any person and shall assess a claim for benefits in accordance with this Part and the regulations notwithstanding the claim for benefits submitted or information provided.

(2.2) When assessing claims under subsection (2), the Minister may select a random sample of claims for assessment and apply a

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 9 statistical methodology, including extrapolation based on the assessment of the random sample of claims, to the population of claims from which the sample was drawn.

(2.3) No order under proceedings referred to in subsection (2.4) may be made varying or vacating an amount assessed under subsection (2) by reason only that the amount assessed was determined from a random sample of claims and by the application of a statistical methodology, including extrapolation, to the population of claims from which the sample was drawn.

(2.4) An assessment of a claim under subsection (2) is, subject to being varied or vacated on appeal under subsection (6), valid and binding notwithstanding any error, defect or omission in the assessment or in any proceeding under this Part relating to it.

(3) A resident is not entitled to the payment of benefits in respect of health services provided to the resident if the resident is (

a) a member of the Canadian Forces, (

b) repealed 2013 c4 s1, (

c) a person serving a term of imprisonment in a penitentiary as defined in the Corrections and Conditional Release Act (Canada), or (

d) a resident who has not completed the waiting period prescribed by the regulations.

(4) A claim for benefits is not payable under this Part until the information required under this Part and the regulations is provided to the Minister and the Minister is satisfied that (

a) a health service was provided to a person, (

b) the person was a resident at the time the health service was provided, and (

c) the claim for benefits is ap propriate for the health service provided.

(5) For the purposes of subsection (4), a certificate of registration under the Health Insurance Premiums Act is proof, in the absence of evidence to the contrary, that the person is a resident if the certificate was in effect at the time the service was provided to that person.

(6) The Minister shall notify the practitioner, resident or person referred to in

section 20.1 concerned by mail or electronic

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 10 notification of a denial of payment of a claim assessed under subsection (2) and the practitioner, resident or person referred to in

section 20.1 so notified may appeal the assessment to the Court of King’s Bench by way of application if the application is returnable within 60 days after the date on which that person was notified. RSA 2000 cA-20 s4;2013 c4 s1;2020 c27 s1;2022 c4 s2;AR 217/2022; 2025 c21 s1(8) Change in residence 5(1) Subject to the regulations, a person who ceases to be a resident of Alberta and becomes a resident of any other place remains entitled to benefits for health services provided to that person during the period prescribed in the regulations.

(2) A resident does not cease to be entitled to benefits by reason of being temporarily absent from Alberta. RSA 1980 cA-24 s5;1983 c32 s1;1984 c26 s1 Payment of benefits 6(1) No physician, dentist or person referred to in

section 20.1 may receive the payment of benefits from the Minister for insured health services provided in Alberta to a resident unless the physician or dentist was opted into the Plan when the insured health services were provided.

(2) No resident may receive the payment of benefits from the Minister for insured health services provided in Alberta to the resident by a physician or dentist unless the physician or dentist who provided the insured health services was opted into the Plan when the insured health services were provided.

(3) Notwithstanding subsections (1) and (2), the Minister may pay benefits for insured health services provided in Alberta to a resident by a physician or dentist who was opted out of the Plan if the insured health services were provided in an emergency. RSA 2000 cA-20 s6;2020 c27 s1;2025 c21 s1(9) Opting in and out by dentists 7(1) Subject to this section, every dentist is deemed to have opted into the Plan.

(2) A dentist may opt out of the Plan by (

a) notifying the Minister in writing indicating the effective date of the opting out, (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the dentist practises, and

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 11 (

c) posting a notice of the proposed opting out in a part of the dentist’s office to which patients have access at least 30 days prior to the effective date of the opting out.

(3) A dentist who has not previously practised in Alberta may opt out of the Plan prior to commencing practice by (

a) notifying the Minister in writing indicating the date on which the dentist will commence opted-out practice, and (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the dentist intends to practise.

(4) A dentist who has opted out of the Plan shall (

a) post a notice in a part of the dentist’s office to which patients have access advising patients of the dentist’s opted-out status, and (

b) ensure that each patient is advised in person of the dentist’s opted-out status before any service is provided to the patient.

(5) A dentist who has opted out of the Plan may opt into the Plan by notifying the Minister in writing at least 30 days prior to the effective date of the opting in. 1986 c3 s2;1994 c2 s4;1998 c31 s2;1999 c32 s2 Opting in and out by physicians 8(1) Subject to this section, every physician is deemed to have opted into the Plan.

(2) A physician may opt out of the Plan by (

a) notifying the Minister in writing indicating the effective date of the opting out, (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the physician practises, and (

c) posting a notice of the proposed opting out in a part of the physician’s office to which patients have access at least 180 days prior to the effective date of the opting out.

(3) A physician who has not previously practised in Alberta may opt out of the Plan prior to commencing practice by

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 12 (

a) notifying the Minister in writing indicating the date on which the physician will commence opted-out practice, and (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the physician intends to practise.

(4) A physician who has opted out of the Plan shall (

a) post a notice in a part of the physician’s office to which patients have access advising patients of the physician’s opted-out status, and (

b) ensure that each patient is advised in person of the physician’s opted-out status before any service is provided to the patient.

(5) A physician who has been opted out of the Plan for a continuous period of at least one year may opt into the Plan by notifying the Minister in writing at least 30 days prior to the effective date of the opting in.

(6) A physician who has been opted out of the Plan for a continuous period of less than one year may apply to the Minister to opt into the Plan.

(7) An application under subsection (6) must be in a form acceptable to and contain the information required by the Minister.

(8) In making a decision on an application under subsection (6), the Minister shall take into consideration the factors, if any, that are set out in the regulations. 1998 c31 s2 Extra billing 9(1) No physician or dentist who is opted into the Plan who provides insured health services to a person shall charge or collect from any person an amount in addition to the benefits payable by the Minister for those insured health services.

(1.1) No person referred to in

section 20.1 shall charge or collect from any person an amount for an insured health service in addition to the benefits payable by the Minister for that insured health service.

(2) If a physician or dentist contravenes subsection (1), the Minister may, (

a) in the case of a first or subsequent contravention, send a written warning to the physician or dentist,

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 13 (

b) in the case of a 2nd or subsequent contravention, refer the contravention to the College or the College of Dental Surgeons of Alberta, as the case may be, and (

c) in the case of a 3rd or subsequent contravention, order that, after a date specified in the order, the physician or dentist is deemed to have opted out of the Plan for the period specified in the order.

(2.1) If a person referred to in

section 20.1 contravenes subsection (1.1), the Minister may, (

a) in the case of a first or subsequent contravention, send a written warning to the person, (

b) in the case of a 2nd or subsequent contravention, send a notice to the person that a 3rd or subsequent contravention will result in the immediate termination of the agreement or arrangement referred to in

section 20.1(1)(a), and (

c) in the case of a 3rd or subsequent contravention, terminate the agreement or arrangement referred to in

section 20.1(1)(a).

(2.2) An agreement or arrangement that is terminated pursuant to subsection (2.1)(

c) is deemed to have been terminated with cause and the Minister shall not be liable with respect to any such termination of the agreement or arrangement.

(3) An order under subsection (2)(

c) shall, prior to the effective date of the order, be served personally or by registered mail on a physician, dentist or person referred to in

section 20.1 who is affected by the order. RSA 2000 cA-20 s9;RSA 2000 cH-7 s145;2005 c13 s1;2020 c27 s1; 2025 c10 s4;2025 c21 s1(13) Emergency services 10 If a physician or dentist who is opted out of the Plan provides insured health services in Alberta in an emergency to a resident in respect of whom benefits may be paid and the physician, dentist or resident is paid benefits with respect to those insured health services, the physician or dentist shall not charge or collect from any person an amount in addition to those benefits. RSA 2000 cA-20 s10;2025 c21 s1(14) Other prohibited fees 11(1) No person shall charge or collect from any person

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 14 (

a) an amount for any goods or services that are provided as a condition to receiving an insured health service provided by a physician or dentist who is opted into the Plan, or (

b) an amount the payment of which is a condition to receiving an insured health service provided by a physician or dentist who is opted into the Plan where the amount is in addition to the benefits payable by the Minister for the insured health service. (2) Subsection (1) does not prohibit the charging or collecting of an amount paid for non-insured health or pharmaceutical goods or services where the charging or collecting of that amount is not otherwise prohibited under this Act and a physician or dentist reasonably determines that it is necessary to provide the non-insured health or pharmaceutical goods or services before the insured health service is provided.

(3) If a person receives an amount in contravention of subsection (1), the Minister may recover that amount in a civil action in debt as though that amount were a debt owing from the person to the Crown in right of Alberta.

(4) Where the Minister recovers any amount under subsection (3), the Minister shall reimburse the person who was charged the amount. RSA 2000 cA-20 s11;2025 c21 s1(16) Prohibition on receiving benefits 12(1) A physician or dentist who is opted into the Plan and provides insured health services to a person in circumstances where the physician or dentist knows or ought reasonably to know that the person is being charged an amount in contravention of

section 11 shall not receive the payment of benefits from the Minister for those insured health services.

(1.1) A person referred to in

section 20.1 who employs or has entered into a service agreement with a physician who provides insured health services to a person in circumstances where the person referred to in

section 20.1 knows or ought reasonably to know that a person is being charged an amount in contravention of

section 11 shall not receive the payment of benefits from the Minister for those insured health services.

(2) Section 9(2) applies where (

a) a physician or dentist contravenes subsection (1), or

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 15 (

b) a person referred to in

section 20.1 contravenes subsection (1.1). RSA 2000 cA-20 s12;2020 c27 s1;2025 c21 s1(17) Prohibitions re submission of claims 12.1(1) No person shall, with respect to the submission of a claim for benefits, provide information that the person knows or ought reasonably to know is incomplete, erroneous or false.

