AHCIP forms may now be submitted by fax at 780-422-0102, as well as by mail or through a participating registry agent. Ensure copies of all documents being faxed are clear and readable.
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 a participating registry agent office
Apply for health care coverage
PDF form issues
Fillable PDF forms do not open properly on some mobile devices and web browsers. To fill in and save the form:
- Save the PDF form to your computer – click or right-click the link and download the form.
- Open the PDF form with Adobe Reader. Fill it in and save it.
- 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
- AHCIP Notice of Change/UPDATE – Name, address, date of birth, gender, or replace a card
- AHCIP Notice of Change/ADDITION (PDF, 303 KB) – Add a family member
- AHCIP Notice of Change/DELETION (PDF, 286 KB) – Delete a family member
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
Find out how 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.
- Proof of Age for Alberta Senior Benefit Program (PDF, 149 KB)
- Application for Alberta Blue Cross Non-group Coverage (PDF, 174 KB)
- Application for Premium Subsidy for Non-Group Premiums (PDF, 157 KB)
- Current and Retroactive Premium Subsidy (PDF, 145 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 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
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:
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:
- 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.”
If a third-party such as law firm or insurance company wishes to request an SOBP on behalf of an Albertan, contact Alberta Health by emailing [email protected].
Effective January 1, 2020, the fee for third-party SOBP requests is $75 ($78.75 with GST).
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
Email: [email protected]
Connect with the Alberta Health Care Insurance Plan office.
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