Forms – Health Care Insurance Plan

Important: Due to the sensitive nature of the information required, DO NOT return forms via e-mail. Print and return your application by mail, fax or in person.

Forms – Individuals

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.

  • For group forms, instructions and additional information, select from the links on the left.

Forms for individual use

Important: Due to the sensitive nature of the information required, DO NOT return forms via e-mail. 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 PDF icon Print only
AHC0107 Notice of Change PDF icon To change a name, address or add/delete family members Print only
AHC0312W Proof of Age Declaration PDF icon Fill & Print

Premium Assistance

AHC0208G

Application for Premium Subsidy PDF icon Current form for April 1, 2009 to March 31, 2010 based on your 2008 taxable income. Print only
Based on 2006, 2007 or 2008 taxable income

Disclaimer
Please note that the Subsidy Calculator is a tool only. No personal information is recorded at any time.

AHC0391 Current and Retroactive Premium Subsidy PDF icon
- April 1, 2007 to March 31, 2008 based on 2006 taxable income
- April 1, 2008 to March 31, 2009 based on 2007 taxable income
- April 1, 2009 to March 31, 2010 based on 2008 taxable income
Print only
Payment Plan
AHC0104A Pre-authorized Payment Plan PDF icon Print only

Optional health plans - Alberta Blue Cross
Alberta Health and Wellness contracts with Alberta Blue Cross to offer supplementary health plans.

AHC0201 Alberta Blue Cross Non-group Coverage PDF icon Print only
ABC20039 Alberta Blue Cross Health Services Claim form PDF icon Print only
AHC0222 Alberta Blue Cross Palliative Care Drug Program PDF icon Print only
Brochures
AHC0009 About Alberta Health Care Insurance Plan brochurePDF icon  
ABC40005 Alberta Blue Cross Coverage for Seniors brochure PDF icon  
Non-Group Alberta Blue Cross Non-Group Coverage brochure PDF icon  
ABC40501 Alberta Blue Cross MS Drug Coverage brochure PDF icon  
Palliative Care Alberta Blue Cross Palliative Care Drug Program brochure PDF icon  
AHC1443 Premium Assistance Program brochure PDF icon  
AHC0012 Travel Health Insurance Matters brochure PDF icon  

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.