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See the tables below for premium rates from 2014 to 2018, to determine whether your adjusted annual net income for a given year is above or below the eligible threshold. You can also apply by submitting a completed Application for Retroactive Premium Assistance (HLTH 104) form along with copies of a Notice of Assessment or Reassessment from the Canada Revenue Agency (CRA) for you (and your spouse): You were on a group MSP account during the period for which you are applying (submit a single print application form authorized by your Group Administrator, specifying each year for which you are authorized to apply).You are applying for Retroactive Premium Assistance for years during which you had a spouse who lived and earned income outside Canada (you must complete and submit a separate print application form for each year for which you are applying) or.Note: you must apply using the print Application for Retroactive Premium Assistance (HLTH 104) if: You are able to include a Power of Attorney letter if you are applying on behalf of someone else.You have a Social Insurance Number for you and your spouse, if applicable.You have a personal health number for you and your spouse, if applicable.
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If you are claiming retroactive deductions for child care expenses (line 214), Universal Child Care Benefit (line 117) or Registered Disability Savings Plan income (line 125), ensure the Notices of Assessment or Reassessment you submit include these deductions.You have a Notice of Assessment or Reassessment from CRA for you (and your spouse) from last year and any previous years when you might have qualified for assistance (up to six previous years can be included).You are using one of these web browsers: Internet Explorer 11 or the latest version of Mozilla Firefox, Google Chrome or Apple Safari.The data you enter will be saved locally to the computer or device you are using up until the point that you close your browser window or submit the form. The online application takes about 15 minutes to complete.
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You can apply for Retroactive Premium Assistance online. Retroactive Premium Assistance may be available for up to six years prior to the current year for those on self-administered accounts and for up to five years prior to the current year for those on group accounts. Eligibility is based on an account holder’s annual net income (combined with a spouse’s, if applicable) for a given tax year, less deductions for age, family size, disability and any reported Universal Child Care Benefit and Registered Disability Savings Plan income. Retroactive Premium Assistance provides financial adjustments for previously billed Medical Services Plan (MSP) premiums.