July 2007 Focus Update #121

Quebec amends basic drug plan

Quebec has announced some changes to the parameters of the basic drug plan administered by the Régie de l’assurance maladie du Québec (RAMQ). Effective July 1, 2007, the following changes will affect plan sponsors who provide drug coverage to Quebec plan members.

Legislative change Drug claims for your Quebec plan members
Increase in annual out-of-pocket maximum to $904 from $881.
  • Drug claims from your Quebec plan members will now be subject to the new out-of-pocket maximum of $904.
Reduction in co-insurance (amount RAMQ pays) to 70% from 71%.
  • Drug claims that were previously paid at 71% to comply with RAMQ’s minimum requirements will now be paid at 70%.
  • If your plan supplements RAMQ coverage for plan members age 65 and over, you can expect a slight increase in claim costs for these members because the portion reimbursed by RAMQ will decrease by 1%.

We’re in the process of updating our systems to reflect these changes. There will be no immediate rate adjustments due to these changes and we expect that the impact on claim experience will be minimal.

Please share this information with your plan members, as you see necessary. If you have any questions, contact your group benefits representative.