Quebec group insurance pooling update 2015 – 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 2015 renewal calculations that involve Quebec plan members. Details of the new parameters are described below.

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 2015 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 2015
  • eligible amounts are now defined as paid claims amounts and the compensation formula is calculated as 100% of the amount in excess of the threshold
  • eligible medications remain those covered by the private plan

2015 pooling parameters

Size of group  

(number of certificates)

Threshold per certificate

Annual factor

(without dependants)

Annual factor

(with dependants)

Fewer than 25

$7,500

$170.00

$470.00

25–49

$17,000

$95.00

$263.00

50–124

$30,000

$50.00

$138.00

125–249

$45,000

$29.00

$81.00

250–499

$65,000

$17.75

$48.75

500–999

$85,000

$10.50

$28.75

1000–2,999

$110,000

$7.50

$20.50

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.