Alberta Bill 11 legislation takes effect this fall

This fall, the Alberta government will implement three main provisions of the Health Statutes Amendment Act, 2025 (Bill 11). This summary explains what the new legislation means for group benefits plans in the province, and for employers across Canada with plan members living in Alberta.

 

1. Province becomes ‘payor of last resort’

Starting Oct. 1, 2026, the province’s public health plans, including the Alberta Non-Group Coverage supplementary health insurance program and the Coverage for Seniors program, will become the “payor of last resort” for several health benefits, including:

• prescription drugs,

• ambulance services,

• mastectomy prosthesis,

• clinical psychological services,

• chiropractic services,

• hospital accommodation,

• prosthetic and orthotic benefits,

• home nursing care and

• diabetes coverage.

 

When an Alberta resident with employer-sponsored group benefits coverage submits a claim for any of these products and services, their private benefits plans must be billed first. Alberta’s public health plans will only cover the remaining eligible costs once all other available coverage has been exhausted.

 

What this means for plan members

Coordination of benefits between private and public plans in the province will be handled at the pharmacy counter for prescription drugs. A plan member must simply ensure their pharmacist knows they have private coverage through their group benefits plan when filling their prescriptions.

 

Plan members will need to submit claims for other health benefits impacted by the legislation through their private group plans before submitting to the province’s plan.
 

Health Care Spending Accounts (HCSAs) are excluded from this section of the legislation and do not need to be exhausted before a member submits a claim to the public plan. However, they can still be used to cover other benefits, deductibles, coinsurance or amounts over any policy maximums.

 

2. Extending health coverage for seniors

Also starting Oct. 1, 2026, plan sponsors will be required to provide eligible employees in Alberta age 65 and over the same coverage for prescription drugs and some health benefits that they provide plan members under age 65.

 

That means plan sponsors will not be allowed to take away, reduce or change an employee’s drug and supplemental benefits plan solely based on age. They will also be required to add or reinstate any eligible employees to the extended health care (EHC) plan who were previously excluded or terminated from their benefits plan due to age.

 

This requirement applies only to the following health benefits provided under the province’s Coverage for Seniors program:

• prescription drugs,

• ambulance services,

• clinical psychological services,

• home nursing care,

• chiropractic services, and

• diabetes coverage.

 

Plan sponsors are only required to maintain the benefits listed above until retirement. Coverage for spouses and dependants is not included in the requirement to maintain coverage for eligible employees until retirement.

 

How we’re supporting Equitable clients

We’re committed to helping affected clients navigate these changes. Here’s how we’re supporting them.

 

• Clients with Equitable EZBenefits® plans: To comply with Bill 11, we’ll create a new benefits class for Alberta members age 70 and over that provides them with the required EHC coverage.  

• Clients with traditional benefits plans and myFlex Benefits® plans: To comply with Alberta’s new requirements, we will remove age-based EHC coverage termination limits from all benefits classes that include any Alberta plan members. Groups with eligible members whose coverage will terminate based on age before the end of the year will be prioritized for updating. Other plans will be updated in the coming months. Clients should be aware that this change will remove age-based termination limits for everyone in the benefits class, not just Alberta residents. If you have a client who doesn’t want to extend the EHC termination age for plan members outside Alberta, please contact your Equitable group account executive (GAE).

 

How to add eligible employees and reinstate terminated coverage

If you have a client who needs to either add eligible employees who were previously excluded from the benefits plan due to age or reinstate coverage for eligible employees whose benefits were terminated because of age, please contact your GAE as soon as possible so we can update their plan.

 

Once we’ve updated the plan, the plan administrator can add new eligible members using EquitableHealth.ca.

 

However, if a client needs to reinstate coverage for employees who were previously terminated due to age, the plan administrator must contact us for support. Plan administrators with traditional benefits plans or Equitable EZBenefits plans can email groupbenefitsadmin@equitable.ca. Those with myFlex Benefits plans can email myflexbenefits@equitable.ca.

 

3. Implementation of “dual practice model”

The legislation also includes introducing a “dual practice model” that would allow eligible physicians in Alberta to provide some surgical procedures as either publicly funded or privately paid services in accredited facilities. These procedures will not be covered under Equitable group benefits plans since they’ll continue to be eligible for public coverage.

 

While the provincial government has indicated the new model could come into effect in September, details are still pending. We will update you as we learn more.

 

Bill 11 client readiness checklist

Use this checklist to help ensure your clients are prepared for Alberta’s upcoming legislative changes.

 

Questions?

If you have any questions about the legislation or implications for your clients’ benefits plans, please contact your group account executive.

We will share this information with your clients.