(2) No person shall submit a claim for benefits if the person knows or ought reasonably to know that (

a) the information provided with respect to the claim is incomplete, erroneous or false, or (

b) no benefit is payable in respect of the claim or a benefit is payable in an amount other than the amount claimed. 2025 c21 s1(18) Prohibition on causing or contributing to contravention or failure to comply 12.2 No person shall commit

an act or omission or make a statement or representation that the person knows or ought reasonably to know that, if acted or relied on by another person, may (

a) cause that other person or another person to contravene or fail to comply with this Division or the regulations made under this Division, or (

b) contribute to that other person or another person contravening or failing to comply with this Division or the regulations made under this Division. 2025 c21 s1(18) Minister’s right to recover amounts 13(1) If a physician, dentist or person referred to in

section 20.1 (

a) in contravention of

section 9 or 10, receives an amount in addition to the benefits payable by the Minister, or (

b) receives the payment of benefits in contravention of

section 12, the Minister may act under subsection (2).

(2) If subsection (1) applies, the Minister may recover the additional amount and the benefits in a case referred to in subsection (1)(a), or the benefits in a case referred to in subsection (1)(b), by one or more of the following means:

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 16 (

a) by withholding those amounts from any benefits payable to the physician, dentist or person referred to in

section 20.1; (

b) by civil action as though those amounts were a debt owing to the Crown in right of Alberta; (

c) pursuant to any agreement between the Minister and the physician, dentist or person referred to in

section 20.1 that provides for the repayment of those amounts.

(2.1) Despite subsection (2)(a), the Minister may not withhold an amount from any benefits payable to a person referred to in

section 20.1 if the amount or benefits received in contravention of

section 9, 10 or 12 were received by a physician for services that were not provided (

a) as part of the physician’s employment with the person referred to in

section 20.1, or (

b) pursuant to the service agreement between the person and the physician.

(3) The Minister shall reimburse a person in respect of whom benefits may be paid for any amounts recovered under this

section that were paid by the person and have not been previously reimbursed. RSA 2000 cA-20 s13;2020 c27 s1 Offence 14(1) A person who contravenes

section 9, 10, 11 or 12 is guilty of an offence and liable to a fine of not more than (a) $50 000 for the first offence, and (b) $100 000 for the 2nd and each subsequent offence.

(2) A prosecution of an offence under subsection (1) must not be commenced more than 6 years after, (

a) if the offence is of a continuing nature, the last day on which the alleged offence occurred, or (

b) in any other case, the day on which the alleged offence occurred. RSA 2000 cA-20 s14;2022 c4 s2;2025 c21 s1(20) Duty to advise 15(1) Prior to providing insured health services in Alberta to a resident in respect of whom benefits may be paid, a physician or dentist who is opted out of the Plan shall advise the resident of that

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Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 17 fact and that the resident is not entitled to be reimbursed from the Plan for the cost of any insured health services provided by the physician or dentist.

(2) This

section does not apply when the insured health services are provided in an emergency. RSA 2000 cA-20 s15;2025 c21 s1(21) Regulations 16(1) The Lieutenant Governor in Council may make regulations (

a) authorizing or requiring the doing of any act or thing by the Minister, or any other person, for the purpose of having the Plan meet the criteria prescribed under the federal Act or to enable the Government of Alberta to receive payment of contributions by the Government of Canada under the federal Act; (

b) deeming persons to be residents for the purposes of this Part; (

c) prescribing classes of good s and services as basic health services or extended health services; (c.1) respecting benefits payable in respect of basic health services referred to in

section 1(b)(ii), (iii), (iv) or (

v) provided to residents or classes of residents, including eligibility criteria and conditions under which the benefits are payable; (

d) providing, in respect of benefits for any or all health services provided outside Alberta or any specified place outside Alberta, that the benefits may be paid only for services provided during a specified period of time or that the Minister is empowered in a particular case to prescribe the period in respect of which benefits may be paid; (

e) prescribing the waiting period for a person who is or becomes a resident and in respect of which the costs of any health services provided during that period to that person are not payable as benefits; (

f) subject to

section 4(2), providing for procedures for the review of any decision or the settlement of any question pertaining to the determination of (

i) the amount of benefits payable for a particular service, (ii) whether any service is a health service or not,

RSA 2000

Section 16

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 18 (iii) whether any service provided by a physician is medically required or not, or (iv) any other matter that affects the entitlement to benefits; (

g) providing, for the purpose of removing doubt, that (

i) any service is or is not a basic health service, extended health service or insured health service, or (ii) any particular service that may be provided by a physician is or is not medically required; (

h) prescribing the duration of periods for the purposes of

section 5(1) and any conditions on which a person continues to be entitled to benefits by virtue of that subsection; (

i) providing the circumstances under which a person is or is not to be considered as temporarily absent from Alberta for the purposes of

section 5(2); (

j) governing notifications under

section 7 or 8; (

k) respecting the factors to be taken into consideration by the Minister in dealing with applications under

section 8(6); (

l) requiring practitioners to file with the Minister the kinds of information that the regulations prescribe for the purpose of facilitating the handling, assessing and payment of claims for benefits; (

m) prescribing the times by wh ich or the circumstances under which practitioners are required to file information pursuant to the regulations under clause (l); (

n) authorizing the Minister to withhold the payment of benefits to any practitioner or person referred to in

section 20.1 until the practitioner or person referred to in

section 20.1 has complied with the regulations under clauses (l), (

m) and (n.1); (n.1) respecting information referre d to in

section 20.1(4)(b)(ii); (n.2) further defining or setting out criteria in respect of “publicly funded health services” for the purposes of

section 20.3(1)(b); (n.3) respecting any matter or thing relating to a regulation under

section 20.3(2) or (4), including regulations

RSA 2000

Section 16

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 19 (

i) respecting the identification of any person or any part or all of an organization or body, whether incorporated or not, as a health entity for the purposes of

section 20.3(2)(e), and (ii) specifying part or all of any person, organization or body, whether incorporated or not, as a health entity for the purposes of

section 20.3(2)(f); (n.4) establishing criteria that must be met to exclude the disclosure of information, documents or records under

section 20.3(5); (n.5) respecting the documents, records and information, including practitioners’ personal information, required to be disclosed under

section 20.3(2) and (4), including the types of documents, records and information required to be disclosed; (n.6) respecting the disclosure of information, records and documents under

section 20.3(2) and (4), including regulations respecting (

i) the form and manner of disclosure, (ii) the time period and extension of the time period within which disclosure must take place, and (iii) the disclosure of information, records and documents in partial or redacted form; (n.7) respecting the information, including personal information, that may be disclosed under

section 20.31, including the types of information that may be disclosed; (n.8) respecting the disclosure of information under

section 20.31, including regulations respecting (

i) the form and manner of disclosure, and (ii) the disclosure of information in partial or redacted form; (n.9) establishing criteria that must be met to exclude the disclosure of information under

section 20.31(2); (

o) prohibiting a practitioner who submits a claim to the Minister for a benefit on behalf of a resident from submitting an account to the resident or to a Government department or agency with respect to the same health services, except when the account is for an amount in

RSA 2000

Section 17

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 20 addition to the benefit and is payable under an agreement or arrangement referred to in

section 21(1)(b); (

p) providing, without limiting the meaning of “residents’ or practitioners’ registration information” in

section 22, that certain information relating to the registration or enrolment of residents or practitioners obtained under this Part or the Health Insurance Premiums Act is included in the meaning of “residents’ or practitioners’ registration information” in

section 22; (

q) designating a person or entity with which the Minister may enter into an agreement under

section 22(15)(b).

(2) A regulation made under subsection (1)(n.2) to (n.9) may apply to all persons, organizations or bodies to which this

section applies or to a class of persons, organizations or bodies to which this

section applies, and there may be different regulations for different classes of such persons, organizations or bodies. RSA 2000 cA-20 s16;2020 c27 s1;2022 c4 s2;2025 c21 s1(22) Regulations 17 The Minister may make regulations (

a) respecting the rates of benefits in respect of basic health services or extended health services; (a.1) specifying the goods and serv ices that are included within a class of basic health services referred to in

section 1(b)(ii), (iii) or (iv); (

b) respecting the manner in which benefits are to be paid and the persons to whom benefits are to be paid, the conditions of payment and the information required to be submitted in connection with claims for benefits; (

c) specifying, within the classe s prescribed by the Lieutenant Governor in Council, the goods and services that are basic health services or extended health services for the purpose of the Plan; (

d) specifying goods or services referred to in

section 1(b)(iii) or (iv) that are basic health services (

i) for a prescribed period of time, or (ii) for the duration of a specified event. RSA 2000 cA-20 s17;2022 c4 s2

RSA 2000

Section 18

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 21 Reassessment of claims 18(1) The Minister may reassess, in accordance with this section, any claim for benefits that has been assessed under

section 4(2) if the Minister is of the opinion that no benefit is payable in respect of the claim or a benefit is payable in an amount other than the amount claimed.

(2) For the purposes of subsection (1), the circumstances in which no benefit is payable in respect of a claim or a benefit is payable in an amount other than the amount claimed include the following: (

a) the payment or rejection of the claim was made in error or as a result of incomplete, erroneous or false information provided to the Minister with respect to the claim; (

b) the Minister is of the opinion that (

i) the claim relates to a health service of a kind that the practitioner concerned has provided to the practitioner’s patients with a frequency that, in the circumstances, is unjustifiable, (ii) the total amount of benefits paid for the service was, in the circumstances, greater compensation to the practitioner or person referred to in

section 20.1 for that service than it should have been, taking into account the amount that would have been reasonable compensation for the service provided, in view of the time and degree of skill involved in providing the service, (iii) the service provided was, in the circumstances, inappropriate or unnecessary, (iv) the service provided could have been replaced by another professionally acceptable service for which a lower rate of benefits was payable, (

v) in the case of a service provided by a physician, the service was not medically required, or (vi) the service was not provided in accordance with (

A) the normal patterns of practice in Alberta of practitioners of the same profession who carry on similar types of practice in similar circumstances, or (

B) accepted standards of pr actice in Alberta of the profession of the practitioner concerned.

(3) Repealed 2025 c21 s1(23).

RSA 2000

Section 18

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 22

(4) When reassessing a claim, the Minister may (

a) establish a committee to prepare a report or make recommendations respecting the reassessment and may select and appoint persons from the roster established under subsection (4.1) as members of the committee, and (

b) have regard to any report or recommendations of the committee.

