Get Letters Only

Filling out the LETTERS ONLY form for medical services plan premium assistance can be straightforward when you follow our step-by-step guide. This document provides essential guidance to help you fill out each section accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to access the LETTERS ONLY form and open it in your browser.
2. Begin by providing your applicant information, including your legal last name, first name, and personal health number (PHN). Ensure that you indicate your birth date in the format MM/DD/YYYY.
3. Fill in any additional names, including the second name if applicable, and provide a daytime telephone number. Next, enter your complete mailing address, including the apartment or unit number, street number, street name, city, province, and postal code.
4. Proceed to the financial information section. Enter the tax year and your net income as stated on your income tax return or Notice of Assessment. Do not forget to include your spouse’s net income if applicable.
5. Calculate the total net income by adding your net income and your spouse’s net income. Include claims for deductions such as the amount for your spouse, your age if over 65, and any disability claims.
6. Complete the section for adjusted net income, recalculating after deductions. Make sure you check that this amount does not exceed $30,000 to qualify for regular premium assistance.
7. Review the declaration and consent section and sign, ensuring that your spouse also signs if applicable. Provide the date signed, your Social Insurance Number, and your spouse's PHN.
8. Once all fields are filled out accurately, save any changes made. You can then download, print, or share the form as needed.

Take the necessary steps to complete your LETTERS ONLY form online today!