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