Alberta 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.

This program provides coverage for:

• dental care
• prescription drugs
• eye exams and glasses
• essential diabetes 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 dental provider, optical provider 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 is 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 eye glasses for adults every 2 years
  • Eye glasses each year for dependents up to 18 years of age
• Prescription drugs
  • The list of eligible prescription drugs can be found here:
    • Interactive Drug Benefit List
  • Some over-the-counter products, such as prenatal vitamins for expectant mothers and children’s vitamins
  • Your family doctor or pharmacist has a list of what is covered under this health benefit plan
• Ambulance services
  • Emergency ambulance trips to the nearest hospital
• Diabetes supplies
  • Diabetes supplies such as injection supplies, testing strips and lancets
  • Plan members with diabetes will receive coverage for blood glucose test strips purchased from a licensed pharmacy, up to a maximum of 3000 per eligible person depending on the method of diabetes management. This benefit will be for each benefit year, that is, July 1 to June 30. (Read the Coverage Maximums for Diabetes Supplies fact sheet (PDF, 76 KB)).

Talk to your doctor, dental provider, optical provider 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 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
• meet the guidelines below
• not be receiving health benefits from other government programs:
  • Income Support
  • Assured Income for the Severely Handicapped (AISH)
  • Child and Youth Support Program
  • Canadian government programs for First Nations people and Inuit (Health Canada Non-Insured Health Benefits Program - NIHB)
  • sponsored immigrants
  • victims of human trafficking
  • Alberta Seniors Benefit
  • incarcerated individuals

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

*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 23600 to find out your basic income.
2. Add any child support you receive, which is on Line 15600.
3. Subtract the amount you were taxed, which is on Line 12800.

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

How to apply

Step 1. Fill out the application form

Alberta Adult Health Benefit application (PDF, 450 KB)

• Sign and date the sections marked My Declaration and Consent for Canada Revenue Agency.
• If applicable, include documentation that demonstrates your high ongoing prescription drug needs, such as a pharmacy dispensing history report.

Step 2. Mail or fax your application form

See Contact

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 September, 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).

Alberta Adult Health Benefit dependents

In order for Alberta Adult Health Benefit coverage to remain active for dependent children who are 18 or 19 years old, living at home and attending high school, you must complete the following declaration form:

Declaration of 18 and 19 Year Old Dependent (PDF, 650 KB)

Change of Information

If there is a change to the applicant’s, spouse or cohabitating partner or child’s personal information, you must inform the Alberta Adult Health Benefit program area by completing the following form. Failure to update personal information may impact your eligibility for the program.

Alberta Adult/Child Health Benefit Change of Information (PDF, 144 KB)

Consent to the release of information

Applicants who wish to allow the Alberta Adult Health Benefit program to communicate with any third party (including family members, social workers or health care professional) on their behalf, you must complete the following declaration form:

Consent to the Release of Information (PDF, 88 KB)

Reassess application rejection

In certain circumstances, an income reassessment can be requested if your application was rejected based on the income used to determine eligibility. In order for your income to be reassessed, you must have applied.

If you are applying for a reassessment between October 1, 2021 and February 28, 2022

If your Alberta Adult Health Benefit application was denied between October 1, 2021 and February 28, 2022, you can apply for an income reassessment based on your estimated 2021 income. If your estimated income is projected to be below the income guidelines, you may be eligible for coverage.

An estimated income reassessment requires the following:

1. Income verification from January 1, 2021 to present day. This may include the following:
   • gross employment earnings (pay stub showing year-to-date income or at least 3 months’ worth of pay stubs)
   • Employment Insurance Claim Statement (My Latest Claim)
   • Canada Pension Plan or private plan benefits
   • taxable student funding (payments as listed on Notice of Assessment, not including tuition fees)
   • cashed in RRSPs
   • workers compensation benefits
   • child support payments
2. Evidence to support your estimated income from present day up to December 31, 2021. This may include:
   • the remaining weeks of Employment Insurance you are eligible to receive
   • a current pay stub
   • a copy of a denied Income Support decision

To apply for an income reassessment

You must follow these steps:

1. Complete the Request for Reassessment of Eligibility for Health Benefits form (PDF, 704 KB).
2. Write a cover letter explaining your current income situation and why it differs from your 2020 income.
3. Collect appropriate income verification/estimated income documents as stated above.
4. Mail or fax all reassessment documents.

If you are applying for a reassessment between March 1, 2022 and September 30, 2022

If your Alberta Adult Health Benefit application was denied between March 1, 2022 and September 30, 2022, you can re-apply using your 2021 income as submitted to the Canada Revenue Agency. If your 2020 income is below the income guidelines, you may be eligible for coverage.

To apply for an income reassessment

You must follow these steps:

1. Complete the Alberta Adult Health Benefit application as before.
2. Attach a copy of your 2021 CRA Notice of Assessment.
3. Mail or fax it.

Exception committee

The Health Benefits Exception Committee reviews requests for drugs, optical, dental, ambulance services or diabetes 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 (PDF, 1.4 MB) 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 (PDF, 160 KB).

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 (PDF, 170 KB).

Contact

Connect with the Health Benefits Contact Centre:

Phone: 780‑427‑6848
Toll free: 1‑877‑469‑5437

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

Mailing address:

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