HLTH 5355 Fair PharmaCare Income Review: Fill Online

What is HLTH 5355 Fair PharmaCare income review?

Fair PharmaCare helps B.C. families pay for prescription drugs, and your deductible and family maximum are normally based on your net income from two years ago. If your income has fallen since then, those numbers can be out of date. HLTH 5355 lets you ask for a review based on a more recent year. The form says the review is possible when your net income for last year, or your expected gross income for this year, is at least 10% lower than your net income from two years ago, for any reason.

The form is two pages. Page 1 has your name, Personal Health Number and address, your spouse's details if you have one, the result of the worksheet in Box A or Box B, and a checklist and declaration. Page 2 is the income calculation worksheet: column A adds up last year's net income and takes off RDSP income, and column B adds up this year's expected gross income. You choose the year with the lower income, or the year you have all the documents for.

FileIt asks which year you're using, adds up the worksheet for you and copies the total into the right box on page 1, one digit per cell. Names are printed in capitals into the form's letter boxes, as it asks. The finished PDF goes into your FileIt vault. You mail it yourself with copies of your income documents. FileIt doesn't send anything to Health Insurance BC.

Who fills it: Registered Fair PharmaCare families whose income has dropped by 10% or more
Income years: Last year's net income (Box A) or this year's expected gross income (Box B)
Deadline: December 31 of the year you want reviewed. Earlier years can't be changed
Signatures: You, and your spouse if you have one
Edition: HLTH 5355 V14 Rev. 2023/05/17
Send to: Fair PharmaCare, PO Box 9685 Stn Prov Govt, Victoria BC V8W 9P7

Who needs to fill out HLTH 5355 Fair PharmaCare income review?

B.C. residents already registered for Fair PharmaCare whose income has dropped since the tax year used for their coverage.
Couples where one or both partners lost a job, retired, went on leave or cut their hours.
People whose self-employment, pension or investment income is lower this year than two years ago.
Anyone who just registered: the form says to wait for the Confirmation of Assistance letter first.

When to use HLTH 5355 Fair PharmaCare income review

When last year's net income or this year's expected gross income is at least 10% below your net income from two years ago.
Before December 31, because only the current year's coverage is reviewed and past years can't be changed.
Using tax slips instead of a Notice of Assessment only before June 1, if you haven't filed last year's return yet.

What you need before you start

Your Personal Health Number and your spouse's, from your BC Services Cards.
For column A: last year's Notice of Assessment or Reassessment (line 23600 net income and line 12500 RDSP income) for you and your spouse.
For column B: documents showing gross income for this year, such as an employer letter, pay stubs, a record of employment, or pension benefit letters.
Copies of every supporting document, for you and your spouse, to mail with the form.
A notarized affidavit (HLTH 5357) first, if in the last two years you moved to Canada, lived abroad, had no income as a minor or were otherwise exempt from filing.

What’s on HLTH 5355 Fair PharmaCare income review

The 2023 edition has 2 pages. FileIt asks for it in 4 parts, and it is signed by Registrant and Spouse:

1. Tell us who you areRegistrant
SpouseRegistrant
2. Your income (worksheet on page 2)Registrant
3. Checklist and declarationRegistrant

How to fill out HLTH 5355 Fair PharmaCare income review, step by step

1 Section 1: Tell us who you are

Enter your last and first name exactly as they appear on your income tax return, your Personal Health Number, your street address and city, and your postal code. If you have a spouse or common-law partner, add their names and PHN too.

2 Worksheet A: Last year's net income

Enter your net income from line 23600 of last year's Notice of Assessment and your spouse's, then any Registered Disability Savings Plan income from line 12500. FileIt adds each pair and takes the RDSP total off the net income total. The result is Box A.

3 Worksheet B: This year's gross income

Estimate everything you and your spouse have received and expect to receive this calendar year, before deductions, without RDSP income. If you don't have a spouse, the spouse line prints as 0, as the form asks. The total is Box B.

4 Section 2: Your income

Only one box is used: Box A for a review based on last year's net income, Box B for this year's gross income. FileIt copies the worksheet total into it in whole dollars. The cents are already printed as 00.

5 Section 3: Checklist and declaration

Tick that you have enclosed your supporting documents and that their totals match the box you filled in. Then tick the four declarations: the information is true, your income dropped by at least 10%, the CRA may share your tax information with the Ministry of Health, and you'll repay any extra assistance if your income turns out higher. You and your spouse sign and date the form.

Common mistakes to avoid

Filling in both Box A and Box B. Choose one year.
Leaving out your spouse's income. Fair PharmaCare looks at family income.
Including RDSP income in the gross income column. The form says not to.
Sending original documents. The form asks for copies only.
Missing the December 31 deadline. The review covers only this year.

After you fill it out

Print the PDF, sign it, and have your spouse sign it if you have one.

Mail it with copies of your supporting documents to Fair PharmaCare, PO Box 9685 Stn Prov Govt, Victoria BC V8W 9P7. The form also points to an online version at my.gov.bc.ca/fpincome.

Keep a copy in your FileIt vault. The form says processing usually takes about a month and you'll get a letter telling you whether your assistance went up.

Fill out HLTH 5355 Fair PharmaCare income review online with FileIt

Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 28 fields in all. Your answers save as you go.
Check the live preview. Watch your answers land on the real BC Ministry of Health / Health Insurance BC form, and let FileIt do any worksheet arithmetic.
Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault. Sign it, or send it for e-signature.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start HLTH 5355 Fair PharmaCare income review now — it’s free

HLTH 5355 Fair PharmaCare income review: frequently asked questions

When can I ask for a Fair PharmaCare income review?

The form says you can apply if you are registered for Fair PharmaCare and expect your net income for last year, or your gross income for this year, to be at least 10% less than your net income from two years ago.

Should I use Box A or Box B?

The worksheet says to choose the year with the lower income, or the year for which you have all the required documents. Box A is last year's net income and Box B is this year's estimated gross income.

Can a review change my coverage for past years?

No. The form says only the current year's coverage is reviewed, and earlier years can't be changed retroactively. Submit it by December 31.

What if I haven't filed last year's taxes yet?

The form says you may apply using tax slips for all your income sources, but only before June 1. Fair PharmaCare also requires you to file your taxes every year.

What happens if my coverage is increased?

According to the form, new assistance starts on the day the review is approved. At the end of the year your records are reviewed for a possible refund on eligible items bought that year.

Can I fill out HLTH 5355 with FileIt?

Yes. FileIt adds up the worksheet, prints the total into Box A or Box B and fills the official PDF for you to sign and mail. It stays in your vault, and FileIt never sends it for you.

Official sources

Blank form (PDF), published by BC Ministry of Health / Health Insurance BC: https://www2.gov.bc.ca/assets/gov/health/forms/5355fil.pdf
Official instructions and guidance: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/who-we-cover/fair-pharmacare-plan/income-review
Edition shown on this page: HLTH 5355 V14 Rev. 2023/05/17 (checked 2026-10-19).

FileIt is not affiliated with or endorsed by BC Ministry of Health / Health Insurance BC or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-19.