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.
What does this change mean for ARTA members residing in Alberta?
Albertans who are fortunate enough to have private drug coverage, such as an ARTA Benefit Plan could, under the current system, submit the out-of-pocket costs to their respective private plan and receive 100% coverage for eligible prescription drugs. As of October 1, private plans — including ARTA’s — will become first payor for those expenses. As payor of last resort, the Coverage for Seniors program will then cover any remaining costs that would otherwise be paid out-of-pocket by the individual.
The reason for this change is to transfer public health care costs to private benefit plan sponsors, specifically employers operating in Alberta. This includes voluntary private plans such as the ARTA Benefit Plans, for which members pay the entirety of the premiums.
The Bill further stipulates that employers are not allowed to change their benefits coverage for employees age 65 and over, meaning those employers will then be forced to cover the costs incurred by their employees who are currently covered by the Coverage for Seniors program. Since ARTA members are not employees of ARTA, we do have some options available to help offset the expected higher costs.
How will ARTA address this change?
ARTA’s Health Benefits Committee is actively investigating ways to help minimize the additional costs that will inevitably be transferred by the public plan to ARTA Benefit Plans. These options may include:
- updating the plan design for Albertans age 65 and over covered by any ARTA Benefit Plans;
- reallocating resources to ensure affected plan participants still receive the health coverage they need; or
- removing coverage for certain items that will otherwise continue to be covered by the Coverage for Seniors program.
If you are an ARTA Benefit Plan member who does not reside in Alberta, rest assured you will not see any change to your coverage.
Stay tuned for more updates from ARTA this fall, including information about any changes to the plan related to these required legislative changes. Keeping ARTA members informed every step of the way remains our top priority.
After working in group benefits consulting for twenty years, Gary joined ARTA to serve as Chief Operating Officer in November 2017. Gary has his Certified Employee Benefits Specialist designation.