(4.1) The Minister may establish a roster of practitioners and members of the public who may be appointed to committees established under subsection (4).

(4.2) The Minister is not bound by a claim for benefits submitted, or by information provided in respect of a claim for benefits, by or on behalf of any person and shall reassess a claim for benefits in accordance with this Part and the regulations notwithstanding the claim for benefits submitted or information provided.

(4.3) When reassessing claims, the Minister may select a random sample of claims for reassessment and apply a statistical methodology, including extrapolation based on the reassessment of the random sample of claims, to the population of claims from which the sample was drawn.

(4.4) No appeal under subsection (9) shall be allowed by reason only that the amount under appeal was determined from a random sample of claims and by the application of a statistical methodology, including extrapolation, to the population of claims from which the sample was drawn.

(4.5) A reassessment of a claim is, subject to being varied or vacated on appeal under subsection (9), valid and binding notwithstanding any error, defect or omission in the reassessment or in any proceeding under this Part relating to it.

(5) When the Minister reassesses a claim, the Minister may make any appropriate adjustments to the amounts paid with respect to the claim, and (

a) if the amounts paid were in excess of the benefits payable under the adjustment, recover the excess amount from the person to whom the benefits are payable (

i) by withholding an amount equivalent to the excess from any benefits payable to the person, (ii) by proceedings on a certif icate registered with the Court of King’s Bench under subsection (5.2), or

RSA 2000

Section 18

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 23 (iii) under an agreement between the Minister and the person providing for the payment of the excess amount, or (

b) if the amounts paid were less than the benefits payable under the adjustment, pay the amount of the deficiency to the person to whom the benefits are payable.

(5.1) The Minister may certify an excess amount referred to in subsection (5)(

a) as an amount payable to the Minister by the person to whom the benefits are payable after (

a) the expiry of the appeal pe riod under subsection (9), if no application for an appeal is made, or (

b) if an application for an app eal is made, the day on which the Court dismisses the application, the application or appeal is discontinued or final judgment is given in the appeal confirming an excess amount.

(5.2) A certificate under subsection (5.1) shall, on production to the clerk of the Court of King’s Bench at the judicial centre closest to the place where the person to whom the benefits are payable resides or has an office according to the records of the Minister’s Department, be registered in the Court as a judgment of the Court and when registered has the same force and effect, and all proceedings may be taken on it, as if the certificate were a judgment obtained in the Court for a debt in the amount specified in the certificate.

(5.3) Any fees paid by the Minister for the registration of a certificate under subsection (5.2) or for the filing of a writ of enforcement under the Land Titles Act may be included in the amount specified in the certificate.

(6) The Minister may, with respect to any excess or deficiency referred to in subsection (5), charge or pay simple interest at a rate the Minister determines but not exceeding 8% per year.

(7) If the Minister reassesses a claim in respect of services provided by a practitioner, the Minister may withhold the payment of benefits in respect of any services provided by the practitioner until the Minister completes the reassessment.

(8) When the Minister reassesses a claim, the Minister shall notify the person who submitted the claim of the reassessment by mail.

(9) A person notified under subsection (8) may appeal the reassessment by filing an application with the Court of King’s

RSA 2000

Section 19

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 24 Bench within 60 days after the date on which the person was notified of the reassessment under subsection (8). RSA 2000 cA-20 s18;RSA 2000 cH-7 ss144,145,149;2005 c13 s1; 2007 c18 s1;2009 c53 s17;2020 c27 s1;2022 c4 s2;AR 217/2022; 2025 c21 s1(23) Order reducing future benefits 19(1) If a practitioner or person referred to in

section 20.1 becomes liable under

section 18(5) by reason of one or more reassessments of claims pursuant to subsection (1) of that section, the Minister may, with or without the consent of the practitioner or person referred to in

section 20.1, make an order directing that, after a date specified in the order and with respect to any specified kind of health service provided by that practitioner or person referred to in

section 20.1, the Minister will pay no benefits or only a portion of the benefits otherwise payable.

(2) An order under subsection (1) (

a) may be for a stated period or of indefinite duration; (

b) shall specify the health services to which it relates; (

c) shall specify, as to any service referred to in clause (b), whether no benefits are to be paid by the Minister in respect of it, or the portion of the benefits that are to be paid.

(3) A copy of an order under this

section shall be served (

a) in the case of a practiti oner, on the practitioner against whom it is made, and (

b) in the case of a person referred to in

section 20.1, on the person against whom it is made.

(3.1) Except where the order was made with the consent of the affected practitioner or person referred to in

section 20.1, the affected practitioner or person may, within 30 days after the date on which the practitioner or person received the copy of the order, apply to the Court of King’s Bench to have the order rescinded or varied.

(4) After hearing the application, the Court may (

a) confirm the order, or (

b) direct the Minister to (

i) rescind the order, if the Court considers the Minister had no reasonable justification for making it, or

RSA 2000

Section 20

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 25 (ii) vary the order in the manner specified by the Court.

(5) When an order of the Minister under this

section is of indefinite duration, the Minister shall review the order at least annually. RSA 2000 cA-20 s19;2009 c53 s17;2020 c27 s1;AR 217/2022; 2025 c21 s1(24) Remuneration of practitioners 20 The Minister may enter into agreements or establish arrangements for the payment of benefits on a basis other than a fee for service basis. RSA 2000 cA-20 s20;2020 c27 s1 Remuneration to other person 20.1(1) A person may submit a claim to the Minister in accordance with this

section for a benefit for an insured health service provided by a physician if (

a) the Minister has, in accordan ce with

section 20, entered into an agreement or established an arrangement with the person for the payment of benefits for the insured health service on a basis other than a fee for service basis, (

b) the person employs or has entered into a service agreement with the physician to provide the insured health service, and (

c) the physician was opted in to the Plan when the insured health service was provided.

(2) For the purposes of subsection (1) a “person” does not include an individual or a professional corporation.

(3) If a claim is submitted to the Minister in accordance with subsection (1), (

a) the payment of a benefit by the Minister to the person who submitted the claim discharges the Minister’s duty with respect to the payment of that benefit to the physician who delivered the insured health service, (

b) the physician who delivered the insured health service is not eligible to submit a claim to the Minister for a benefit for the insured health service, and (

c) no physician shall claim or receive the payment of a benefit from the Minister with respect to the insured health service.

(4) A person who submits a claim for benefits in accordance with subsection (1)

RSA 2000

Section 20.2

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 26 (

a) has all the duties of a practitioner with respect to the provision to the Minister of information required to facilitate the handling, assessing and payment of that claim for benefits, and (

b) shall provide the Minister (

i) on request, with a copy of an agreement referred to in subsection (1)(b), and (ii) with any other informati on prescribed for the purposes of this section. 2020 c27 s1;2025 c21 s1(26) Minister not liable 20.2 The Minister is not liable in respect of (

a) any provision of an agreement referred to in

section 20.1(1)(b), or (

b) any breach, termination or act done or omitted to be done by a party to an agreement referred to in

section 20.1(1)(b). 2020 c27 s1 Disclosure re practitioners and publicly funded health services 20.3(1) In this section, (a) “benefits” means (

i) the amounts payable by the Minister in respect of the cost of health services provided to residents, and (ii) any other amounts payable by a health entity or the Minister in respect of publicly funded health services and in respect of practitioners; (b) “personal information” means personal information as defined in the Protection of Privacy Act; (

c) subject to the regulations, “publicly funded health services” includes health-related programs and services that are funded fully or partially and directly or indirectly with public funds.

(2) The Lieutenant Governor in Council may, by regulation, require the following health entities to disclose to the Minister, subject to the regulations and in the form and manner determined by the Minister or under the regulations, the information, documents and records, including practitioners’ personal

RSA 2000

Section 20.3

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 27 information, required by the regulations with respect to any funding received, payments made or benefits provided by that health entity in respect of publicly funded health services and in respect of practitioners: (

a) the Government of Alberta; (

b) a provincial health agen cy, regional health authority, provincial health corporation and subsidiary health corporation under the Provincial Health Agencies Act; (

c) the Alberta Medical Association; (

d) Covenant Health and the subsidiaries of Covenant Health; (

e) any part or all of any other person, organization or body, whether incorporated or not, that provides or receives funding in respect of publicly funded health services; (

f) any part or all of any other person, organization or body, whether incorporated or not, that is specified in the regulations.

(3) Subject to the regulations, the Minister may require an officer, director or employee of a person, organization or body, whether incorporated or not, that the Minister believes to be a health entity under subsection (2)(

e) to provide any information, including practitioners’ personal information, required to determine whether the person, organization or body is a health entity.

(4) The Lieutenant Governor in Council may, by regulation, require the Minister to disclose to the public, subject to the regulations and in the form and manner determined by the Minister or under the regulations, (

a) all or part of the information, documents and records, including practitioners’ personal information, that have been disclosed to the Minister under subsection (2), and (

b) all or part of the information, documents and records, including practitioners’ personal information, that are in the Minister’s custody or control and that are required by the regulations with respect to any payments made or benefits provided by the Minister in respect of publicly funded health services and in respect of practitioners.

(5) The Minister may, on application by a practitioner or a health entity on behalf of a practitioner, exclude information, documents or records, including practitioners’ personal information, from

RSA 2000

Section 20.31

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 28 disclosure to the public under subsection (4) if the Minister is of the opinion that (

a) disclosure could unduly threaten the safety of the practitioner, or (

b) other criteria established by the regulations are met.

(6) The Minister may use the information, records and documents disclosed under subsection (2), including practitioners’ personal information, for purposes other than disclosure to the public under subsection (4).

(7) This

section does not authorize the disclosure of personal information about patients. 2020 c27 s1;2024 c10 s3;2025 c10 s4;AR 141/2025 Disclosure re contravention or failure to comply 20.31(1) If a person contravenes or fails to comply with this Division or the regulations made under this Division, the Minister may disclose to the public, in accordance with the regulations, information relating to the contravention or failure to comply.

