AHCIP forms – Apply or update information
To apply for the Alberta Health Care Insurance Plan (AHCIP) or make changes to your information:
- download and complete the appropriate form
- send the completed form to the AHCIP office, or bring it to an authorized registry agent
Apply for health care coverage
Trouble opening PDF forms?
Fillable forms do not open on some mobile devices and web browsers. To fill in and save this form:
- Click on the PDF link to save it on your computer.
- Launch Adobe Reader.
- Open the PDF from within Adobe Reader. You can now fill and save your form.
- Application form for AHCIP Coverage (PDF, 200 KB)
- Application form for AHCIP Coverage: Canadian Children of Non-Eligible Parents (PDF, 169 KB)
- Use only for your Canadian child if you are the child’s parent, you are physically present in Alberta, and you, the parent, are not eligible for AHCIP coverage.
Update or make changes to your card information
- Change a name and/or address (PDF, 220 KB)
- Add or update a family member (PDF, 303 KB)
- Delete or update a family member (PDF, 286 KB)
- Proof of Age (PDF, 149 KB)
Do not send information or forms by email. Email is not secure. Fill in, print and submit your application:
- Employee Group Commencement and Termination form (PDF, 95 KB)
Order a replacement card
Contact the AHCIP office to request a replacement card if you lost your card or it is damaged.
Alberta Blue Cross benefits
Alberta Blue Cross administers supplementary benefit plans on behalf of the Government of Alberta.
- Application for Alberta Blue Cross Non-group Coverage (PDF, 174 KB)
- Application for Premium Subsidy for Non-Group Premiums (PDF, 300 KB)
- Current and Retroactive Premium Subsidy (PDF, 206 KB)
- Registration for Preauthorized Monthly Payment for Non-Group Premiums (PDF, 57 KB)
- Alberta Blue Cross Health Services Claim form (PDF, 158 KB)
- Palliative Coverage Program form (PDF, 156 KB)
If you have questions about benefit forms, Contact Alberta Blue Cross.
Find out how to claim for benefits through Alberta Blue Cross.
Statement of Benefits Paid
A Statement of Benefits Paid (SOBP) is a list of physician services paid for by the AHCIP on your behalf during a specific period. It includes the date and general type of service, physician name and the amount that was paid to the physician.
The current SOBP covers July 1 to June 30 of the previous year, and up to the current date.
The requested SOBP is sent directly to the individual or their authorized representative.
Hospital services do not appear on the SOBP. These may be requested directly from the hospital.
How to order a SOBP
SOBP – Current year
There is no cost for a current SOBP. To request an SOBP:
- Download and complete the Request for Statement of Benefits Paid form (PDF, 156 KB) or order the current SOBP through an automated phone system:
- Mail the completed form to the AHCIP office.
SOBP – Previous years
A SOBP can be requested back to October 1, 1993. There is a fee of $25 plus GST ($26.25) per request.
Families ordering for more than one person on the same AHCIP account pay only $26.25 for everyone.
To request an SOBP from previous years:
- Download and compete the Request for Statement of Benefits Paid form (PDF, 156 KB).
- Mail the completed form with your payment. Only cheques or money orders are accepted, payable to “Government of Alberta.”
Contact us if you need help, or are from a law firm or insurance company requiring this statement.
Connect with the Alberta Health Care Insurance Plan office.