Alberta Announces Seniors Program Coverage Changes and Provides New Emergency Out-of-Country Coverage Definition
Elimination of Dependent Coverage for Non-senior Spouses and Adult Interdependent Partners
As announced in the Alberta budget tabled on 24 October 2019, Alberta is moving forward with the planned elimination of non-group dependent drug coverage under the Alberta Coverage for Seniors program for spouses and adult independent partners who are not seniors. The changes will come into effect on 01 March 2020.
Seniors’ drug coverage in Alberta is available under the Alberta Health Care Insurance Plan (AHCIP) Coverage for Seniors program, which is administered by Alberta Blue Cross. In addition to the senior, coverage under the province’s seniors’ drug plan currently extends to the senior’s spouse/interdependent partner and dependents registered under the same AHCIP account. Effective 1 March 2020, coverage will no longer be extended to spouses/partners and/or dependents who are younger than 65 years of age. Albertans 65 years of age and older will continue to be covered under the program.
After 1 March 2020, reduced coverage under the public drug plan may lead to a transfer of costs to privately-sponsored drug plans. Retiree drug plans and their corresponding liabilities may see a direct impact. Private plans that cover active employees may also be affected where an age 65+ employee or an employee with an age 65+ spouse no longer has access to spousal/partner/dependent coverage under the provincial plan and associated drug costs shift to the employer plan.
Aon anticipates that, in most cases, the effect on group plan premiums will be minor. However, there are scenarios where more notable impacts might be felt. In the context of high cost drugs, the loss of public/private coordination opportunities could result in higher claims and/or pooling costs and influence overall group plan premiums. Employers may wish to review claims data to assess the degree of potential impact on the plans they sponsor.
In addition to the changes outlined above, the October 2019 provincial budget revealed that means testing for the seniors drug program is being considered. Though still under review, a means test could place limits on public drug coverage for high income earners in Alberta and lead to further public/private cost shifting. No information is available on the progress of these considerations. Aon is monitoring the issue and will keep you informed as more information\ is made available.
Emergency Out-of-Country Health and Hospital Coverage Further Defined
Under current Alberta health care insurance and hospitalization benefits regulations, services provided outside Canada that are available inside Canada (i.e., out-of-country services) are excluded from Alberta Health Care Insurance Plan (AHCIP) coverage except “in the case of emergency”. No definition of “emergency” is provided.
Effective 1 April 2020, “emergency” services will be defined as, “…services provided in the case of an emergency resulting from an acute and unexpected illness, disease, condition or injury that requires medically required treatment without delay outside Canada.”