(2) The Minister may, on application by a person who has contravened or failed to comply with this Division or the regulations made under this Division, exclude information, including the person’s personal information as defined in the Protection of Privacy Act, from disclosure to the public if the Minister is of the opinion that (

a) disclosure could unduly threaten the safety of the person, or (

b) other criteria established by the regulations are met.

(3) This

section does not authorize the disclosure of personal information about patients. 2025 c21 s1(27) Disclosure permitted despite other laws 20.4(1) Except for the Alberta Bill of Rights,

section 20.3 prevails over any enactment that it conflicts or is inconsistent with, and a regulation under

section 16(1)(n.2) to (n.6) or 20.3(2) or (4) prevails over any other bylaw, rule, order or regulation with which it conflicts.

(1.1) Except for the Alberta Bill of Rights,

section 20.31 prevails over any enactment that it conflicts or is inconsistent with, and a regulation under

section 16(1)(n.7) to (n.9) prevails over any other bylaw, rule, order or regulation with which it conflicts.

RSA 2000

Section 21

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 29

(2) A disclosure required under

section 20.3 or the regulations or permitted under

section 20.31 or the regulations does not contravene any enactment made on or before the day this

section comes into force.

(3) A disclosure required under

section 20.3 or the regulations or permitted under

section 20.31 or the regulations does not breach or contravene any contractual or other legal right of confidentiality.

(4) No cause of action lies against any person by reason of a disclosure required under

section 20.3 or the regulations or permitted under

section 20.31 or the regulations. 2020 c27 s1;2025 c21 s1(28) Relationship between practitioner and patient 21(1) Nothing in this Part or the regulations (

a) interferes with the right of any person to the person’s own choice of practitioner, (

b) except sections 9 and 10, in terferes with the right of any practitioner to make an agreement or arrangement with any person to collect from that person an amount in addition to the benefits payable by the Minister with respect to goods or services provided by the practitioner, if the agreement or arrangement is made before the goods or services are provided, (

c) except sections 9 and 10, affects the right of any resident to receive any health services or benefits in respect of them by reason of the resident’s choice of practitioner, or (

d) interferes with the right of a practitioner to accept or refuse to accept a patient who is a resident, subject to humanitarian considerations and the traditions and ethics of the profession of which the practitioner is a member.

(2) Nothing in this Part or the regulations prevents a resident from assuming the responsibility for the payment of the costs of health services provided to the resident or the resident’s dependants. RSA 2000 cA-20 s21;2025 c21 s1(29) Disclosing health information 22(1) Except as permitted or required under this Part, the Minister or a person employed in the administration of this Part and authorized by the Minister may disclose health information acquired under this Part or the Health Insurance Premiums Act only in accordance with the Health Information Act.

RSA 2000

Section 22

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 30

(1.1) If there is an inconsistency or conflict between subsection (6.1) or (7) and the Health Information Act, subsection (6.1) or (7), as the case may be, prevails.

(2) The Minister or any person authorized by the Minister may, for the purpose of enforcing the Crown’s right of recovery under the Crown’s Right of Recovery Act or the Opioid Damages and Health Care Costs Recovery Act, disclose information acquired under this Part.

(3) The Minister or a person employed in the administration of this Part and authorized by the Minister may disclose information pertaining to the date on which health services were provided, a description of those services, any diagnosis given by a person who provided the services, the name and address of the person who provided the services, the benefits paid for those services and the person to whom they were paid, the name and address of the person to whom the services were provided and any other information pertaining to the nature of the health services provided to any committee established to advise the Minister in respect of matters under

section 18.

(4) The Minister or a person employed in the administration of this Part and authorized by the Minister may, in connection with the administration of the Criminal Code (Canada), disclose to the Minister of Justice or a person or persons designated by the Minister of Justice information pertaining to the date on which health services were provided, a description of those services, any diagnosis given by a person who provided the services, the name and address of the person who provided the services, the benefits paid for those services and the person to whom they were paid, the name and address of the person to whom the services were provided and any other information coming to the knowledge of any person employed in the administration of this

Part in the course of that person’s employment.

(5) The Minister or a person employed in the administration of this Part and authorized by the Minister may disclose information pertaining to the date on which health services were provided and a description of those services, the name and address of the person who provided the services, the benefits paid for those services and the person to whom they were paid, the name and address of the person to whom the services were provided and any other information pertaining to the nature of the health services provided, to The Workers’ Compensation Board, a director under the Child, Youth and Family Enhancement Act, the Sexually Transmitted Disease Control Unit of the Department of Health, or the Director of Medical Services appointed under the Occupational Health and Safety Act, if

RSA 2000

Section 22

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 31 (

a) a member or officers of th e Board, a director under the Child, Youth and Family Enhancement Act, or an officer of the Unit, or the Director of Medical Services, as the case may be, makes a written request for it, and (

b) the information required is necessary and relevant to a matter being dealt with by the Board, a director under the Child, Youth and Family Enhancement Act, an officer of the Unit or the Director of Medical Services.

(6) Notwithstanding subsection (5), the Minister or a person employed in the administration of this Part and authorized by the Minister may disclose to the Director of Medical Services for The Workers’ Compensation Board or the Director of Medical Services appointed under the Occupational Health and Safety Act any diagnosis given by a person who has provided health services to another person if (

a) the Director makes a written request for the diagnosis, and (

b) the health services provided relate to or likely relate to the occupation or former occupation of the person for whom the health services were provided or to a disease that is related to that person’s occupation or former occupation.

(6.1) The Minister or a person employed in the administration of this Part and authorized by the Minister may disclose individually identifying health information, other than a diagnosis given by a person who has provided health services, acquired under this Part (

a) to the individual who is the subject of the information, (

b) to a person referred to in

section 104(1)(

c) to (

i) of the Health Information Act who is acting on behalf of the individual who is the subject of the information, or (

c) to a person other than the individual who is the subject of the information if the individual has consented to the disclosure in accordance with

section 34 of the Health Information Act.

(7) The Minister or a person employed in the administration of this Part and authorized by the Minister may disclose information pertaining to the date on which health services were provided and a description of those services, the name and address of the person who provided the services, the registration number of the person who received the services, the benefits paid for those services and the person to whom they were paid, but the information may be disclosed only

RSA 2000

Section 22

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 32 (

a) in connection with the administration of this Part, the regulations or the federal Act, (

b) in proceedings under th is Part or the regulations, (

c) in connection with the administration of the Financial Administration Act or regulations, orders or directives under that Act, (

d) to the person who provided that service, the person’s solicitor or personal representative, the committee of the person’s estate, the person’s trustee in bankruptcy or other legal representative, (e) - (

g) repealed RSA 2000 cH-5 s110, (

h) to a committee established under

section 18(4) for purposes in connection with that section, (

i) to a medical examiner appointed under the Fatality Inquiries Act for the purposes of an investigation under that Act, (

j) to the Hospital Privileges Appeal Board continued under the Provincial Health Agencies Act for the purposes of an appeal to that Board, or (

k) repealed RSA 2000 cH-7 s155, (

l) to a hearings director of a college under the Health Professions Act, if the information is furnished in compliance with a notice under

section 73 or 74 of the Health Professions Act.

(8) The Minister or a person employed in the administration of this Part and authorized by the Minister may disclose information, other than information related to health services, about a person, but the information may only be disclosed in connection with the administration of the Seniors Benefit Act.

(9) Notwithstanding subsection (7), the Minister or a person authorized by the Minister may disclose residents’ or practitioners’ registration information obtained under this Part or the Health Insurance Premiums Act (

a) for the purpose of the administration of this Part or the regulations, the Health Insurance Premiums Act or the regulations under that Act, the federal Act or a program that receives funds directly or indirectly from the Minister responsible for the Provincial Health Agencies Act or the

RSA 2000

Section 22

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 33 Minister responsible for the Emergency Health Services Act, or (

b) in proceedings under th is Part, the regulations, the Health Insurance Premiums Act or the regulations under that Act. (10) to

(14) Repealed RSA 2000 cH-5 s110.

(15) The Minister may enter into an agreement respecting the disclosure of practitioners’ registration information obtained under this Part or the Health Insurance Premiums Act with (

a) any Minister or government, or (

b) a person or entity designated in the regulations.

(16) The Minister may, in accordance with an agreement made under subsection (15), disclose practitioners’ registration information obtained under this Part or the Health Insurance Premiums Act.

(17) A government, person or entity that receives information under an agreement referred to in subsection (15) shall use the information only for the purposes specified in the agreement.

(18) With the consent of the Minister or an employee of the Government authorized by the Minister to do so, information of the kind referred to in subsection (5) and any other information pertaining to the nature of the health services provided and any diagnosis given by a person who provided the services may be disclosed or communicated to a disciplinary body of the organization of which that person is a member if an officer of that organization makes a written request for the information and states that the information is required for the purposes of investigating a complaint against one of its members or for use in disciplinary proceedings involving that member.

(19) The Minister may disclose to a disciplinary body of an organization any information referred to in subsection (7) and any other information pertaining to health services provided by a member of that organization if the Minister considers that it is in the interests of the public and of the organization that the information be so disclosed.

(20) In subsections (18) and (19), “disciplinary body” means (

a) the council or hearing tribun al of the College of Physicians and Surgeons of Alberta,

RSA 2000

Section 22

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 34 (

b) the council or a hearing trib unal of the College of Dental Surgeons of Alberta, (

c) the council or a hearing trib unal of the Alberta College of Optometrists, (

d) repealed 2019 c22 s1, (

e) the council or a hearing trib unal of the College of Podiatric Physicians of Alberta, (

f) the council or a hearing trib unal of the College of Alberta Denturists, (

g) the council or a hearing tribunal of the College of Opticians of Alberta, (

h) the council or a hearing tribunal of the College of Physiotherapists of Alberta, or (

i) the council or a hearing tribunal of the College of Registered Nurses of Alberta.

(21) The Minister or a person authorized by the Minister may disclose information obtained under the Blue Cross agreement to the council or complaints director of the Alberta College of Pharmacy for that organization’s use in investigating a complaint against a member of that organization or in disciplinary hearings involving that member if (

a) an officer of the Alberta College of Pharmacy makes a written request for the information, or (

b) the Minister considers that it is in the interests of the public and of the Alberta College of Pharmacy that the information be disclosed.

