Quebec group insurance pooling update 2014 – what's changing?

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Every year, the Quebec Drug Insurance Pooling Corporation (also referred to as the Société de Compensation en Assurance Médicaments du Québec) revises the Quebec group insurance pooling parameters. We have started applying new pooling levels and fees to all 2014 renewal calculations that involve Quebec plan members. Also new in 2014: pooling will apply to the private plan formulary for all groups, independent of size.

Who does it affect?

All group insurers in Quebec contribute to a pooling plan that protects private sector plan sponsors against the financial impact of large claims for drug costs. Based on pooling results for previous years, the Quebec Drug Insurance Pooling Corporation submitted a report to Quebec’s Health and Social Services minister. The report details 2014 pooling parameters and has been approved by all industry members.

How does it affect our clients?

Pooling levels and fees are designed to cover predicted costs for claims and operating expenses associated with prescription drugs. While the overall pooling structure remains similar, new pooling levels and fees apply for 2014. The other significant change for 2014 is that pooling will apply to all drugs paid by the private plan for all groups, independent of size.

2014 pooling parameters

Size of group 

(number of certificates)

Threshold per certificate

Annual factor

(without dependants)

Annual factor

(with dependants)

Fewer than 25

$6,000

$163.00

$449.00

25–49

$15,500

$83.00

$230.00

50–124

$27,500

$40.00

$110.00

125–249

$42,000

$21.00

$58.00

250–499

$60,000

$12.50

$33.75

500–999

$80,000

$7.75

$21.50

1000–2,999

$100,000

$5.50

$14.75

3,000 and over  Free market – Groups not subject to Quebec Industry Pooling


Questions?

Please contact your Client Service Administrator at 1-877-786-7227.