Alberta Health Care Insurance Plan Group Coverage Fact Sheet

To Whom Does This Apply?

Health Insurance Premiums Act and Regulations state that all employers with five or more eligible employees (owners are included) must form employer groups. Any employer who fails or refuses to form an employer group plan is guilty of an offence – Health Insurance Premiums Regulation 14(2).

Summary

Employers are responsible for:

• submitting full monthly Alberta Health Care Insurance Plan (AHCIP) premiums for all eligible employees by the due date indicated on the premium statement. Premium rates for group coverage are not lower. Penalties will be applied to all unpaid premiums.
  Note: Employers are not responsible for submitting premiums for employees receiving full premium assistance. However, these employees must still be enrolled on your group plan.
• notifying Alberta Health and Wellness promptly of employee commencements and terminations.
• notifying Alberta Health and Wellness of all changes to employees’ personal information (e.g. address, name, dependants, marital status).
• ensuring payroll records are maintained as they relate to AHCIP premiums.
• notifying employees of changes in their AHCIP coverage, new premium rates, etc.
  Note: Employers are not required to pay any portion of their employees’ premiums.  However, employers may choose to pay part or all of their employees’ premiums as a benefit to the employees.  This is a matter between employers and their employees.

Valid Reasons for Excluding Employees from Your Group

• employee works casual or part-time hours (term of employment is less than 100 hours per month). Employers may cover these employees on their groups if they wish, but it is not mandatory.
• employee is already covered under another Alberta Health and Wellness group plan and this coverage is to be retained.
• employee is the spouse/adult interdependent partner on the account. This exclusion applies if the spouse/partner is already covered as a dependant on the account and does not wish to have group coverage.
• employee is a student under 25. This exclusion applies to persons who are single, under 25, and enrolled and attending three or more courses at an accredited educational institution, and covered on their parents’ account.
• employee is not a resident of Alberta .
• employee has opted out of the AHCIP and has a valid Certificate of Exemption from the AHCIP.
• employee is a registered First Nation individual or the spouse of a registered First Nation individual.
• employee receives the Alberta Widows' Pension.
• employee is a commission sales person or contract employee.
• employee is 65 years of age or over, or is the spouse/adult interdependent partner of an individual who is 65 years of age or over, and therefore is not required to pay AHCIP premiums.
  
  

  Note: Receiving premium assistance is not a valid reason for an employer to exclude or terminate an employee from their group.

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• Workers' Compensation Board (WCB) - Alberta
• Occupational Health and Safety
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DISCLAIMER
Information contained in this section is of a general nature only and is not intended to constitute advice for any specific fact situation. For particular questions, the users are invited to contact their lawyer. For additional information, see contact(s) listed below.

Alberta Contact(s):
Alberta Health and Wellness
10025 Jasper Avenue NW
PO Box 1360 Stn Main
Edmonton, Alberta  T5J 2N3
Telephone: (780) 422-1212 within Edmonton
Fax: (780) 422-0102
Toll-free (information): 1-800-272-8864 toll-free for the rest of Alberta
Hours of operation: Office hours are from 8:15 a.m. to 4:30 p.m. Monday to Friday.