No action is required from GMS members at this time. Changes to how some Government of Alberta-sponsored health benefits coordinate with private insurance take effect October 1, 2026. GMS is prepared for the change and will continue to keep members informed if any action is needed.
What you need to know
|
What is changing?
Beginning October 1, 2026, Coverage for Seniors and Non-Group Coverage will become payors of last resort for certain benefits when a member also has eligible private health coverage. This means eligible private coverage, including a GMS plan, is considered first before applicable government-sponsored coverage.
Depending on the Alberta government program, affected benefits may include prescription drugs, land ambulance, clinical psychology, home nursing, chiropractic services, prosthetic and orthotic benefits, mastectomy prostheses and hospital accommodation.
Bill 11 also introduces requirements for actively working Alberta employees. Employers must maintain prescription drug coverage and specified supplemental health benefits for active employees regardless of age. Other benefits may continue to have age-related provisions depending on the plan.
What GMS is doing
- Updating claims processes to support the new coordination rules effective October 1.
- Preparing Customer Care and Claims teams to support members with claim-specific issues.
- Reviewing the impact across affected products and updating customer information as needed.
If a future change to your specific GMS plan or pricing applies, GMS will communicate that information to you in advance through the appropriate renewal process.
Frequently Asked Questions
- Who may be affected by these changes?
The change is most relevant to Alberta residents who have both private health coverage, such as a GMS plan, and applicable government-sponsored coverage, including Coverage for Seniors or Non-Group Coverage. If you only have one of these types of coverage, the new order of payment generally will not affect you.
- Do I need to do anything before October 1?
No action is required from GMS members at this time. Continue using your GMS coverage and submitting claims as you normally do. If you have more than one source of coverage, make sure your pharmacy or health care provider has your current information.
- What does it mean when private coverage pays first?
For an eligible expense, your private health plan is considered before the applicable Alberta government-sponsored plan. If an eligible amount remains after your private plan has paid, government-sponsored coverage may then be considered based on that program's rules.
- Could I reach a GMS benefit maximum sooner?
It is possible. If your GMS plan begins paying first for expenses previously paid first through a government-sponsored program, more of those expenses may count toward your GMS maximum. If a maximum is reached, applicable government-sponsored coverage may still be considered for eligible expenses based on that program's rules.
- I am 65 or older and still working. What does this mean for me?
For actively working Alberta employees, Bill 11 requires employer plans to maintain prescription drug coverage and specified supplemental health benefits regardless of age. This requirement does not apply to every type of employee benefit, so other benefits may still have age-related provisions depending on the plan.
- Is Alberta government-sponsored health coverage ending?
No. The change affects the order in which certain eligible expenses are paid when someone has both applicable private coverage and government-sponsored coverage. Government-sponsored programs continue to operate under their eligibility and coverage rules.
- Is my GMS plan or premium changing on October 1?
The October 1 change primarily affects how certain claims coordinate with Alberta government-sponsored coverage. Your GMS plan remains in place. If a future change to your coverage or pricing applies, GMS will communicate it to you in advance.
- What if a claim does not process as expected after October 1?
Review the claim details and any explanation from your pharmacy, health care provider or GMS. If you still need help, contact GMS with your identification information, the date of the expense and details of any other health coverage.
We will update this page as new information becomes available. For details about Alberta government-sponsored programs, visit Alberta.ca.