(22) A person who contravenes this

section is guilty of an offence.

(23) No report, form or return prescribed by or required for the purposes of this Part or the regulations shall be admitted in evidence in any judicial proceeding, other than a judicial proceeding under this Part, to adversely affect the interest of the person making the report, form or return.

(24) Notwithstanding subsection (23), the judge of the Court of Justice presiding at a public inquiry under the Fatality Inquiries Act may admit in evidence information obtained by a medical examiner under subsection (7)(i), but all proceedings related to that information shall be held in private.

RSA 2000

Section 23

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 35

(25) In this section, (a) “health information” means health information as defined in the Health Information Act; (b) “individually identifying”, when used to describe health information, means that the identity of the individual who is the subject of the information can be readily ascertained from the information.

RSA 2000 cA-20 s22;RSA 2000 cH-5 s110;RSA 2000 cH-7 ss143,144,145,146,147,148,149,150,151,152,155;2002 c30 s11;AR 49/2002; 2003 c16 s117;2003 c39 s8;2005 c13 ss1,4(4),(5),(21); 2007 c18 s1;2007 c32 s1(35),(41);2008 cH-4.3 s9;2008 c32 s6; 2008 c34 s19;2009 cC-35 s54;2013 c10 s6;2016 c9 s24;2017 c22 s3; 2019 cO-8.5 s15;2019 c22 s1;2022 c17 s2;AR 75/2023;2025 c10 s4; 2025 c21 s1(30);2026 c9 s1 Protection from action 23(1) If a practitioner or an agent or employee of a practitioner discloses information to the Minister or to a person employed in the administration of this Part, no action lies against the practitioner or the agent or employee in respect of the disclosure of that information.

(2) If a person referred to in

section 20.1 or an agent or employee of that person discloses information to the Minister or to a person employed in the administration of this Part, no action lies against the person referred to in

section 20.1 or the agent or employee of that person in respect of the disclosure of that information. RSA 2000 cA-20 s23;RSA 2000 cH-5 s110;2020 c27 s1;2025 c21 s1(31) Assignment of benefits 24 Subject to this Part and the regulations, the right of any person to receive payment of benefits is not assignable and no sum owing by the Minister as benefits is liable to be charged or to be attached in any proceedings or subject to an order for equitable execution against the person entitled to receive payment of benefits.

RSA 2000 cA-20 s24;2020 c27 s1;2025 c21 s1(31) Crown’s right of recovery 25 The Crown in right of Alberta is entitled to recover the Crown’s cost of health services under the Crown’s Right of Recovery Act or the Opioid Damages and Health Care Costs Recovery Act. RSA 2000 cA-20 s25;2009 cC-35 s54;2019 cO-8.5 s15 Prohibitions 26(1) In this section, (a) “carrier” means an insurer licensed under the Insurance Act;

RSA 2000

Section 26

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 36 (b) “insurer” means (

i) a carrier, or (ii) an employer, corporation or unincorporated group of persons that administers a self-insurance plan; (c) “self-insurance plan” means a contract, plan or arrangement entered into, established, maintained in force or renewed under which coverage is provided (

i) by an employer for all or some of the employer’s employees who are residents, (ii) by a corporation for all or some of its members who are residents, or (iii) by an unincorporated group of persons for all or some of its members who are residents.

(2) An insurer shall not enter into, issue, maintain in force or renew a contract or initiate or renew a self-insurance plan under which any resident or group of residents is provided with any prepaid basic health services or extended health services or indemnification for all or part of the cost of any basic health services or extended health services.

(3) An insurer that contravenes subsection (2) is guilty of an offence.

(4) Notwithstanding subsection (2), an insurer may enter into, issue, maintain in force or renew a contract or initiate or renew a self-insurance plan under which a resident is indemnified (

a) for the cost of any basic h ealth service or extended health service provided outside Alberta that is over and above the benefits payable by the Minister for that service, or (

b) to the extent prescribed by the regulations and in those cases specified in the regulations, for the cost of any basic health services or extended health services other than insured health services over and above the benefits payable by the Minister for those services.

(5) Subject to the regulations, if (

a) a carrier carries on a business of

RSA 2000

Section 27

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 37 (

i) providing for the prepayment of the cost of health services other than basic health services by way of group contracts and individual contracts, or (ii) selling insurance in respect of the cost of any health services other than basic health services by way of group contracts and individual contracts, (

b) the carrier has entered into such a group contract with an employer in respect of some or all of the employer’s employees who are residents, (

c) an employee who is a resident and is covered by that group contract retires from the employment of that employer in accordance with the employer’s retirement plan or policy, and (

d) that employee applies to the carrier, not later than 30 days after the date of the employee’s retirement, for an individual contract that is then being offered by the carrier to the public, and the employee pays the required initial premium or subscription, the carrier shall issue the individual contract to that resident to provide coverage for that resident and any of that resident’s dependants included in the application, regardless of the age or state of health of the resident or any of the resident’s dependants.

(6) A carrier that contravenes subsection (5) is guilty of an offence.

(7) This

section applies notwithstanding anything in the Insurance Act or any other Act. RSA 2000 cA-20 s26;2020 c27 s1;2025 c21 s1(32) False statements 27(1) A person providing health services to a resident who wilfully makes a false statement in any report, form or return required to be submitted to the Minister to enable benefits to be paid to the resident or to any other person is guilty of an offence and liable to a fine of not less than $10 000 and not more than $25 000.

(2) A person, other than a person providing health services to a resident, who wilfully makes a false statement in any report, form or return prescribed by or required for the purposes of this Part or the regulations is guilty of an offence and liable to a fine of not less than $10 000 and not more than $25 000. RSA 2000 cA-20 s27;2025 c21 s1(33)

RSA 2000

Section 28

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 38 Information for claim 28(1) A person who provides health services but does not claim payment from the Minister of the benefits in respect of them shall provide to a person referred to in

section 20.1 or any other person authorized by the regulations to make the claim all information required for the purpose of making the claim and obtaining payment from the Minister.

(2) When a person provides information under subsection (1), the person shall do so in the form prescribed by the Minister.

(3) A person who contravenes this

section is guilty of an offence. RSA 2000 cA-20 s28;2020 c27 s1 Administrative penalties 28.1(1) If the Minister is of the opinion that a person has contravened or failed to comply with this Division or the regulations made under this Division, the Minister may impose an administrative penalty on the person by issuing a notice of administrative penalty requiring the person to pay an amount determined in accordance with the regulations.

(2) In determining whether to impose an administrative penalty, the Minister may consider the following factors: (

a) the importance to the regulatory scheme of compliance with the provision that was contravened or with which the person failed to comply; (

b) the severity of the contravention or failure to comply; (

c) the degree of wilfulness or negligence, if any, on the part of the person; (

d) any steps taken by the person to mitigate actual or potential loss or damage resulting from or related to the contravention or failure to comply; (

e) any steps taken by the pers on to prevent recurrence of the contravention or failure to comply; (

f) any previous contraventions or failure to comply with the provision, this Act or the regulations made under this Act by the person; (

g) whether the person derived any economic benefit from the contravention or failure to comply; (

h) any other factors the Mi nister considers relevant.

RSA 2000

Section 28.2

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 39

(3) A notice of administrative penalty must be (

a) in writing and contain the information set out in the regulations, and (

b) served on the person in accordance with the regulations.

(4) A notice of administrative penalty may not be issued more than 6 years after the date on which the contravention or failure to comply came to the attention of the Minister.

(5) The Minister may not impose an administrative penalty in respect of a contravention or failure to comply on a person who has been charged with an offence in respect of the same contravention or failure to comply unless the person is not convicted of the offence. 2025 c21 s1(34) Appeal of administrative penalty 28.2(1) A person served with a notice of administrative penalty may appeal the administrative penalty by submitting a notice of appeal to the Minister in accordance with the regulations.

(2) On receiving a notice of appeal, the Minister may establish an appeal panel to hear the appeal.

(3) An appeal panel may confirm, vary or rescind a notice of administrative penalty. 2025 c21 s1(34) Administrative penalty not stayed 28.3(1) The commencement of an appeal of a notice of administrative penalty does not operate to stay the administrative penalty.

(2) The reassessment of a claim for benefits under

section 18 or an appeal of a reassessment under

section 18(9) does not operate to stay an administrative penalty issued for a contravention of

section 12.1. 2025 c21 s1(34) Enforcement or collection of administrative penalty 28.4 The Minister shall enforce or collect the payment of an administrative penalty in accordance with the regulations. 2025 c21 s1(34) Regulations 28.5 The Lieutenant Governor in Council may make regulations

RSA 2000

Section 29

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 40 (

a) respecting administrative penalties, including regulations respecting (

i) notices of administrative penalty, including the form, content and service of notices, and (ii) the amounts of administrative penalties and the manner of determining the amounts of administrative penalties; (

b) respecting appeals of administrative penalties, including regulations (

i) respecting notices of appeal of administrative penalties, including the form, content and service of notices of appeal, (ii) respecting appeal panels and authorizing the Minister to establish appeal panels, and (iii) respecting the conduct of appeals before appeal panels; (

c) respecting the enforcement and collection of administrative penalties for the purposes of

section 28.4, including regulations (

i) authorizing the Minister to bring proceedings or enter into agreements to enforce or collect administrative penalties, and (ii) respecting the imposition of interest on administrative penalties. 2025 c21 s1(34) Division 2 Optional Health Services

Definitions 29 In this Division, (a) “optional contract” means a c ontract issued by the Minister to a resident pursuant to the regulations under this Division; (b) “subscriber” means a person who is the holder of an optional contract; (c) “subscription” means an amount payable to the Minister by a subscriber under an optional contract; (d) “subsidy” means the amount prescribed in the regulations made under this Division by which a subscription is reduced. RSA 2000 cA-20 s29;2025 c21 s1(36)

