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Out-of-Country Claim Form

All emergency out-of-country claims must first be reviewed by Alberta Health Services (AHS) to determine if any expenses are eligible to be paid by AHS. This process can be time consuming and confusing which is why ASEBP has teamed with AHS to coordinate the entire claims process on your behalf. This will help ensure eligible amounts are paid to you or your service provider in timely manner. It may also prevent service providers or collection agencies from contacting you directly and requesting immediate payment.

To take advantage of this coordination service, please complete the following forms (available in the link below) and submit them directly to ASEBP:

  1. ASEBP Emergency Out-of-Country Claim form
  2. Alberta Health Services Insurance Claim Consent and Authorization form

When completing the Alberta Health Services Claim Consent and Authorization form, the dates that are required in the ‘Effective Date’ section are as follows:


  • 'From Date’ should be the date your trip began
  • 'To Date’ should be 18 months from the date in which your trip began

AHS can take several months to assess out-of-country claims, and forward their final payment and Statement of Account. Ensuring information on your documents is accurate and complete, and submitting documents together will help prevent any further delays in this process.


Completed claim forms should be mailed to:

Alberta School Employee Benefit Plan
Allendale Centre East
Suite 301, 6104-104 Street NW
Edmonton AB T6H 2K7

Download the Emergency Out-of-Country Claim forms (ASEBP and Alberta Health Services)