iAtoday

On October 1, 2026, Alberta’s Bill 11 (Health Statutes Amendment Act, 2025 (No. 2)) will take effect and amend certain rules governing group insurance plans that cover plan members residing in Alberta.

Key changes

1. Alberta government to become payor of last resort

Until now, certain Alberta public drugs and health insurance programs have been able to act as primary payors, covering certain benefits before private group insurance plans. As of October 1, however, plan members will be required to submit claims for a number of eligible expenses, including prescription drugs, to their private plan first. The government program will reimburse claims only after private coverage has been applied.

This new rule will affect, in particular:

• Prescription drugs
• Land ambulance services
• Clinical psychologist services
• Home nursing care
• Chiropractic services
• Prosthetic and orthotic devices
• Mastectomy prosthesis
• Hospital accommodation

What this means for group insurance plans

The shift of some claim costs to private group insurance plans could increase the costs of prescription drug and health care coverage in some plans and affect their pricing at renewal.

2. End of age-based coverage reductions for active employees

Bill 11 will prohibit employers from reducing or terminating prescription drug coverage and certain extended health care benefits based on the age of an actively employed individual, for example at age 65 or 70.

The affected coverage will include:

• Prescription drugs
• Land ambulance services
• Clinical psychologist services
• Home nursing care
• Chiropractic services

What this means for group insurance plans

Organizations whose plan members reside in Alberta will need to review their plan design and eligibility rules to ensure compliance with the new legislative requirements. Those whose plans currently terminate or reduce certain benefits because of employees’ age will need to make the necessary adjustments.

Also, organizations will be required to reinstate coverage for active employees whose coverage had previously ended because of their age.

3. Reimbursement of private health care expenses by private insurance plans

Bill 11 also introduces the possibility of a dual-practice model for physicians, which could eventually allow private insurance plans to reimburse certain expenses for private health care services. However, the Government of Alberta has yet to clarify several aspects of how this dual-practice model will be implemented.

What this means for group insurance plans

Since a number of regulatory details have yet to be confirmed, it is still too early to assess their impact on plan design. We will continue to monitor developments on this. At this time, we do not anticipate any changes to our product offering.

For more information about Bill 11 and its impacts on group insurance plans, please refer to the reference guide published by Alberta Blue Cross.

Next steps

We will be incorporating these new rules into our practices and group insurance contracts. Our teams will communicate directly with advisors and plan administrators whose group insurance contracts need to be amended.

We will inform plan administrators of any group-specific pricing adjustment at renewal. At that time, we will be available to provide guidance and answer their questions.

Communications to administrators

We will send a communiqué to group insurance plan administrators on September 21.

See the French version of the communiqué.