RSA 2000

Section 30

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 41 Regulations 30 The Lieutenant Governor in Council may make regulations (

a) authorizing the Minister to issue contracts to residents providing insurance in respect of the cost of optional health services provided to the subscribers under it and their dependants; (

b) prescribing the classes of goods and services that are optional health services for the purposes of optional contracts; (

c) governing applications for optional contracts and the requirements to be met by applicants for those contracts; (

d) prescribing any terms or conditions of optional contracts; (

e) fixing subscription rates under optional contracts; (

f) authorizing the Minister to grant subsidies prescribing the amounts of the basis for calculating subsidies and prescribing the conditions as to eligibility of persons for subsidies; (

g) authorizing and empowering the Minister and a carrier as defined in

section 26 to enter into an agreement providing for (

i) the allocation of optional contracts by the Minister to the carrier for the purposes of administration, (ii) the fees to be paid to the carrier for its services, (iii) the powers and duties of the carrier under the agreement in respect of the administration of the contracts, and (iv) any other matters incidental to the allocation of the contracts or their administration; (

h) generally, providing for any other matter considered necessary for the purpose of administration and operation of this Division or to meet cases that may arise and for which no provision is made by this Part. RSA 2000 cA-20 s30;2025 c21 s1(37) 31 Repealed 2003 cI-0.5 s52. Regulations 32 The Minister may make regulations

RSA 2000

Section 33

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 42 (

a) prescribing the rates of benefits payable for optional health services under optional contracts; (

b) specifying, within the classe s prescribed by the Lieutenant Governor in Council, the goods and services that are optional health services for the purposes of optional contracts. RSA 1980 cA-24 s29 Division 3 General Regulations 33 The Lieutenant Governor in Council may make regulations (

a) defining “dependant” for the purposes of the Plan, this Part and the regulations; (

b) providing for the establishment of committees in connection with the Plan and prescribing their powers and duties; (

c) prescribing the remuneration and expenses to be paid to committees appointed under clause (b); (

d) providing, as to any provision of the regulations, that its contravention is an offence; (

e) respecting and authorizing the types of recoverable payments that may be made under the Plan; (

f) respecting and authorizing the programs the costs of which may be paid under the Plan; (

g) generally, providing for any other matter considered necessary for the purpose of administration and operation of this Part or to meet cases that may arise and for which no provision is made by this Part. RSA 2000 cA-20 s33;2025 c21 s1(39) Retrospectivity of regulations 34 A regulation made under

section 33(

e) may be effective as of any date not earlier than November 1, 1981 and may validate recoverable payments referred to in the regulation that were made under the Plan since that effective date. 1983 c32 s1;1994 c31 s1 Retrospectivity of regulations 35 A regulation made under

section 33(

f) may be effective as of any date not earlier than January 1, 1985 and may validate the

RSA 2000

Section 36

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 43 payment of the costs of the programs referred to in the regulation that were made under the Plan since that effective date. 1985 c32 s1;1994 c31 s1 Payments out of General Revenue Fund 36 The following may be paid out of the General Revenue Fund: (

a) recoverable payments pursuant to regulations under

section 33(e); (

b) payments required to be made by the Minister pursuant to an arrangement made pursuant to

section 88 of the Workers’ Compensation Act; (

c) any payment required to be made under the Plan pursuant to this or any other Act that is not paid under the authority of a supply vote. RSA 1980 cA-24 s31;1983 c32 s1;1985 c32 s1; 1987 c29 s2;1994 c31 s1 Benefits review committees 37(1) Notwithstanding

section 40.1(2), the Minister may establish one or more benefits review committees.

(2) The Minister may, with respect to a benefits review committee established under subsection (1), (

a) appoint or provide for the appointment of its members, (

b) prescribe the term of office of any members, (

c) designate a chair, vice-chair and secretary, and (

d) authorize, fix and provide for the payment of remuneration and expenses to its members.

(3) A benefits review committee shall, when directed to do so by the Minister, conduct a review of the rates of benefits payable in respect of (

a) basic health services or an y class of basic health services, (

b) extended health services or any class of extended health services, or (

c) optional health services or any class of optional health services, whichever are specified in the direction.

RSA 2000

Section 38

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 44

(4) If a benefits review committee is directed to conduct a review under subsection (3), the Minister may direct the committee to conduct the review in consultation with representatives of an association of persons who provide the services concerned.

(5) After conducting a review, a benefits review committee shall make recommendations to the Minister with regard to the rates of benefits it has reviewed. RSA 2000 cA-20 s37;2022 c4 s2 Forms 38 The Minister may prescribe any forms to be used under this Part or the regulations that the Minister considers necessary. RSA 2000 cA-20 s38;2025 c21 s1(39) Examination of practitioner’s records 39(1) A person employed in the administration of this Part who is expressly authorized to do so by the Minister may, for the purpose of conducting an examination and audit of the claims for or payments of benefits relating to health services provided by a practitioner or group of practitioners, (

a) enter the premises of the practitioner or group of practitioners, or a person referred to in

section 20.1, and (

b) examine and audit any books , accounts, patient records or other records that are maintained by or on behalf of the practitioner, group of practitioners or person referred to in

section 20.1.

(2) A person conducting an examination and audit under subsection (1) may (

a) take extracts from or make copies of all or any part of the books, accounts and records referred to in subsection (1)(b), and (

b) make inquiries of the prac titioner, the members of the group of practitioners or the person referred to in

section 20.1 respecting the claims, payments and health services.

(3) A practitioner, each member of a group of practitioners and a person referred to in

section 20.1 shall provide a person who has been authorized by the Minister under subsection (1) with access to the premises and to the books, accounts and records referred to in that subsection and shall answer the person’s inquiries respecting the claims, payments and health services.

(4) If a practitioner or a member of a group of practitioners fails or refuses to provide access to premises or to books, accounts or

RSA 2000

Section 39.01

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 45 records or fails or refuses to answer inquiries as required by subsection (3), the Minister, after advising the council of the College or the board of directors or council of the organization that represents the practitioner’s profession of the failure or refusal, may withhold the payment of benefits to that practitioner in respect of claims made by that practitioner on behalf of residents until the access is provided or the answers are given.

(5) If a person referred to in

section 20.1 fails or refuses to provide access to premises or to books, accounts or records or fails or refuses to answer inquiries as required by subsection (3), the Minister may withhold the payment of benefits to that person in respect of claims made by that person until the access is provided or the answers are given. RSA 2000 cA-20 s39;2007 c18 s1;2020 c27 s1;2025 c21 s1(39) Requirement for information, documents or access to premises 39.01(1) In this section, “authorized person” means a person who is expressly authorized by the Minister for the purposes of this section.

(2) In addition to any other requirement under this Part, the Minister may, for any purpose related to the administration or enforcement of this Part, including the collection of any amount payable to the Minister by any person, by notice served personally or by registered mail, require a person to do any of the following within a reasonable period stipulated in the notice: (

a) provide any information; (

b) produce any document or record; (

c) provide an authorized pers on access to premises in which information, documents or records required under clause (

a) or (

b) are located.

(3) A notice referred to in subsection (2) must set out (

a) a reasonable period of not less than 7 days within which the information or access must be provided or the document or record must be produced, (

b) a description of the information, document or record sought or the premises to which access is sought, and (

c) information respecting the order that may be made under subsection (6) if the person fails to provide the information or access sought or to produce the document or record sought within the period set out in clause (a).

RSA 2000

Section 39.1

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 46

(4) An authorized person may, for a purpose related to the administration and enforcement of this Part, (

a) make inquiries of any person, and (

b) on being provided access to premises referred to in subsection (2)(c), (

i) examine, take extracts from or make copies of any relevant document or record maintained on the premises, and (ii) use any electronic data pr ocessing equipment at or in respect of the premises and examine, take extracts from, make copies of or print any data contained in or available to the data processing equipment.

(5) Any person who has custody or control of the electronic data processing equipment referred to in subsection (4)(b)(ii) shall, on request, assist the authorized person with the use of the equipment.

(6) On

summary application by the Minister to the Court of King’s Bench, a judge may order a person to provide any information or access to premises, or produce any document or record, sought by the Minister under subsection (2) if the judge is satisfied that (

a) the person was required under subsection (2) to provide the information or access to the premises, or produce the document or record, and did not do so, and (

b) in the case of informatio n, a document or a record, the information, document or record is not protected from disclosure by solicitor-client privilege.

(7) An application under subsection (6) must not be heard before the end of 5 clear days from the day the notice of application is served on the person against whom the order is sought.

(8) A judge making an order under subsection (6) may impose any conditions in respect of the order that the judge considers appropriate. 2022 c4 s2;AR 217/2022;2025 c21 s1(40) Disclosure of information to prevent or limit fraud or abuse of health services 39.1(1) In this section, “custodian” means a custodian as defined in the Health Information Act.

(2) A custodian may disclose information about a health service referred to in subsection (3) without the consent of the person who

RSA 2000

Section 40

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 47 provided the health service or of the person who received the health service to a police service or the Minister of Justice where the custodian reasonably believes (

a) that the information relates to the possible commission of an offence under a statute or regulation of Alberta or Canada by the person who provided the health service, and (

b) that the disclosure will detect or prevent fraud or limit abuse in the provision of health services.

(3) A custodian may disclose the following information under subsection (2): (

a) the name and business address of the person who provided the health service; (

b) the name and address of the person who received the health service; (

c) the date on which the health service was provided; (

d) the description of the health service provided; (

e) the benefits that were paid or charged in relation to the health service provided. 2009 c25 s27;2013 c10 s6;2022 c17 s3 Special agreements 40(1) The Minister may enter into agreements with any government, person or unincorporated group of persons (

a) respecting any matter relating to the administration or operation of the Plan, or (

b) providing for any matter for which no provision is made elsewhere in this Part or in the regulations that the Minister considers necessary, and the Minister may implement any agreement so made.

(2) An agreement under subsection (1) between the Minister and the Alberta Medical Association may provide for the submission of differences to arbitration.

