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

Forms For Group Use

Group Administrators requiring large quantities of forms may order forms and publications online through the Restructuring and Government Efficiency. On-line orders will be processed within one working day.  For quantities less than 10, or to obtain forms immediately, you may download individual forms from this website. 

• Alberta Health and Wellness Group Administrator's Handbook - January, 2006
  

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.

Forms for Group Use
CSR-AIRa	Adult Interdependent Relationship Insert The definition of dependants has changed resulting from the Adult Interdependent Relationships Act.  This new insert provides the new definition of dependants.	Print only
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
AHC0144	Forms Requisition Form to order bulk quantities of Alberta Health Care Insurance Plan forms.	Print only
AHC0208G	Current Application for Premium Subsidy April 1, 2006 to March 31, 2007 based on your 2005 taxable income.	Fill & Print
AHC0391	Retroactive Premium Subsidy April 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
AHC199	Employee Group Commencement and Termination Application to commence or terminate employees on your group, or to change your group's coverage start or end.	Print only
AHC460	Notice to Terminating Employees Notice to employees terminating from your group.	Print only
AHC520	Employee Group Coverage Change Notice Application to make changes to your employee's group coverage.	Print only
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
AHC930	Changes to Group Administrator Information Application to change group administrator information.	Print only
AHC0901G	Supplementary Application for Premium Subsidy Application to add income information for a spouse/partner, for accounts receiving premium subsidy.	Fill & Print
AHC1086	Seniors Remittance Listing To be completed by groups submitting premiums for employees who are senior citizens.	Print only