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

You can also get forms from an authorized registry agent or contact us to get a form.

Apply for health care coverage

Trouble opening or completing PDF forms?

Fillable forms do not open properly on some mobile devices and web browsers. To fill in and save this form:

  1. Click on the PDF link to save it on your computer.
  2. Launch Adobe Reader.
  3. Open the PDF from within Adobe Reader. You can now fill and save your form.

Update or make changes to your card information

Submit form

Do not send information or forms by email. Email is not secure. Fill in, print and submit your application:

Group forms

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.

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 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 an SOBP

Current year

There is no cost for an SOBP for the most recent benefit year (July 1 to June 30) to the current year to date.

To request a current SOBP:

Download and complete the Request for Statement of Benefits Paid form (PDF, 156 KB) and mail the completed form to the AHCIP office.

Or, place an order using the automated phone system:

Previous years

An SOBP can be requested back to October 1, 1993. There is a fee of $25 plus GST ($26.25) per request for individuals ordering a personal SOBP directly..

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:

  1. Download and compete the Request for Statement of Benefits Paid form (PDF, 156 KB).
  2. Mail the completed form with your payment. Only cheques or money orders are accepted, payable to “Government of Alberta.”

Third-party requests

If a third-party such as law firm or insurance company wishes to request an SOBP on behalf of an Albertan, contact Alberta Health at 780-644-7551 (toll-free: 310-0000 before the phone number).

Effective January 1, 2020, the fee for third-party SOBP requests will be increasing to $75 ($78.75 with GST).

SOBP help

Contact us if you need help, or are from a law firm or insurance company requiring this statement.

Office hours: 8:15 am to 4:30 pm, Monday to Friday, excluding holidays
Phone: 780-644-7551
Toll free: 310-0000 before the phone number (in Alberta)

Contact

Connect with the Alberta Health Care Insurance Plan office.

Related

When to cancel health care coverage