As of July 1, 2021, the out-of-pocket maximum increased. But the co-insurance didn’t change for the basic drug plan. The out-of-pocket increase affects employers who provide drug coverage to plan members residing in Quebec.

Legislative changes

Drug claims for Quebec plan members

Increase in annual out-of-pocket maximum from $1,117 to $1,161

Drug claims from plan members residing in Quebec for drugs listed on the RAMQ formulary will now be subject to the new annual out-of-pocket maximum of $1,161.

No change to the amount RAMQ pays (co-insurance)

Drug claims from plan members residing in Quebec for drugs listed on the RAMQ formulary are still subject to the minimum co-insurance amount of 65.0%.

We’re in the process of updating our systems to reflect this change. There’ll be no immediate rate adjustments due to this change. We expect minimal impact on plan members and their claims experience.

Questions? We’re here to help.

If you have fewer than 50 employees, please contact your Client Service Administrator at 1-877-786-7227.

If you have more than 50 employees, please contact your Sun Life Group Benefits representative.