(3) If an agreement between the Minister and the Alberta Medical Association provides for arbitration, (

a) the arbitration is final and binding on the Crown and the Alberta Medical Association, and

RSA 2000

Section 40.01

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 48 (

b) the Arbitration Act does not apply to the arbitration. RSA 2000 cA-20 s40;2025 c21 s1(41) Retroactive adjustment of benefits for purposes of agreement 40.01(1) For the purposes of implementing an agreement entered into with the Alberta Medical Association under

section 40(1), the Minister may make an adjustment to a benefit payable in respect of an insured health service that is effective on a date before the date on which the adjustment is made.

(2) When the Minister makes an adjustment, the Minister shall publish information respecting the adjustment, including the benefit to which the adjustment applies, the amount of the adjustment and the effective date of the adjustment.

(3) When the Minister makes an adjustment in respect of a benefit that has already been paid to a person, the Minister may, (

a) if the benefit paid was in excess of the adjusted benefits, recover the excess amount from the person to whom the benefit was paid (

i) by withholding from any benefits payable to the person an amount equivalent to the excess amount, or (ii) under an agreement between the Minister and the person providing for the payment of the excess amount, or (

b) if the benefit paid was less than the adjusted benefit, pay the amount of the deficiency to the person to whom the benefit was paid.

(4) The Minister may, with respect to any excess or deficiency referred to in subsection (3), charge or pay simple interest at a rate the Minister determines but not exceeding 8% per year.

(5) An adjustment under this

section is not a reassessment of a claim for benefits under

section 18. 2025 c21 s1(42) AMA representation rights 40.1(1) In this section, (a) “AMA Agreement” mean s the agreement between Her Majesty the Queen in Right of Alberta, as represented by the Minister of Health, and the Alberta Medical Association (C.M.A. Alberta Division) made effective April 1, 2011, as amended from time to time;

RSA 2000

Section 41

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 49 (b) “compensation matters” means (

i) the rates of benefits payable for the provision of insured health services by a physician, and (ii) funding for the physician assistance programs and physician support programs referred to in the AMA Agreement, or any successors to those programs; (c) “physician” means a physician referred to in

section 1(t)(

i) who provides insured health services and is paid in accordance with this Part.

(2) The Minister recognizes the Alberta Medical Association as the exclusive representative of physicians on compensation matters.

(3) The Minister recognizes the Alberta Medical Association as a representative of physicians on health matters that touch and concern physicians.

(4) The Minister shall engage the Alberta Medical Association in good faith and consider the Association’s representations on matters for which the Association represents physicians. 2018 c22 s1;2019 c18 s1;2022 c17 s4;2025 c21 s1(43) 40.2 Repealed 2022 c17 s5. Blue Cross agreement 41(1) Subject to the approval of the Lieutenant Governor in Council, the Minister and the ABC Benefits Corporation may enter into an agreement, referred to as the Blue Cross agreement, providing for the following: (

a) programs to provide goods and services to residents and their dependants by the ABC Benefits Corporation on payment of the premiums prescribed in respect of the programs under the regulations made pursuant to the Health Insurance Premiums Act; (

b) the payments to be made by the Minister to the ABC Benefits Corporation with respect to goods and services provided to residents and their dependants under the Blue Cross agreement; (

c) the goods and services that are to be provided under the Blue Cross agreement with respect to residents and their dependants;

RSA 2000

Section 42

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 50 (

d) generally, any matter in connection with or incidental to the matters referred to in clauses (a), (

b) and (c).

(2) Only goods and services that are not basic health services or extended health services may be provided under the Blue Cross agreement.

(3) If a resident is in arrears of premiums under the Health Insurance Premiums Act, the resident and the resident’s dependants are not entitled to receive goods and services under the Blue Cross agreement. (4) Subsection (3) does not apply if (

a) the resident or the resident’s spouse or adult interdependent partner is 65 years of age or over, or (

b) repealed 2 003 cI-0.5 s52.

(5) The Lieutenant Governor in Council may make regulations not inconsistent with the Blue Cross agreement governing any matter in connection with or incidental to matters provided for in the agreement. RSA 2000 cA-20 s41;2002 cA-4.5 s16; 2003 cI-0.5 s52;2004 c5 s3 General penalty 42 A person who is guilty of an offence under the regulations or under this Part and for which no penalty is specifically provided, is liable (

a) for a first offence, to a fine of not more than $10 000 and in default of payment to imprisonment for a term of not more than 90 days, (

b) for a 2nd offence, to a fine of not more than $50 000 and in default of payment to imprisonment for a term of not more than 6 months, and (

c) for a 3rd or subsequent offence, to a fine of $100 000 or imprisonment for a term of not more than 12 months. RSA 2000 cA-20 s42;2025 c21 s1(44) Financial assistance 43(1) The Lieutenant Governor in Council may establish a program to provide financial assistance in cases where, because of the sickness or disability of a resident or dependant, the resident is faced with expenses that could not reasonably be foreseen and guarded against and that place an undue burden on the financial resources of the resident.

RSA 2000

Section 44

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 51

(2) The program may specify the types of expenses in respect of which assistance may be given and the portion of the expense that is to be borne by the resident. RSA 1980 cA-24 s39;1983 c81 s1;1984 c26 s1 Residence requirements 44(1) A resident who is entitled to benefits under this

Part is also entitled to receive, without charge, insured health services that are provided under (

a) repealed 2 008 cH-4.3 s9; (

b) the Mental Health Act; (

c) the Public Health Act; (

d) any other Act under which insured health services are provided, notwithstanding any provision of those Acts or the regulations under them that provide requirements as to residence in Alberta that are inconsistent with or more onerous than the requirements as to residence under the Plan. (2) Subsection (1) does not affect any provision in any Act referred to in that subsection or in any regulations under such

an Act that pertain to requirements as to residence in Alberta in relation to the provision of any services that are not insured health services. RSA 2000 cA-20 s44;2008 cH-4.3 s9;2025 c21 s1(45)

Part 2 Insured Hospital Services Plan

Definitions 45 In this Part, (a) “approved facility” means a facility designated by the oversight Minister as an approved facility under

section 65(1); (b) “approved hospital” means an approved hospital under the Provincial Health Agencies Act; (c) “authorized charges” means the authorized charges a patient is required to pay under

section 56(1); (d) “enhanced goods and services” means enhanced goods and services referred to in

section 57;

RSA 2000

Section 45

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 52 (e) “hospital operator” means hospital operator as defined in the Provincial Health Agencies Act; (f) “health services sector” me ans, with respect to a sector Minister, the health services sector for which the sector Minister is responsible under the Provincial Health Agencies Act; (g) “hospital services” means health services that a hospital services facility operator provides in a hospital services facility; (h) “hospital services facility” means (

i) a health services sector in an approved hospital, (ii) a prescribed institution, (iii) a location where a prescr ibed body provides hospital services, or (iv) an approved facility; (i) “hospital services facility operator” means (

i) a hospital operator, (ii) the operator of a prescribed institution, (iii) a prescribed body, or (iv) the operator of an approved facility; (j) “insured hospital service” means an insured hospital service referred to in

section 52; (k) “non-entitled person” means a person who is not entitled to receive insured hospital services under this Part; (l) “non-insured hospital service” means a non-insured hospital service referred to in

section 54; (m) “operating costs” means the costs of providing insured hospital services in a hospital services facility that are paid by the sector Minister under the Plan; (n) “oversight Minister” means the oversight Minister under the Provincial Health Agencies Act; (o) “patient” means a person

RSA 2000

Section 45

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 53 (

i) admitted as an in ‑patient to a hospital services facility, or (ii) to whom hospital services are provided as an out-patient in a hospital services facility; (p) “Plan” means the Insured Hospital Services Plan referred to in

section 47(1); (q) “prescribed body” means a body prescribed by the regulations for the provision of insured hospital services; (r) “prescribed institution” means an institution prescribed by the regulations for the provision of insured hospital services; (s) “regulations” means the regul ations made under this Part, unless the context otherwise requires; (t) “resident” means a person who is, in accordance with the regulations, (

i) lawfully entitled to be or remain in Canada and makes the person’s home and is ordinarily present in Alberta, or (ii) deemed by the regulations to be a resident, but does not include a tourist, transient or visitor to Alberta or a person assumed under the Health Insurance Premiums Act no longer to be a resident; (u) “sector Minister” means, (

i) with respect to a hospital services facility that is a health services sector in an approved hospital and a hospital services facility operator that is a hospital operator, the sector Minister responsible for the health services sector under the Provincial Health Agencies Act, or (ii) with respect to a hospita l services facility other than a health services sector in an approved hospital and a hospital services facility operator other than a hospital operator, (

A) the sector Minister re sponsible for the provincial health agency under the Provincial Health Agencies Act, if the hospital services facility operator is a provincial health agency, (

B) the responsible Minister for the provincial health corporation under the Provincial Health Agencies

RSA 2000

Section 46

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 54 Act, if the hospital services facility operator is a provincial health corporation, or (

C) the sector Minister de signated by the oversight Minister for the purpose, if the hospital services facility operator is not a provincial health agency or provincial health corporation; (v) “standard hospital services ” means the following services provided to in-patients: (

i) accommodation and meals at the standard ward level; (ii) necessary nursing services; (iii) laboratory, radiological and other diagnostic procedures, together with the necessary

interpretation; (iv) drugs, biologicals and related preparations when administered in a hospital services facility; (

v) use of radiotherapy facilities; (vi) use of operating room, case room and anaesthetic facilities, including necessary equipment and supplies; (vii) surgical equipment and supplies; (viii) use of physical therapy services; (ix) services provided by persons who receive remuneration for those services from the hospital services facility operator. 2025 c21 s1(46);2026 c9 s1 Application of

Part 46 Except as otherwise provided in the regulations, this Part and the regulations apply in respect of a facility as defined in the Mental Health Act. 2025 c21 s1(46) Division 1 Insured Hospital Services Plan Establishment, administration and operation of Plan 47(1) This Part and the regulations establish the Insured Hospital Services Plan to provide insured hospital services to all residents.

(2) Each sector Minister shall administer and operate the Plan on a non-profit basis with respect to

RSA 2000

Section 48

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 55 (

a) the provision of hospital serv ices in the sector Minister’s health services sector, and (

b) the hospital services facilities for which the sector Minister is responsible. 2025 c21 s1(46) Entitlement to insured hospital services 48(1) Subject to

section 49, a resident is entitled to receive insured hospital services.

