Forms Health Care Insurance Plan
Forms
Alberta Health Care Insurance Plan forms for individual use are listed below. You can also contact us to request a form or obtain additional information.
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 by mail, fax or in person.
| Applying for coverage or change of status | ||
| AHC0102 | Application for Alberta Health Care Insurance Plan Coverage  |
Fill & Print |
| AHC0107 | Notice of Change To change a name, address or add/delete family members |
Print only |
| AHC0312W | Proof of Age Declaration |
Fill & Print |
|
Premium Assistance |
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AHC0208G |
Application for Premium Subsidy Current form for April 1, 2012 to March 31, 2013 based on your 2011 taxable income. |
Print only |
| AHC0391 | Current and Retroactive Premium Subsidy April 1, 2009 to March 31, 2010 based on 2008 taxable income April 1, 2010 to March 31, 2011 based on 2009 taxable income April 1, 2011 to March 31, 2012 based on 2010 taxable income |
Print only |
| Payment Plan | ||
| AHC0104A | Registration for Preauthorized Monthly Payment For Alberta Blue Cross Non-Group Premiums |
Print only |
|
Optional health plans Alberta Blue Cross |
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| AHC0201 | Alberta Blue Cross Non-group Coverage |
Print only |
| ABC20039 | Alberta Blue Cross Health Services Claim form |
Fill & Print |
| AHC0222 | Alberta Blue Cross Palliative Care Drug Program |
Print only |
| Brochures | ||
| AHC0009 | About Alberta Health Care Insurance Plan |
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| ABC40005 | Alberta Blue Cross Coverage for Seniors |
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| ABC40004 | Alberta Blue Cross Non-Group Coverage |
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| ABC40501 | Alberta Blue Cross MS Drug Coverage |
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| ABC40500 | Alberta Blue Cross Palliative Care Drug Program |
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| AHC1443 | Premium Assistance Program |
|
| AHC0012 | Health Coverage Outside Alberta |
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| Group forms | ||
| AHC0199 | Employee Group Commencement / Termination |
Print only |
New and revised forms and brochures are posted on the form pages on a regular basis. To avoid using an outdated form, we recommend you do not save any form. If you need a form, check this page to ensure you have the most current version of the form.
