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 88 provides the eligibility rules for the AAHB program for low income households with a pregnant member.

Pregnant women who are not on Income support are able to access information and application forms for the Alberta Adult Health Benefit (AAHB) program through Human Services offices, the Human Services Internet site, as well as community agencies providing prenatal services.

In order to be enrolled in the AAHB program, the AEHB 3931 Alberta Adult Health Benefit Application form must be completed and mailed or faxed to Centrally Delivered Services:

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, the CDS staff person:

1. Faxes the application form to Canada Revenue Agency (CRA) requesting income verification for the applicant and their spouse. CDS staff then confirm that the household income 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.

2. Sends the AEHB 3654 Declaration of 18 and 19 Year Old Dependant form to the applicant, if appropriate.

3. Advises the applicant of their eligibility for the AAHB program by sending them the AEHB 3844 AAHB Enrollment Confirmed letter or AEHB 3934 AAHB Application Not Approved letter. If the application is approved, children in the household receive health benefits coverage; however, spouses do not receive coverage.

4. If eligible, uses normal CCD process

5. In LISA enters the required information in the mandatory fields in Eligibility Determination

6. Assigns the Client Type (CT) 78 Health Benefits Card Only – Pregnancy

7. Uses Function 3 or 4 to add or reopen the file.

8. Assigns caseload 353H01

9. Changes the defaulted Diary Date to the first day of the month of the expected delivery date. This will result in the file closing at the end of the month when the baby is due.

10. Enters a ‘Y’ for Medical Coverage.

11. Enters a ‘1’ for AHCIP Status.

12. Enters Medical Code 6 – Health Benefits/Standard Dental Benefits or Medical Code 9 - Health Benefits/Standard Dental Benefits/Restricted Drugs.

13. Enters Budget Status ‘0’.

14. Adds Need Code 1729 Adult Health Benefit in the amount of $1. This will generate the Health Benefits Card (HBC) and release the benefit.

15. Enters a Task in Mobius for the month prior to file closure as a reminder to advise the client that their file will close at the end of the month when the baby is due.

16. Prior to file closure, sends the AEHB 3935 AAHB File Closure Notice - Pregnancy letter advising of the termination date for AAHB coverage and providing information on other options for health benefits coverage.
    • If they or any member of their household has an ongoing need for prescription drugs or diabetic supplies, they can request  to be re-assessed for eligibility in AAHB sub-type 79 High Drug Needs at any time. 

    • The children can be covered under the ACHB program until the end of the benefit year.

LISA

At rollover, LISA copies the CRC Release Flag and Cheque Release Flag from the current budget to the next month’s budget (this means the worker does not have to enter a CRC received date and change the CRC Flag to ‘Y’).

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