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Alberta Child Health Benefit (ACHB)

Published Date: July 01, 2015
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Annual Renewal

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.

All active ACHB applicants/clients have their eligibility for the next benefit period automatically reassessed based on income reported by Canada Revenue Agency (CRA). Annual renewals cannot be processed until financial eligibility is determined.

Prior to June 30 of each year, ACHB sends an electronic file transfer to CRA containing data for each active ACHB parent or guardian. CRA sends back an electronic tax information report for all active ACHB files.

A child continues to be eligible if the total household income is equal to or less than the applicable qualifying income amount.

The transmission of CRA tax information may be rejected when there is a mismatch of information such as SIN numbers or spousal information, or the applicant has not filed the current year’s taxes. In these situations, applicants are sent an AEHB 3643 Annual Review for ACHB letter informing them of the reason for delay in determining their financial eligibility and the action required prior to processing the renewal.

If it is determined that the client is not eligible, an AEHB 3645 Closure Notice for ACHB letter is sent informing them of their financial ineligibility and options, such as reassessment based on current income or their right to appeal. An AEHB 4008 Request for Reassessment of Eligibility for Health Benefits form is sent with this letter.

Exception to Qualifying Income Levels
An applicant’s current household income may be significantly lower than reported on last year’s income tax return. In this case, the applicant may request a reassessment based on their current income and the household’s ongoing health needs. For this reassessment an ACHB representative requests documentation to verify:

  • Anticipated income for the current income tax year, and
  • Ongoing health needs (only those prescription drugs and diabetic supplies required on an ongoing basis and covered by the HBC.)

Based on this documentation, the ACHB representative may determine an applicant is eligible for the ACHB if the following conditions apply:

  • Current verified combined income from all sources of the adult household members,
  • Minus verified on-going eligible health needs of the household members,
  • Is equal to or less than applicable qualifying income level.

Example
Household unit (2 adults and 3 children) had $45,000 net combined household income in the last taxation year verified by their CRA Notice of Assessment. The applicable qualifying income level is $41,594. Due to reduced work hours, their anticipated combined net income for the current income tax year is $3,550 monthly. One child has a monthly need for asthma medication costing $80, and an adult has a monthly need for diabetic supplies costing of $95. They have no health coverage through employment or any other source.

Total projected income for the year ($3,550 x 12) = $42,600
Minus health costs ($80 + $95 x 12) $2,100 = $40,500

Qualifying income level for this household unit is $41,594 or less, therefore, they are eligible for ACHB.

Substantiation for Exceptions to Qualifying Income Level
Applicants verify their income for the current income tax year by providing pay stubs, bank records, letter from employer or other income source sufficient to establish the anticipated income for the rest of the year.

Applicants verify their health needs by providing pharmacy printouts and/or letter(s) from the doctor. Only the cost of prescription drugs and diabetic supplies required by the family on an ongoing basis (every month or every two months) that are covered by the HBC may be used to establish an estimated cost of the household’s health needs.

Applicants must declare if they have employer health benefits or health benefits through private insurance either verbally or on the application or change of information forms. If they have such coverage they must provide details of what coverage is available through their other plan.

Household units not financially eligible for the ACHB based on the qualifying income levels, or the exception, may appeal the decision to an appeal panel.