Role Reversal: Bill 11 Changes Employee Group Benefits Plans As Of October 1

Many Albertans simultaneously hold coverage from a private, employer-funded, benefits plan, as well as a government-sponsored plan administered through Alberta Blue Cross. For several years under this arrangement—which is also known as dual coverage—the government plan generally paid claims first, with the private plan covering remaining unpaid eligible health related costs. 

As of October 1, 2026, changes implemented under the Health Statutes Amendment Act, 2025 - commonly called Bill 11 - have now designated private plans as the primary payor, with employers also being prohibited from ending or reducing certain health coverage for actively working employees due to their age.

What Changes and What it Means

The primary changes brought about by Bill 11 are the result of a new Part 3 being added to the Alberta Health Care Insurance Act, which governs drug and supplemental benefits plans. Here are some of the most important changes, at a glance:

  • Group plans pay first. For employees with dual coverage, claims must be processed by their private—often employer-funded—plan first, with the government plan becoming the “payor of last resort.” This means that the government plan covers only eligible costs that remain unpaid after the claim has been processed by the private plan(s). Employees who only possess government coverage will see no change.
  • No age cut-offs. Many private employer plans previously ended or reduced benefits to employees over the age of 65 or 70, such that that government-funded programs, such as Coverage for Seniors, would supplement any shortfalls. Bill 11 now prohibits employers from removing, reducing, changing, or limiting drug and supplemental health coverage for employees on the basis of their age. This change only applies to employees who are Alberta residents and actively working. Employers are not required to maintain these benefits for retirees who are no longer working or employees’ dependents.
  • Reinstatement: Bill 11 also requires active employees who were previously removed from coverage after reaching the designated age cut-off to be added back to the employer-funded plan.
  • Exceptions. These changes only apply to prescription drugs and certain supplemental health benefits, including ambulance, clinical psychological services, home nursing care, chiropractic, and hospital accommodation.
    The age discrimination ban is targeted to specific forms of health coverage. It does not apply to items such as life insurance, long-term disability (LTD), dental coverage, travel insurance, or Health Spending Accounts (HSAs). A situation could therefore arise where an employee maintains their employer-funded drug and supplemental health benefits past the age of 65, while benefits related to dental, disability, life, travel, or spending account eligibility still end at the designated age cut-off. 
  • Private Retiree Plans. The age cut-off rule does not apply to private retiree plans, although those plans will still be designated as the primary payor ahead of government-sponsored plans. 

It is worth noting that Bill 11 does not set minimum coverage levels for employer-funded plans. Employers should still, however, prepare for a surge in the volume of overall claims volume and potentially increased costs associated with being designated the primary payor on employee health claims, particularly where they maintain older workforces or offer high drug maximums. Officials from Alberta Blue Cross have projected an increase of anywhere from 2 to 5 per cent in combined drug and health claims for affected plans. 

Bill 11 Overview

BenefitAge Rule Applies?Employer Pays First?
Prescription drugs and supplemental health benefits (psychological services, nursing care, chiropractic services, ambulance, hospital accommodation, etc.)YesYes
DentalNoNo
Life and DisabilityNoNo
TravelNoNo
Health Care Spending AccountsNoNo
Retiree PlansNoYes

 

Your to-do list

While insurers are already amending contracts and adjusting premiums, employers may not be aware of the changes brought about by Bill 11 and their resulting obligations. If you haven’t already, here are some steps you can take to ensure compliance and avoid any associated penalties:

  • Check plan booklets, policies and employment agreements for age cut-off provisions. If necessary, consider asking your insurer or benefits advisor to confirm that any age-related limits have been removed for actively working Alberta-based employees.
  • Identify any active employees previously removed from drug or health coverage due to their age and arrange with your insurer to have them re-instated.
  • Budget for higher claims and review dental and spending account eligibility at renewal. Consider whether plan design changes—such as adjusted maximums—are needed, while keeping in mind the age-based protections under Bill 11.

More than before, Bill 11 puts employers in the driver seat when it comes to assuming the costs of employee health care costs. Employers that proactively review their plans, update their documents, and communicate with their employees will be best positioned to manage both the costs and risks associated with these legislative changes.

Our Labour and Employment team would be happy to address any questions you have about these changes, as well help review plan documents and agreements, and advise on re-enrolment procedures. Please call us if you would like assistance.

This article provides general information only and is not legal advice.