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 2020 pooling parameters and has been approved by all industry members.
How does it affect plan sponsors?
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, note the following:
- all existing pooling levels remain unchanged
- a new threshold of $300,000 is introduced for groups from 4,000 to 5,999 certificates
- all fees are increasing for 2020
- eligible amounts remain the 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
- a per certificate pooling approach continues to apply
2020 pooling parametersi
| Size of group (no. of certificates) | Threshold per certificate 2020 | Annual factor without dependent(s) | Annual factor with dependent(s) |
|---|---|---|---|
| Fewer than 25 | $8,000 | $211.00 | $581.00 |
| From 25 to 49 | $16,500 | $137.00 | $376.00 |
| From 50 to 124 | $32,500 | $74.00 | $205.00 |
| From 125 to 249 | $47,500 | $52.00 | $142.00 |
| From 250 to 499 | $72,000 | $34.00 | $94.00 |
| From 500 to 999 | $95,000 | $27.00 | $74.00 |
| From 1,000 to 3,999 | $120,000 | $23.00 | $62.00 |
| From 4,000 to 5,999 | $300,000 | $11.00 | $31.00 |
| 6,000 and over | Free market – Groups not subject to Quebec Industry Pooling | ||
Questions? We’re here to help.
For Clients with less than 50 employees, please contact your Client Service Administrator at 1-877-786-7227.
For Clients with more than 50 employees, please contact your Sun Life Group Benefits representative.
