Choose the appropriate category below to locate the Alberta Health Care Insurance Plan form(s) you require. You can also contact us directly to request a form, or obtain additional information.

The documents below are in PDF using the latest version. Download the software for free from Adobe.

Instructions
Forms For Individual Use
Forms For Group Use
Claims Submission Resources/Forms

Forms For Individual Use

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	Print only
AHC0107	Notice of Change To change a name, address or add/delete family members	Print only

Premium Assistance
AHC0208G	Current Application for Premium Subsidy April 1, 2006 to March 31, 2007 based on your 2005 taxable income.	Fill & Print
Based on 2005 taxable income Disclaimer Please note that the Subsidy Calculator is a tool only. No personal information is recorded at any time.
AHC0391	Retroactive Premium SubsidyApril 1, 2004 to March 31, 2005 based on 2003 taxable income - April 1, 2005 to March 31, 2006 based on 2004 taxable income.	Fill & Print
Based on 2003 or 2004 taxable income Disclaimer Please note that the Subsidy Calculator is a tool only. No personal information is recorded at any time.

AHC0656

Waiver of Premiums Elimination of premiums for a 6 month period based on your average gross income for the prior three months.

Fill & Print

Payment Plan
AHC104A	Pre-authorized Payment Plan	Fill & Print

Optional health plans Alberta Health and Wellness contracts with Alberta Blue Cross to offer  supplementary health plans, forms are listed below.
AHC201	Alberta Blue Cross Non-group Coverage	Fill & Print
ABC20039	Alberta Blue Cross Health Services Claim Form	Print only
AHC222	Alberta Blue Cross Palliative Care Drug Program	Fill & Print

Additional forms
AHC312W	Proof of Age Declaration To determine eligibility to receive premium free Senior's Alberta Blue Cross Coverage	Print only

Brochures
NCN8	Alberta Blue Cross Non-Group Coverage brochure	Print only
NCN0012	Travel Health Insurance Matters	Print only
	Alberta Blue Cross Palliative Care Drug Program brochure	Print only