Bill 11 took effect October 1, and also bars employers from cutting drug benefits by age
Private drug and supplemental benefits plans in Alberta must be billed before government-sponsored coverage as of October 1, under Bill 11, the Health Statutes Amendment Act, 2025 (No. 2).
Section 77 of the Act prohibits payment of a drug and supplemental benefit under a public plan where the member is entitled to the same or equivalent benefit from an alternative payor.
A public plan may pay only after the member has submitted a claim to that payor and the payor has paid none of the amount claimed, paid only part of it, deemed the member not entitled, or denied the claim.
Any public payment must not exceed the portion the alternative payor did not pay.
Section 74(2) states that a plan established for the employees of a municipality or of the Government of Alberta is a private plan.
Coverage for Seniors and Non-Group Coverage become last payor for prescription drugs, land ambulance services, clinical psychological services, home nursing care, chiropractic services, prosthetic and orthotic benefits, mastectomy prosthesis and hospital accommodation, according to Alberta Blue Cross, which administers both programs for the province.
Alberta Blue Cross published an example using a $100 claim for a drug on the Alberta Drug Benefit List, for a member over 65 holding both a Retiree plan and Coverage for Seniors.
Before October 1, Coverage for Seniors paid $70 and the Retiree plan paid the remaining $30.
Under the new order the Retiree plan pays $30 first, at 30 percent to a maximum of $35 per prescription, and Coverage for Seniors pays the remaining $70.
Members who coordinate an employer or personal plan with a Government of Alberta-sponsored plan may reach their private plan's annual maximum sooner and carry out-of-pocket costs for expenses covered by neither plan.
Health spending accounts are not included in the legislation.
Section 78(1) bars an employer that establishes, maintains in force or renews an employer-sponsored drug and supplemental benefits plan from including a provision allowing it, solely on the basis of a member's age, to terminate the member's membership or to terminate, reduce or modify the member's benefits.
Section 79 renders any such provision of no force or effect.
Section 80 allows the Minister to order a contravening employer to reinstate a member on the terms that applied before termination, restore benefits that were terminated, reduced or modified, and reimburse the member for amounts paid during the period the coverage was withdrawn.
Section 81 allows the Minister to apply to the Court of King's Bench where an employer does not comply.
Alberta Blue Cross is removing the age limit on drugs and all extended health benefits on standard insured plans that currently carry termination ages, effective October 1.
Active employees already terminated on the basis of age have to be added back.
Dental, life insurance, disability, travel insurance and spending accounts may still change at term age depending on the employer.
The insurer told plan sponsors to review eligibility rules and contract wording, assess plan design for savings opportunities, and consider the budgetary impact.
Randy Howden, a pharmacist and owner of The Medicine Shoppe in Calgary, told CTV News that the private plan provider expects premium increases in the next few years.
Howden said the provider links the increases to more use of private plans.
Costs previously paid first by the public plan are now charged to private insurance, Chris Gallaway with Friends of Medicare told CTV News.
Gallaway said premiums will rise or coverage will be cut, and he expects employers, workers, and retirees to face higher costs.
Bill 11 does not freeze premiums or limit how much plan costs can increase, CTV News reported.
The Ministry of Primary and Preventative Health Services told CTV News the changes "align Alberta with other provinces and help ensure public coverage remains available for those who need it most."
The ministry did not explain how co-payments would be calculated or address premium increases and costs to employers and seniors, CTV News reported.
