Alberta Bill 1 would strengthen the province’s restrictions on private payment for insured health services. It would prohibit any person from charging an amount beyond the provincial benefit for an insured service provided by an opted-in physician or dentist, and would specifically address private organizations that use membership or periodic fees to facilitate access to those services.
The bill targets a structure that can sit between a patient and a physician: a fee-based private health organization. A patient could not be treated as having paid for an insured service merely because the organization charged a block billing fee, and the organization could face the same extra-billing offence framework that applies to other actors.
The bill also removes an existing statutory provision that protects certain advance payment arrangements and gives the government power to define the new categories by regulation.
At a Glance
What It Does
The bill adds a prohibition on extra billing by any person in connection with an insured service provided by an opted-in physician or dentist. It also treats a private organization’s block billing fee as prohibited extra billing when the fee is connected to, or operates as a condition of receiving, an insured service.
Who It Affects
The changes directly affect physicians and dentists who participate in Alberta’s health insurance plan, private clinics and membership-based health organizations, and patients who use those organizations. They also affect the Minister of Health, which would receive expanded regulation-making and enforcement responsibilities.
Why It Matters
The bill closes a potential gap in the existing framework by focusing on the organization collecting the payment, not only on the practitioner delivering the insured service. Its reach will depend partly on regulations defining block billing fees, covered organizations, and possible transitional exceptions.
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What This Bill Actually Does
The bill begins by recasting the Alberta Health Care Insurance Act around a single-tier public system. Its new preamble expressly commits the government to the Canada Health Act criteria, including public administration, universality, accessibility, and a prohibition on private insurance and queue-jumping for insured services.
The preamble is not itself the main enforcement mechanism, but it supplies the legislative context for the operative amendments that follow.
The core change is new section 9.1. It prevents any person from charging or collecting an amount on top of the provincial benefit when an opted-in physician or dentist provides an insured service.
That wording reaches beyond the practitioner who submits the claim. It is designed to capture payments collected by another entity, including a clinic, company, or intermediary connected to the delivery of the service.New section 11.1 addresses fee-based private health organizations in more detail.
A block billing fee can include a membership fee, periodic fee, or other advance payment covering two or more non-insured medical services. If an organization collects that fee, contracts with an opted-in physician, and the physician provides an insured service during the relevant period or in circumstances linking the fee to that service, the organization is treated as having charged extra for the insured service.
The bill also covers situations where the fee is effectively a condition of receiving the insured service, even if the organization does not describe it that way.The bill preserves two specific limits on that new rule. It does not apply to insured services provided in an emergency, and it does not apply to services delivered before the legislation comes into force.
The Minister may also create regulations protecting certain patients who paid a block billing fee before the new provision took effect, provided they meet conditions set by regulation. The bill separately expands regulation-making authority so the government can refine the definitions and identify additional covered persons or organizations.Finally, the bill raises the compliance stakes through the existing offence framework.
A violation of the listed extra-billing provisions could result in a fine of up to $10,000 for a first offence and $20,000 for later offences, with a two-year prosecution period running from when evidence first comes to the Minister’s attention. The bill also removes the Act’s general statutory authorization for practitioners to make advance agreements for additional payment, while adjusting related language about accounts and agreements.
The Five Things You Need to Know
The new definition of “block billing fee” covers advance membership, periodic, or other payments for two or more non-insured medical services, as well as fees later prescribed by regulation.
New section 9.1 applies to any person—not just the physician or dentist—who charges an amount beyond the provincial benefit for an insured service provided by an opted-in practitioner.
A fee-based private health organization can be treated as extra billing when it collects a block fee and an associated opted-in physician provides an insured service during the applicable fee period or in circumstances connecting the fee to that service.
The new organization-specific rule excludes emergency services and services provided before the legislation comes into force; the Minister may also establish transitional exemptions by regulation for earlier-paying patients.
Contraventions remain subject to fines of up to $10,000 for a first offence and $20,000 for a second or subsequent offence, with prosecutions barred more than two years after the evidence first reaches the Minister.
Section-by-Section Breakdown
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Adds a public-health-care policy framework
The bill replaces the Act’s enacting clause with a preamble committing Alberta to a single-tier public health care system and to the Canada Health Act’s criteria. It also states commitments against two-tier medicine, extra billing, private payment for insured services, queue-jumping, and private insurance for those services.
Because the operative prohibitions appear elsewhere in the bill, the preamble primarily frames interpretation and policy purpose rather than creating a standalone offence.
Defines the private-payment structures covered
The bill adds definitions for block billing fee, fee-based private health organization, non-insured medical service, and professional service. The definitions distinguish services that patients may lawfully purchase from payments that can be used to obtain or condition access to an insured service.
The organization definition focuses on entities other than physicians that have an arrangement with opted-in physicians and collect a block billing fee. Regulations can expand or refine both the fee and organization categories, giving the government significant control over the framework’s eventual boundaries.
