Update on RAMQ’s interpretation of Bill 130

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Over the last few months, representatives of RAMQ (Régie de l'assurance maladie du Québec) have come out with new interpretations of the prescription drug insurance legislation. The Info assurance médicaments bulletin published in May 2007 infers that the ways in which private insurers have administered plan sponsor contracts since 1996 would now need to be modified in respect to dependent coverage.

Here are some examples of the difficulties that would result from changing group contracts to reflect these new interpretations, with respect to dependent coverage:

  • there could be one definition of dependent for the purpose of drug insurance and another for the purposes of other coverage;
  • there could be one definition of dependent for the purpose of drug insurance in Quebec, and another for the purpose of the same coverage elsewhere in Canada;
  • there could be one definition of dependent for the purpose of drug insurance in the insurance contract which would be in conflict with the definition of dependent in the Labour Agreement from which the insurance contract flowed.

In addition to the above discrepancies, frequent changes in dependent status would not only make it difficult to manage and monitor drug insurance plans, the administrative difficulties surrounding eligibility would be inconsistent with the nature of a group contract.

Sun Life Financial’s legal counsel has led discussions between the Canadian Life and Health Insurance Association (CLHIA) and RAMQ around the difficulties resulting from those interpretations. CLHIA is a voluntary non-profit industry association that looks at areas of common interest and concern for its member life and health insurers as well as the customers they serve. Sun Life Financial’s legal counsel was appointed to represent all members of CLHIA, i.e. all insurance carriers operating in Quebec, in order to have a congruent message around the administrative practices of the private plans.

CLHIA has obtained an external legal opinion from law firm Fasken Martineau that supports the position that the status quo be maintained and that no changes to contracts are required. As such, Sun Life Financial stands firm that until further notice, we will continue to administer plan sponsor contracts as they have been since 1996.

The insurance industry has always enjoyed a harmonious working relationship with RAMQ and is continuing discussions with them in order to resolve this issue.

We’ll keep you informed of all future developments.