Changes to the Alberta Health Insurance Act via Bill 11
Last updated: March 2026
We're continuing to work through the details of this legislation and will provide updates as more information becomes available from the Alberta government. For additional details please visit the government of Alberta website.
The information listed below is based on current information as of March 2026.
*Please note that the examples we are providing are based on Sun Life’s understanding of Bill 11 at this time. This information is subject to change as additional details are released by the Alberta government.
Impact on Prescription Drug Coverage
This change will have a direct impact on how prescription drug claims are coordinated and applies to plans of both active employees and retirees. Here's how the payment responsibility will shift:
Current State (Province pays first) |
Future State |
|
|---|---|---|
Seniors Coverage (age 65+) |
Alberta government is first payer, private plan pays only what is not covered by province |
Private plan pays first, Alberta government is last payer, after all other private drug plans |
Alberta Non-Group Coverage (under age 65) |
Follows CLHIA guidelines: when a plan member has both Non-Group and private drug plan, the plan that was in effect first pays first |
Alberta government is last payer, after all other private drug plans, even if Non-Group was in effect first |
To illustrate how this change works in practice, let’s consider the following example of a drug that is covered by the provincial plan and the private drug plan:
- Drug cost: $250 per claim
- Private plan: 80% coverage
- Provincial plan: Pays the balance of the claim, with plan members paying no more than 30% up to a maximum of $35 per prescription (effective April 1, 2026).
The table below shows how the same drug claims are paid before and after the change in payer order.
Stage of claims |
Current state |
Future state |
|---|---|---|
Province pays first |
Private plan pays first |
|
Individual Claim Scenario |
Province pays $215 |
Private plan pays $200 |
Private plan pays $35 |
Province pays $50 |
|
Plan Member pays $0 |
Plan Member pays $0 |
|
Annual result (12 claims, $250 per claim) |
Province pays $2,580 |
Province pays $600 |
Private plan pays $420 |
Private plan pays $2,400 |
|
Plan Member pays $0 |
Plan Member pays $0 |
|
Conclusion: As private plans move into the first‑payer role, plan sponsor drug costs are expected to increase.
Impact to Supplemental Health Benefits
The Payer of Last Resort provision also extends to certain supplemental health benefits currently covered by the provincial plan. These benefits include ambulance services, clinical psychological services, home nursing care, chiropractic services, prosthetic and orthotic benefits, mastectomy prosthesis, and hospital accommodation. We’re currently evaluating the impact of this change on Extended Health Benefits and will provide updates as more information becomes available.
Sun Life is committed to ensuring Advisors and Plan Sponsors have updated information on all impacts to group benefits plans.
Questions? We’re here to help.
Please contact your Sun Life Group Benefits representative.