Prohibits extra billing by any person
New section 9.1 prohibits any person from charging or collecting an amount in addition to the Minister’s benefit for an insured service provided by an opted-in physician or dentist. The provision closes the argument that only the practitioner who delivered the service can be responsible for extra billing.
For clinics and related entities, the practical question becomes whether a payment is connected to the insured service, not which entity formally labels or receives it. That creates a broader compliance perimeter than the Act’s practitioner-focused provisions.
Regulates fee-based private health organizations
New section 11.1 identifies when a private organization’s block billing fee counts as an additional charge for an insured service. The rule applies when the fee is paid during the period in which the insured service is delivered, when it covers a period ending with the final related service, or when the circumstances reasonably show that the fee relates to the insured service or conditions access to it.
The provision excludes emergency care and services delivered before the amendment takes effect. It also authorizes transitional regulations for people who paid a block fee before the section came into force, which leaves important details—such as qualifying conditions and documentation—to future rules.
Applies the offence and fine structure
The bill adds section 9.1 and section 11.1 violations to the Act’s offence provision. A person who contravenes the listed sections faces a maximum fine of $10,000 for a first offence and $20,000 for a subsequent offence.
The two-year limitation period does not begin simply when the conduct occurs. It runs from the date evidence of the alleged offence first comes to the Minister’s attention, which may extend the practical enforcement window where the payment structure is difficult to identify.
Expands regulations and removes an advance-payment safe harbor
Section 7 authorizes regulations defining or describing block billing fees and fee-based private health organizations, designating additional persons, and setting the application of the new provisions to them. It also changes the language governing accounts for health services so it refers to agreements made before services are provided rather than relying on the repealed statutory clause.
Section 8 repeals section 21(1)(b), which had preserved a practitioner’s ability to make certain agreements for additional payment when made before goods or services were provided, subject to specified exceptions. The amendment also updates the cross-reference in section 21(1)(c) to include the new section 9.1.
Sets proclamation commencement
The bill comes into force on proclamation rather than automatically on a fixed date. That allows the government to coordinate implementation and regulations, but it means the effective date and the period for transitional compliance would depend on a later executive decision.
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Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Patients who cannot afford private access fees benefit from a rule aimed at preventing membership or periodic charges from becoming a gateway to insured physician or dental services.
- Patients using membership-based clinics receive a clearer statutory basis for challenging charges that appear to link payment for non-insured services with access to insured care.
- Opted-in physicians and dentists gain a more explicit boundary between permitted charges for non-insured professional services and prohibited additional payment for insured services.
- Public health administrators gain broader tools to pursue payment arrangements that operate through clinics or organizations rather than through the practitioner’s own billing account.
- Competing clinics that do not use private membership models may face less pressure to adopt fee structures designed to secure faster or conditional access to insured services.
Who Bears the Cost
- Fee-based private health organizations must review membership contracts, fee collection practices, scheduling arrangements, and physician agreements to ensure they do not make insured care conditional on payment.
- Physicians and dentists participating in the public plan may face greater scrutiny over arrangements with private organizations and may need to separate insured and non-insured services operationally and financially.
- Patients who use bundled private services may lose access to a convenient membership model or may have to pay for non-insured services separately without receiving associated access benefits.
- The Minister of Health and enforcement staff must develop regulations, investigate complex payment structures, and determine when a fee is sufficiently connected to an insured service.
- Private clinics may face uncertainty during the period before regulations define covered fees and organizations, particularly where a single payment supports both insured and non-insured services.
Key Issues
The Core Tension
The bill seeks to preserve a single public queue for insured care while allowing patients and providers to pay for services that the public plan does not cover. A broad rule is more effective against disguised access fees, but it can also capture legitimate mixed arrangements and make private organizations responsible for relationships whose clinical and billing details they do not fully control.
The bill draws an important but difficult line between payment for legitimate non-insured services and payment that effectively buys access to insured care. A block fee may cover services that the public plan does not insure, yet the same fee may also influence appointment availability, patient eligibility, or a clinic’s willingness to provide insured services.
The bill’s “condition to receiving” and “reasonable to conclude” language gives enforcement officials room to examine substance over labels, but it also creates uncertainty for organizations designing mixed-service models.
Much of the practical scope is deferred to regulation. The government can define additional fees, organizations, and persons, and can establish transitional protections for people who paid before commencement.
That flexibility may help address new business models, but it means the statute alone does not tell every clinic which bundled arrangements will be permitted. The proclamation-based commencement further separates enactment from the point at which operators must change their systems.
The bill also creates a broader enforcement theory without specifying a detailed administrative penalty, refund process, or patient-complaint mechanism. Fines may deter clear violations, but identifying the responsible person and proving the connection between a block fee and an insured service could require substantial evidence about contracts, billing, scheduling, and patient communications.
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