Claim forms – Health Care Insurance Plan
Important: Due to the sensitive nature of the information required, DO NOT return forms via email. Electronic submission is not available. Print and return your application in person at an authorized registry agent office, or by mail, fax or in person.
- Out-of-Province Claim Form for Physician / Practitioner Services This claim form has two purposes. It is to be used by:
- Alberta physicians (for services that can not be billed through the medical reciprocal billing process) and other practitioners providing services to residents from other parts of Canada.
- Alberta residents wanting to submit a claim to the AHCIP for physician services they received in other parts of Canada.
- Out of Country Health Services Claim Form Application to claim practitioner services and facility services outside Canada.
- Blue Cross Health Services Claim Form Fill and print
- Quebec Claim for Physician / Practitioner Services Used by Alberta physicians and other practitioners providing services to residents from Quebec.
- Complete and send to: Régie de l'assurance maladie, Case postale 500, Québec (Québec) G1K 7B4
- Request for Statement of Benefits Paid Request for practitioner services received during a specific period, by self, parent or legal guardian.
- Insurance Claim Consent and Authorization Application for third-party requests for reimbursement of insured physician and hospital services paid on behalf of Alberta residents who obtained emergency medical services outside Canada.