Quebec group insurance pooling update for 2025 – what’s changing?
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 terms and conditions. We’ve started applying new pooling levels and fees to all 2025 renewal calculations that involve Quebec plan members.
About the pooling plan
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 2025 pooling parameters and has been approved by all industry members.
How does it affect 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:
- all existing pooling levels remain unchanged
- pooling factors are increasing for 2025, with a few exceptions
- 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 still applies
2025 pooling parametersi
Size of group (no. of certificates) |
Threshold per certificate 2025 |
Annual factor Without dependant(s) |
Annual factor With dependant(s) |
|---|---|---|---|
Fewer than 25 |
$10,000 |
$270.00 |
$810.00 |
From 25 to 49 |
$18,000 |
$195.00 |
$584.00 |
From 50 to 124 |
$32,500 |
$113.00 |
$405.00 |
From 125 to 249 |
$60,000 |
$77.00 |
$275.00 |
From 250 to 499 |
$90,000 |
$61.00 |
$218.00 |
From 500 to 999 |
$115,000 |
$46.00 |
$192.00 |
From 1,000 to 3,999 |
$150,000 |
$38.00 |
$159.00 |
From 4,000 to 5,999 |
$300,000 |
$16.00 |
$67.00 |
6,000 and over |
Free market – Groups not subject to Quebec Industry Pooling |
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Questions? We’re here to help.
If you have fewer than 50 employees, please contact the Client Relations Representative Team at 1-866-606-8936.
If you have more than 50 employees, please contact your Sun Life Group Benefits representative.
iTerms and conditions and pooling parameters from http://mutualisation.ca/en/pooling/terms-and-conditions-of-pooling/