(2) For the purposes of this section, a certificate of registration issued under the Health Insurance Premiums Act is proof, in the absence of evidence to the contrary, that a person is a resident if the certificate was in effect at the time the insured hospital services were provided to the person. 2025 c21 s1(46) Residents not entitled to insured hospital services 49(1) If a resident files a declaration under

section 25 of the Health Insurance Premiums Act, the resident and any dependant of the resident to whom the declaration extends or applies are not entitled to receive insured hospital services while the declaration is in effect.

(2) A resident is not entitled to receive insured hospital services during the applicable waiting period prescribed in the regulations made under the Health Insurance Premiums Act. 2025 c21 s1(46) Provision of insured hospital services in emergencies 50(1) In an emergency, a hospital services facility operator shall not, solely on the basis that a person is a non-entitled person, (

a) refuse to admit the person to the hospital services facility, or (

b) refuse to provide hospital services to the person in the hospital services facility. (2) Subsection (1) applies notwithstanding this or any other Act or the regulations made under this or any other Act. 2025 c21 s1(46) Division 2 Insured and Non-insured Hospital Services Provision of insured hospital services 51 Insured hospital services may be provided only by a hospital services facility operator in a hospital services facility. 2025 c21 s1(46)

RSA 2000

Section 52

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 56 Insured hospital services 52 A hospital service is an insured hospital service if (

a) the hospital service is (

i) a standard hospital service, or (ii) a good or service prescr ibed by the regulations as an insured hospital service, and (

b) the cost of providing the hospital service is paid by the sector Minister under the Plan. 2025 c21 s1(46) Payment for insured hospital services 53(1) A sector Minister shall pay for the provision of insured hospital services by hospital services facility operators in hospital services facilities to residents who are entitled to receive insured hospital services.

(2) The sector Minister may make grants to hospital services facility operators for the purposes of subsection (1). 2025 c21 s1(46);2026 c9 s1 Non-insured hospital services 54(1) A hospital service is a non-insured hospital service if the sector Minister is not required to pay the cost of providing the hospital service under the Plan.

(2) The following hospital services are non-insured hospital services: (

a) a hospital service provided to a resident who is entitled to receive the hospital service (

i) under another enactment or under a statute of Canada or another province or territory, or (ii) under the Workers’ Compensation Act or a law of any jurisdiction outside Alberta relating to workers’ compensation; (

b) a hospital service provided to a resident who has been declared, under

section 1.976993(1) of the Provincial Health Agencies Act, to be no longer in need of the hospital service; (

c) an enhanced good or service;

RSA 2000

Section 55

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 57 (

d) a good or service prescr ibed by the regulations as a non-insured hospital service. 2025 c21 s1(46) No payment for non-insured hospital services 55(1) A sector Minister shall not pay for the provision of non- insured hospital services by hospital services facilities operators to residents or non-entitled persons.

(2) Notwithstanding subsection (1), a sector Minister may pay for the provision of non-insured hospital services and other goods and services by operators of approved facilities to residents or non-entitled persons. 2025 c21 s1(46) Division 3 Charges and Fees Authorized charges for non-insured hospital services 56(1) Subject to subsection (2), each patient in a hospital services facility shall pay the applicable authorized charges to the hospital services facility operator, in accordance with the regulations, for any non-insured hospital services provided to the patient.

(2) A sector Minister may pay the authorized charges that a patient with a prescribed illness, disease or condition would otherwise be required to pay under subsection (1) in the amounts set out in or determined in accordance with the regulations. 2025 c21 s1(46) Fees for enhanced goods and services 57(1) The provincial health agency established for a health services sector may designate specific non-insured hospital services provided in a hospital services facility in the health services sector as enhanced goods and services.

(2) Subject to subsection (4), each patient who requests and receives enhanced goods and services in a hospital services facility shall pay a fee to the hospital services facility operator for the enhanced goods and services if the provincial health agency has authorized the hospital services facility operator to charge a fee for those enhanced goods and services.

(3) The provincial health agency shall, in accordance with the regulations, determine the amount of the fee a hospital services facility operator is required to charge for enhanced goods and services.

(4) If a patient’s attending physician is of the opinion that, due to medical necessity, the patient requires enhanced goods or services,

RSA 2000

Section 58

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 58 the patient is not required to pay a fee for those enhanced goods and services. 2025 c21 s1(46) Fees charged to non-entitled persons 58(1) Each patient who is a non-entitled person and to whom hospital services or other goods and services are provided in a hospital services facility shall pay a fee to the hospital services facility operator, in accordance with the regulations, for the hospital services or other goods and services provided to the patient.

(2) The sector Minister shall establish a

schedule of fees to be paid by non-entitled persons under subsection (1).

(3) The sector Minister shall ensure that the

schedule of fees is published or otherwise made publicly available. 2025 c21 s1(46) Fees for health services provided by physicians 59 Each patient to whom health services other than insured health services under

Part 1 are provided by a participating physician or flexibly participating physician when that physician is participating in the Plan in a hospital services facility shall pay a fee to the hospital services facility operator, in accordance with the regulations, for (

a) the health services provided to the patient, and (

b) the goods and services provided to the patient in connection with the health services. 2025 c21 s1(46);2026 c9 s1 Division 4 Recovery and Payment of Costs by Residents Recovery of costs of providing hospital services 60 If, while a declaration under

section 25 of the Health Insurance Premiums Act is in effect, a hospital services facility operator provides insured hospital services to the resident who filed the declaration or a dependant of the resident to whom the declaration extends or applies, (

a) the hospital services facility operator is entitled to recover the costs of providing the insured hospital services only from the resident, and

RSA 2000

Section 61

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 59 (

b) the sector Minister may not make a grant to the hospital services facility operator in respect of the provision of the insured hospital services. 2025 c21 s1(46) Assuming responsibility for costs of insured hospital services 61 Nothing in this Part or the regulations prevents a resident from assuming the responsibility for the payment of all or part of the costs of the insured hospital services provided to the resident in a hospital services facility. 2025 c21 s1(46) Division 5 Payments to Operators of Other Hospitals and Agencies Hospital services outside Alberta 62 If hospital services or other goods and services are provided to a resident in a hospital or health care facility outside Alberta, the Government of Alberta shall pay, in accordance with the regulations, for the hospital services or other goods and services provided to the resident if (

a) the hospital services or other goods and services would have been insured hospital services had they been provided to the resident in Alberta, and (

b) the resident would have been entitled to receive the hospital services or other goods and services as insured hospital services had they been provided in Alberta. 2025 c21 s1(46) Payments to operators of certain public hospitals 63(1) In this section, “public hospital” means a hospital (

a) established by or under, or the establishment or operation of which is governed by, the Workers’ Compensation Act, or (

b) established by the Government of Canada.

(2) A sector Minister may pay the operator of a public hospital for the insured hospital services that the operator provides to residents and their dependants.

(3) An agreement between the sector Minister and the operator of a public hospital for the purposes of subsection (2) must include any terms, conditions or restrictions required by the oversight Minister. 2025 c21 s1(46)

RSA 2000

Section 64

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 60 Payments to agencies 64 The sector Minister responsible for the acute care health services sector under the Provincial Health Agencies Act may pay The Canadian Red Cross Society or the Canadian Blood Services/Société canadienne du sang for services approved by the sector Minister. 2025 c21 s1(46) Division 6 General Designation of approved facilities 65(1) Subject to subsection (2), the oversight Minister may designate a facility as an approved facility for the provision of insured hospital services.

(2) The Minister may not designate any of the following as an approved facility: (

a) a health services sect or in an approved hospital; (

b) a prescribed institution; (

c) a location where a prescribed body provides insured hospital services. 2025 c21 s1(46) Operating costs 66 The operating costs of a hospital services facility shall be shared between the patients of the hospital services facility and the Government of Alberta on the basis set out in the regulations. 2025 c21 s1(46) Records, reports and returns 67(1) A hospital services facility operator shall, on the written request of the oversight Minister or sector Minister, provide to the oversight Minister or sector Minister records, reports and returns relating to the hospital services facility and the provision of hospital services in the hospital services facility as specified in the request.

(2) The records, reports and returns must be provided (

a) at the times and in the manner specified in the request, and (

b) in accordan ce with the Health Information Act.

(3) The sector Minister may, if a hospital services facility operator fails to comply with a request made under subsection (1), suspend

RSA 2000

Section 68

Chapter A-20 ALBERTA HEALTH CARE INSURANCE ACT 61 or cancel the payment of a grant to the hospital services facility operator made under

section 53(2). 2025 c21 s1(46) Participation in federal programs 68 A sector Minister may participate in a prescribed federal program for the provision of insured hospital services. 2025 c21 s1(46) Group contracts 69(1) In this section, (a) “group contract” means an insurance contract under which 2 or more persons, other than members of the same family, are insured severally; (b) “insurer” means an insurer licensed under the Insurance Act.

(2) Subject to subsection (3), an insurer shall not make a new contract or add new members to a group contract under which a resident is to be provided with or reimbursed or indemnified for the cost of (

a) standard hospital services and authorized charges related to those services, or (

b) other insured hospital services, other than authorized charges related to those services.

(3) An insurer may make a contract of insurance in respect of the cost of insured hospital services if (

a) the contract is made with a resident who has filed a declaration under

section 25 of the Health Insurance Premiums Act, (

b) the contract provides insurance coverage for the resident and the resident’s dependants as defined in the regulations under that Act, (

c) the insurance coverage rela tes to insured hospital services provided during the period while the resident’s declaration is in effect, and (

d) no coverage is provided in respect of the cost of authorized charges related to standard hospital services.

(4) A contract made in contravention of subsection (2) or that does not comply with subsec

Document details

Collection	Alberta — Consolidated Statutes
Citation	RSA 2000 cA-20
Type	statute
Volume / chapter	A20
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	56269c41909b3ce43cb63f5e5ddda81b066d0c2b

Source file is stored in the law ingest library (pdf).