Preparing for Alberta's Bill 11

Alberta's Bill 11, formally titled the Health Statutes Amendment Act, 2025 (No. 2), is one of the most consequential pieces of legislation in a generation to affect healthcare and group benefits in the province. The changes most relevant to employer-sponsored group benefits plans are expected to take effect later in 2026, with full implementation anticipated by 2027. Bill 11 carries the following key impacts to Extended Health Care (EHC) within a group benefits plan:

Age-Based Restrictions

Employers will no longer be allowed to terminate or reduce coverage solely on the basis of age - coverage must continue as long as the employee remains actively employed. Employers may still make changes to plan design, provided those changes are not age-based. Additionally, any active employee currently not enrolled due to an age restriction must be enrolled within a limited window (to be confirmed with insurers) once the legislation takes effect later in 2026.

Payor Provisions

Employer group benefits plans will become the first payor for drug and certain supplemental health benefits, with the Alberta government-sponsored programs as the payor of last resort. The largest impact to group benefits plans will be felt for employees who were previously excluded from the plan due to age restrictions - as their inclusion is expected to drive increased EHC claims and higher employer premium costs.

Plan Design Pressures

Eligible practitioners will be able to decide case-by-case whether to provide services as public or private care. This flexibility could lead some practitioners to shift toward private practice. The government has signaled intent to address related concerns through regulation, though specific measures are not set out in the legislation itself. For employers, the practical implication is that employees facing longer public wait times may increasingly seek private-pay services and look to their plan to offset those costs - a pressure that could grow if private care becomes more common.

Administration & Claims Processing

The shift in payor provisions is expected to increase administrative complexity for insurers as they coordinate claims between the group benefits plan and the government plans. As a result, employers should anticipate longer processing times and be prepared for additional employee inquiries as members adjust to the changes.

EMPLOYER KEY CONSIDERATIONS

01 - Age-Based Restrictions

Consider continuing coverage for active employees across Life, AD&D, EHC, and Dental Care (disability insurance is an exception). At minimum, contract language must remove any age-based restrictions on EHC.

02 - Contract Language

Consider removing all vague references to "government pays first" and replace with precise language reflecting the plan adjudicates first with public coordination. Consider defining the government-sponsored programs to explicitly include the Alberta Non-Group Coverage and Coverage for Seniors. Any contract amendments should be confirmed with the insurer to ensure they align with the legislation and the plan’s terms.

03 - Plan Design

The legislation does not mandate employer benefit plan designs. Consider reviewing the plan's drug formulary, specialty drug management program, biosimilar substitution policy, stop-loss and pooling thresholds, coinsurance levels, annual or lifetime maximums, and the potential introduction of a HCSA to offset increased member out-of-pocket costs.

04 - Member Communications

Consider developing member communications outlining the changes and that members not currently enrolled due to an age-based restriction will be contacted directly regarding their enrolment window.

Much about Bill 11 remains under development, but the direction is set. Reviewing plan design, contract language, and cost exposure now - rather than once the changes take effect - is what gives employers time to prepare.