Ministerial Order No. 76/2011 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 AE&I 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 Centrally Delivered Services (CDS) for assessment and eligibility determination. If approved, CDS is responsible for assigning AAHB CT 79 in LISA.

For AAHB CT 79, the following documents:

• AEHB 3931 Alberta Adult Health Benefit Application form, and 
• A list of ongoing needs for prescriptions and diabetic supplies from their physician or a printout from their pharmacist.

must be forwarded to CDS:

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

Fax: Toll-Free 310-0000, then enter 780-415-8386
       Or 780-415-8386 in Edmonton

Phone: Toll-Free 1-877-469-5437
           Or 780-427-6848 in Edmonton

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

CDS staff

• Faxes the application forms to Canada Revenue Agency (CRA) requesting income verification for the applicant and their spouse.
• Confirms 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.
• Notifies the Health Benefits Unit for file review and eligibility determination if the estimate for the prescription drugs and essential diabetic supplies is more than $48,000 for a 12-month period.

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, CDS staff:

1. Ensures the AEHB 3654 Declaration of 18 and 19 Year Old Dependant form is completed by the applicant, if appropriate.
2. Advises the applicant of their eligibility for the AAHB program by sending them the AEHB 3844 AAHB Enrollment Confirmed letter or the AEHB 3934 AAHB Application Not Approved letter.
3. If eligible, uses normal CCD process. 
4. In LISA, enters the required information in the mandatory fields in Eligibility Determination.
5. Assigns the Client Type (CT) 79 Health Benefits Card Only – High Drug Needs 
6. Uses Function 3 or 4 to add or reopen the file. 
7. Assigns caseload 353H01. 
8. Enters a ‘Y’ for Medical Coverage. 
9. Enters a ‘1’ for AHCIP Status. 
10. Enters Medical Code 6 – Health Benefits/Standard Dental Benefits or Medical Code 9 Health Benefits/Standard Dental Benefits/Restricted.
11. Enters Budget Status ‘0’.
12. Enters Need Code 1729 Adult Health Benefit in the amount of $1 and releases the benefit. This will generate a Health Benefits Card (HBC).

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