HEALTH BENEFITS
Alberta’ s Bill 11 and Its Impact on the ARTA Benefit Plans
Gary Sawatzky | Chief Operating Officer, ARTA
The Government of Alberta has announced that changes to the Alberta Health Care Insurance Act( Bill 11, the Health Statutes Amendment Act, 2025, No. 2) are coming into effect on October 1, 2026.
The new Act will have a profound impact on private benefit plans in Alberta, including the ARTA Benefit Plans.
For those who are familiar with the changes, you’ ll know the main conversation has been around the provision that allows private coverage for certain medical procedures normally covered by the Alberta Health Care Insurance Plan. But there is another, less talked about change related to seniors as Bill 11 also indicates that any private benefit plans operating in Alberta will become first payor of items currently covered under the Coverage for Seniors program. As a result, the Coverage for Seniors program will become payor of last resort.
How does Bill 11 impact public and private coverage?
Prior to the change, public and private benefit plans have operated using the widely accepted coordination of group and individual benefit plan guidelines, as outlined by the Canadian Life and Health Insurance Association. This has meant the public plan was treated as a group benefit plan, which pays first. Beginning October 1, this practice will change.
The Coverage for Seniors program is currently the first payor for eligible prescription drugs, ambulance services, clinical psychological services, home nursing services, and chiropractic services. For example, as first payor, the Coverage for Seniors program has been paying for 70 % of the cost of eligible prescription drugs, with covered Alberta seniors paying the remaining 30 %, up to a maximum of $ 35 per script.
Prior to October 1, 2026( Currently)
FIRST PAYOR
Alberta Coverage for Seniors
SECOND PAYOR
ARTA Benefit Plans
Starting October 1, 2026 ARTA Benefit Plans Alberta Coverage for Seniors
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