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Information for individual plan members

Forms and file updates

Personal information

Address change
Note: Only for individual plan members
Submit an address change to us online.

Name change
Notify us of a change of name.

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Claim forms

Health Services Claim form (ABC 20039)
This form is used to submit claims for products or services such as prescription drugs, private or semi-private hospital accommodation, ambulance, psychology services, physiotherapy, chiropractic, wheelchairs, vision care and hearing aids.

Orthopedic shoe and foot orthotic fabrication form/medical supply checklist (ABC 83475)
Claiming for orthopedic shoes, foot orthotics or surgical stockings? View the fabrication form (p.1) and requirements checklist (p.2).

Dental Claim/Treatment Plan form (ABC 20041)
This form is used to submit all dental claims including accidental dental services.

Emergency Out of Province/Out of Country Claims (ABC 30741)
Use this form to submit emergency medical expenses incurred while travelling. These could include expenses such as the following: ambulance, hospital, airfare and vehicle return.

Banking and payment information

Request receipt for tax purposes
Request a receipt for the payments made to Alberta Blue Cross. This receipt may be used for income tax purposes.

Preauthorized Monthly Debit and Direct Deposit of Claims Information
Submit this form if you want to change previous banking information or give permission for Alberta Blue Cross to withdraw monthly payments FROM your account and TO directly deposit claims to the same or different bank account. Or, save time and stamps by registering for direct deposit online through the plan member secure site.

Add or remove a dependent

Add a dependent (ABC 31236)
Use this form to add a spouse or dependent to your Blue Assured, Seniors Plus Plan or Health Plus plan. This form is also used to add a newborn under 30 days of age to a Blue Choice or Personal Choice Plan.

Add a dependent (ABC 30720)
ONLY for Blue Choice and Personal Choice plans. Use this form to add a dependent to your Blue Choice or Personal Choice Plan who is more than 30 days old.

Remove a spouse or dependent (ABC 31239)
Use this form to remove a dependent from your individual health and dental plans.

ID cards and plan contract requests

Replacement ID cards
Submit this online form to request replacement ID cards or a copy of your plan contract. We'll send the documents you requested within 10 business days via Canada Post. Save time by registering for direct deposit online through the plan member secure site.

Consent to disclose personal health information to you or another individual

Consent to Disclose Personal Health Information
If you are 18 years of age or older and want Alberta Blue Cross to provide personal health information to another individual. You may, for example, want Alberta Blue Cross to provide your personal health information to another adult (such as you spouse, child, a relative, a friend or a lawyer). If the person who is the subject of the information request is incapable of making personal decisions or of understanding or signing the form, please contact our Customer Services department for a different consent form.

Consent to appoint or change a beneficiary

Beneficiary Appointment or Change
Submit this form to notify us of the beneficiary designated in your policy. (Beneficiaries receive benefits upon the death of the insured.) Note: If the beneficiary is a minor, designations should be made to a guardian.