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Alberta Adult Health Benefit (AAHB)

Published Date: November 05, 2012
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Enrollment Procedures – High Drug Needs

Health Benefits: Qualifying Income Levels Ministerial Order sets out the maximum qualifying income levels for determining financial eligibility for health benefits at application or annual renewal.

ISTHB Regulation Section 89 provides the eligibility rules for the AAHB program client type 79 (CT 79) high ongoing prescription drugs and/or diabetic supplies.

AAHB CT 79 is for individuals and families who have sufficient ongoing income from any source to meet their basic needs, but do not have sufficient income to pay for ongoing prescription drugs and/or diabetic supplies.

High Drug Costs Definition

To be considered as an ongoing high drug cost the drug(s) must be:

  • Listed on the AHW Drug Benefit List or Community and Social Services Drug Benefit Supplement or approved by the HBEC, and
  • Dispensed at least three times in the last year (substantiated by a pharmacy), or confirmed by the prescriber that it is a new prescription that will be needed ongoing.

All AAHB CT 79 applications must be forwarded to Common Service Delivery (CSD) for assessment and eligibility determination. If approved, CSD is responsible for assigning AAHB CT 79.

For AAHB CT 79, the following documents:

must be forwarded to CSD:

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

Fax: Toll-Free 1-855-415-8386
Phone: Toll-Free 1‑877‑469‑5437 or 780‑427‑6848 in Edmonton

When the application and other documents are received by CSD, the applicant’s income is assessed against the AAHB qualifying income levels based on their previous year’s Notice of Assessment.

CSD staff  - faxes the application forms to Canada Revenue Agency (CRA) requesting income verification for the applicant and their spouse. When the information is received from CRA, CSD staff confirm that the household income less the cost of prescription drugs and diabetic supplies is equal to or less than the AAHB qualifying income level for the applicant’s family type.

    Note
    If the applicant is a refugee claimant, they will be responsible for providing income verification through alternate sources other than CRA as they may not have filed taxes within their first year of residence in Canada.  If the refugee or refugee claimant has been in Canada for more than one year the income verification will be requested from CRA.

Refugees and refugee claimants must provide substantiation of their status in Canada by providing with their application documents from the Citizen and Immigration Canada (CIC) indicating their status.

Note
Income is defined as the total combined household net income (line 236) plus non-taxable child support payments (line 156 minus line 128) as reported by Canada Revenue Agency (CRA). Line 156 is the actual amount of child support received and line 128 is the taxable child support that must be reported.

Once income has been verified against the qualifying income levels, CSD staff:

  1. Ensure the AEHB 3654 Declaration of 18-19 Year Old Dependant form is completed by the applicant, if appropriate.
  2. Advise the applicant of their eligibility for the AAHB program by letter.
  3. Assign the Client Type (CT) 79 Health Benefits Card Only – High Drug Needs.