Quebec group insurance pooling update – 2018

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. New pooling levels and fees will be applied to all 2018 renewal calculations that involve Quebec plan members.

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 from previous years, the Quebec Drug Insurance Pooling Corporation submitted a report to Quebec’s Health and Social Services ministers. The report details 2018 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:

  • all pooling levels remain unchanged and some fees changed slightly for 2018
  • 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

2018 pooling parameters

2018 Pooling parameters

Source:
https://mutualisation.ca/en/pooling/terms-and-conditions-of-pooling/
Quebec Pooling 2018