Changes to out-of-pocket maximum and co-insurance amounts in Quebec
The Régie de l’assurance maladie du Québec (RAMQ) announced changes to the Quebec drug insurance plan. These changes affect plan sponsors who provide drug coverage to plan members residing in Quebec.
Out of pocket maximum and co-insurance (starting July 1, 2023). RAMQ is increasing the out-of-pocket maximum payable for plan members residing in Quebec, for drugs listed on the RAMQ formulary. They’re also increasing the minimum co-insurance amount.
Out-of-pocket maximum and co-insurance
The changes below are effective July 1, 2023.
Legislative changes |
Drug claims for Quebec plan members |
Increase in annual out-of-pocket maximum to $1,196 from $1,161 |
Drug claims for plan members residing in Quebec for drugs listed on the RAMQ formulary are subject to the new annual out-of-pocket maximum of $1,196. |
Increase in co-insurance (amount RAMQ pays) to 67% from 65% |
Drug claims for plan members residing in Quebec for drugs listed on the RAMQ formulary are subject to the new minimum co-insurance amount of 67%. |
We’ve updated our systems to reflect these changes. There will be no immediate rate adjustments due to the changes. We expect minimal impact to plan members and on claim experience.
Questions? We’re here to help.
If you have fewer than 50 employees, please contact your Client Service Specialist at 1-877-786-7227.
If you have more than 50 employees, please contact your Sun Life Group Benefits representative.