Follow the steps to fill out your application correctly.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering your personal information in the designated fields. This includes your last name, first name, middle name, and personal health number.
3. Provide your complete mailing address, including city/town, province, and postal code. If your residence location differs from your mailing address, fill in the location of residence section with the appropriate details.
4. If applicable, list your spouse or partner and any dependants. Include their names, dates of birth, and personal health numbers.
5. Indicate whether you want your Alberta Blue Cross Non-Group Coverage to start on the date your previous coverage was cancelled. If yes, ensure that your application is received within 30 days of cancellation.
6. Fill in the details regarding your previous insurance, including the name of the previous insurance company, policy number, and cancellation date.
7. Review the certification statement, ensuring you understand the terms and conditions for coverage. Confirm that the information provided is accurate.
8. Enter your daytime and work phone numbers, and provide the current date of application.
9. Finally, sign the application to certify that all information is correct and complete.
10. Save your changes, download, print, or share the completed form as required.

Complete your application for Alberta Blue Cross Non-Group Coverage online today.