What is Alberta Bill 11?

Bill 11 is new legislation introduced by the Government of Alberta that will bring changes across the province’s health care system. These include health card requirements, physician practice rules and updates to employer benefits obligations and drug coverage coordination.

How Bill 11 changes drug coverage in Alberta

For actively employed workers aged 65 and older, employers will no longer be able to reduce or remove health benefits based solely on age. This does not apply to dental, life or disability insurance. Employer health plans will also become the first payer, with the provincial public plan paying last. This reverses the previous model, where seniors’ and other public programs typically paid first.

Bill 11 glossary

If you’re unsure what these benefits terms mean, this glossary provides a quick reference.

Coordination of benefits

When you are covered by more than one insurance plan, coordination of benefits determines which plan pays first and how any remaining eligible costs are covered. This helps ensure payments for covered claims do not exceed the total bill.

First payer

The first payer, also called the primary payer, is responsible for paying eligible claim expenses first, up to the plan’s stated limits. This is typically an employer-sponsored benefits plan or personal health plan.

Payer of last resort

Under Bill 11, when a claim is eligible under both a private plan, such as an employer-sponsored benefits plan, and a government-sponsored plan, the private plan must pay first and the provincial plan pays last.

Formulary

A formulary is a list of generic and brand-name prescription drugs covered by a health plan. Depending on the plan, coverage may be limited to drugs on the formulary. Non-formulary drugs can result in higher out-of-pocket costs and may include brand-name medications.

Co-insurance

Co-insurance is the share of eligible medical or dental costs you pay after meeting your deductible. For example, if your employer-sponsored plan covers 80% of a dental expense, you pay the remaining 20%.

What these changes could mean for employers

Rising drug costs: Most employers can expect a 2–5% increase in drug spending, with a greater impact on older or specialty-drug-heavy groups.

Plan design reviews: Co-insurance, formularies, maximums and pooling thresholds may need to be adjusted as private plans take on more first-payer risk.

Eligibility rule updates: Health benefits can no longer be reduced or removed for active employees aged 65 and older, which may require updates to plan texts and employee handbooks.

Alberta-specific considerations: Multi-province employers may need distinct coordination and eligibility rules for Alberta plan members.

Budget and forecast updates: Employers should plan for potential cost increases ahead of carrier repricing.

Employee communications: Alberta employees should confirm their Alberta health care cards are current to help avoid coordination issues.

How Navigate can help

Your dedicated Navigate Benefits Solutions team can help you assess potential cost impacts, review plan design and confirm eligibility compliance. We’ll continue to share updates as the province releases further guidance.