Alberta Adult Health Benefit

Benefits are available to low-income Albertans through the Adult Health Benefit.

Overview

The Alberta Adult Health Benefit program covers health benefits for Albertans in low-income households who are pregnant or have high ongoing prescription drug needs. This health plan includes children who are 18 or 19 years old if they are living at home and attending high school.

Your children may be eligible for free health benefits through the Alberta Child Health Benefit program.

This program provides coverage for:

  • dental care
  • prescription drugs
  • eye exams and glasses
  • essential diabetic supplies
  • emergency ambulance services
  • essential over-the-counter medications

Coverage through other benefits plans

If you or other household members have coverage through another health benefits plan, you must use that plan first. The Alberta Adult Health Benefit plan may cover your remaining costs. Talk to your doctor, dental provider, optician or pharmacist about how this works.

Clients leaving the Income Support or Assured Income for the Severely Handicapped (AISH) programs may be eligible for health benefits coverage if they have household income from employment, self-employment or Canada Pension Plan Disability (CPP-D) benefits.

What’s covered

  • Dental care
    • Basic services like extractions, fillings and dentures
    • Preventative care like x-rays, examinations and teeth cleaning are also covered
  • Eye exams and glasses
    • An eye exam and eyeglasses for adults every 2 years
    • Eye exams and eyeglasses each year for dependents up to 18 years of age
  • Prescription drugs
    • Many prescription drugs are fully covered
    • Some over-the-counter products, such as prenatal vitamins for expectant mothers and children’s vitamins are also provided
    • Your family doctor or pharmacist has a list of what is covered under this health benefit plan
    • Coverage is summarized in the:
  • Ambulance services
    • Emergency ambulance trips to the nearest hospital
  • Diabetic supplies
    • Diabetic supplies such as injection supplies, testing strips, lancets and penlets

Talk to your doctor, dental provider, optician or pharmacist to learn what is paid for by this health benefit plan.

Eligible applicants

You may be eligible if you:

  • are pregnant
  • have high ongoing prescription drug needs
  • are a refugee or refugee claimant who is not receiving health benefits from any other source
  • are leaving the Income Support or Assured Income for the Severely Handicapped (AISH) programs due to excess income from employment, self-employment or CPP-D benefits

To be eligible for the Alberta Adult Health Benefit, you and members of your family must:

  • live in Alberta
  • be Canadian citizens or have permanent resident status in Canada
  • not be receiving health benefits from other government programs
  • meet the income guidelines below

Your total net household income must fall below these maximum income guidelines based on family size.

Table 1. Maximum income guidelines based on family size

Family Maximum income
Single adult $16,580
1 adult + 1 child $26,023
1 adult + 2 children $31,010
1 adult + 3 children $36,325
1 adult + 4 children* $41,957
Couple, no children $23,212
Couple + 1 child $31,237
Couple + 2 children $36,634
Couple + 3 children $41,594
Couple + 4 children* $46,932

*For each additional child, add $4,973

How to calculate your income

You can calculate your income by looking at your last income tax return.

  1. Look at Line 236 to find out your basic income.
  2. Add any child support you receive, which is on Line 156.
  3. Subtract the amount you were taxed, which is on Line 128.

The amount left is your income. If you have trouble calculating your income, contact us.

Exceptions

Exceptions may be made if your income or circumstances have changed significantly in the last year or if someone in your household has ongoing costs for drugs and/or diabetic supplies that is high in relation to income. Contact us to talk about your options.

Ineligible applicants

Those who already have health services paid for by other government programs are not eligible for the Alberta Adult Health Benefit. These programs include:

How to apply

If you are leaving the Income Support or AISH program, speak to your worker.

Step 1. Fill out the application form

Alberta Adult Health Benefit application (0.5 MB)

  • Sign and date the sections marked My Declaration and Consent for Canada Revenue Agency.

The declaration section is important. By signing it, you are saying that you understand everything in your application. The consent section is important because you are giving the Alberta government permission to get your income tax information from Canada Revenue Agency to verify your income. Your information will not be shared anywhere else for any other reason.

Step 2. Mail or fax your application form

Mailing address:

Health Benefits Contact Centre
PO Box 2222 Station Main
Edmonton, AB T5J 5H3

Fax: 780‑415‑8386 (Edmonton area)

1‑855‑415‑8386 (toll-free fax)

After you apply

Alberta Adult Health Benefit Card

If you are approved, you will receive a health benefits card in the mail. The card will list the names of all eligible family members and their identification numbers.

You need to show this card to your doctor, dental provider, pharmacist, optician or ambulance attendant each time you or a family member receives a service paid for by the Alberta Adult Health Benefit plan.

Annual review

Every June, we will confirm with the Canada Revenue Agency that your household income is under the qualifying income level for your family size. If it is, your household will be automatically enrolled for another year. Children 18 and 19 years old must be still living at home and attending high school (up to grade 12).

Health Benefits Exception Committee

The Health Benefits Exception Committee reviews requests for drugs, optical, dental, ambulance services or diabetic supplies that are not covered in the optical agreements, dental agreements or drug benefit lists. To submit a request for an exception, complete the Request for a Health Benefit Exception form and follow the instructions contained in the form.

If your request is for drugs or nutritional products that are not covered on the drug benefit lists, your doctor must provide a detailed medical rationale using the Request for Prescription Drugs and Nutritional Products form.

If your request is for optical services that are not covered in the optical agreements, please have your optical services provider (ophthalmologist, optometrist, or optician) complete the Request for Optical Services form.

Contact

For more information, contact the Health Benefits Contact Centre.

Submit an inquiry online

780‑427‑6848 (Edmonton)
1‑877‑469‑5437 (toll-free)

Fax: 780‑415‑8386 (Edmonton area)
1‑855‑415‑8386 (toll-free fax)

Mailing address:

Health Benefits Contact Centre
PO Box 2222 Station Main
Edmonton, AB T5J 5H3