AADL & Ostomy Supply Reimbursement

AADL may provide funding for ostomy supplies for clients:

• With a permanent, functioning colostomy, urostomy, or ileostomy, and
• Are not expected to have a reversal within six months of the initial ostomy surgery.
• Who are pediatric clients and clients with an esophagectomy, cecostomy, or fistula. (Must be assessed by NSWOC).
• Be an Alberta resident with a valid Alberta Personal Health Care Number;
• Be evaluated by a healthcare professional who is also an AADL-approved Authorizer or Specialty Assessor (i.e., NSWOC); and
• Meet specific eligibility criteria for the recommended benefit.

Who Is Not Eligible for AADL?

Individuals who are not eligible may include:

• Temporary ostomies for less than six months.
• Those with existing insurance coverage such as Veterans Affairs “A” Clients, NIHB, WCB, RCMP & Armed Forces
  • Non-Insured Health Benefits clients (NIHB) who qualify for AADL can access the program for supplies not covered by NIHB.
• Albertans with private health insurance covering 100 percent of the benefit-cost are not eligible for the same benefit under AADL. Once the private health insurance coverage is exhausted, the client may become eligible under AADL.

How To Apply for AADL

Before applying for AADL benefits, you need to be assessed by a healthcare professional, typically an NSWOC. They will determine your basic medical needs and whether you are eligible for the program and provide authorization for your ostomy supplies. AADL will not reimburse clients who purchase ostomy supplies before assessment and authorization.

Ostomy Supply Coverage

AADL provides coverage for ostomy supplies through their cost-share program, where Albertans pay 25% of the benefit-cost to a maximum of $500 per individual or family per year (July 1 to June 30). Coverage is raised to 100% at that point.

Clients may choose an upgraded ostomy supply item and pay the additional cost of this item. These additional costs are not included in the $500 cost-share maximum. Low-income Albertans and people receiving income assistance do not pay the cost-sharing portion. Read more…

Taxable Family Income	AADL Cost-Share	Client Cost-Share	Cost-Share Max, then 100% covered
Clients who do not qualify for the low-income exemption	75%	25%	$500
Low-Income Single, taxable income below $20,970	100%	0%	$0
Low-Income Couple with no children, taxable income below $33,240	100%	0%	$0
Low-Income Parents with children, taxable income below $39,250	100%	0%	$0

What Ostomy Products Are Covered?

AADL covers a comprehensive list of ostomy supplies:

• One and two-piece ostomy appliances
• Ostomy Pouches, drainable, closed, high output & urostomy
• Skin Barrier Wafers / Flanges, flat, convex, extended wear
• Pediatric ostomy supplies
• Ostomy accessories include convex inserts, stoma collars, flange extenders, powder, skin barrier rings/sheets/seals, skin barrier paste/strips, and ostomy tape.
• Odour control
• Ostomy irrigation kits, sleeves
• Continent ostomy dressing
• Ostomy belt and hernia belt

Manufacturers covered include Hollister, Convatec, Coloplast, Salts, Safe & Simple, Marlen, Hernia-Pro, and CUI/Fulcionel.

For a detailed product list, please see AADL Approved Product List.

Biennial Reauthorization for Ostomy Coverage:

AADL is now using a new online system (Bluecross), where your authorization will expire every two years automatically from the date of your initial assessment. You can expect your vendor to notify you of the expiry, but it would be good to put the date in your calendar. Clients can then contact their NSWOC to renew, usually over the phone, unless the authorizer determines that an in-person assessment is necessary. There is a new “Client Consent” form as of July 1, 2022 that NSWOCs can email or fax to clients to have them sign and return. They will keep a copy on file for future changes or renewals.

Quantity & Frequency for Ostomy Supply Orders

You can only order certain ostomy supplies every two months through AADL. (For example, 30 Skin Barrier Wafers every two months). However, an NSWOC can authorize amounts higher than the listed maximums. Most products can be ordered every two months. However, there are some exceptions (such as stoma powder which is one every four months, and Hernia belts, which have an anniversary rule).

Your order can be placed any time during these two-month periods. For instance, you can place an order on February 28, and then place your next order on March 1.

• January/February
• March/April
• May/June
• July/August
• September/October
• November/December

Purchasing Ostomy Supplies From AADL Approved Vendors

You are required to purchase your ostomy supplies from an approved AADL vendor. Approved vendors include home healthcare stores and pharmacies that sell ostomy supplies. AADL does not support online-only shops. Your authorizer will provide you with at least three vendors, or you may choose from the approved vendor list.

AADL Reimbursement Procedure for Ostomy Supplies

Your ostomy vendor will bill (via Blue Cross) the covered amount directly to AADL. At the same time, you will pay the remaining balance. You can claim the out-of-pocket portion to your private insurance. Any remaining unreimbursed amounts can be claimed on your income tax as a Medical Expense.

AADL Policy, Approved Product & Vendor Lists

Ostomy supplies are listed under Section M – Medical Supplies in the following AADL documents. We have provided direct links to the documents for your convenience, but please feel free to contact us if you find one to be out of date.

AADL Contact Information

Alberta Health
Alberta Aids to Daily Living (AADL)

Telus House, 13th Floor
10020 100 Street NW
Edmonton, Alberta  T5J 0N3

Phone: 780-427-0731
Toll-free: 310-0000 before the phone number (in Alberta)
Fax: 780-422-0968 or 780-424-0432

Website: https://www.alberta.ca/alberta-aids-to-daily-living.aspx

Did you find this information helpful? Consider becoming a member! Members receive our quarterly newsletter, which includes important updates about ostomy supply reimbursement through AADL.