Forms for AHCIP and Blue CrossAlberta.ca 2026

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The document is an application form for the Alberta Blue Cross Non-Group Coverage Premium Subsidy for the year 2021-2022, based on 2020 tax information. It outlines the eligibility criteria, personal and income information required from the account holder and their spouse or partner, and authorizations for Alberta Health and the Canada Revenue Agency to verify eligibility for the subsidy. The form must be completed accurately to qualify for financial assistance with health insurance premiums.

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Click ‘Get Form’ to open it in the editor.
Begin with Section A, where you will enter your personal information. Fill in your health number, last name, first name, middle name, and current mailing address including city, province, country, and postal code.
Move to Section B to provide your income information. Indicate whether you filed an income tax return for 2020 and enter your taxable income as per line 260 of your tax return.
In Section C, certify that the information provided is accurate by signing and dating the form. Ensure you include your home and work phone numbers.
If applicable, complete Sections E through H for your spouse or partner's information similarly. Make sure they also sign where required.

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