The Meaning of “Group”

The Meaning of “Group”

• The Law gives the definition of a group eligible for private drug insurance coverage 

In sections 15.1, 42.1 and 42.2 The Drug Insurance Act gives the definition of a group of persons eligible for private coverage of pharmaceutical services and medications and the conditions for applying such coverage.

These definitions affect the number of contracts that must be submitted to pooling. It is important to be familiar with these sections so that each year you can provide the Corporation (through the Pooling Manager), with the precise data on insurance contracts and their related certificates, in compliance with the law. Read more (lien vers le bulletin no 3 sur le site)

Pay attention to section 60 of the Regulation respecting the application of the Insurance Act

It is possible that some groups in Quebec do not meet the criteria of the Act Respecting Prescription Drug Insurance (“the Law”), but do meet those outlined in section 60 of the Regulation respecting the application of the Insurance Act (“RALA”).  Such groups can therefore benefit from group insurance coverage, but not from prescription drug insurance.  Read more

Il existe trois types de groupes admissibles à une couverture privée du coût de médicaments :

Employer – employees
Multi-employeurs
Associations

Read more

Group coverage may extend to one’s spouse and child(ren)

The life insurance industry believes that sections 17 and 18 of the Law allow an individual covered under a group insurance contract or an employee benefits plan to provide drug insurance coverage to a spouse and/or child living separately from the insured. Read more

A group’s legitimacy for pooling must be maintained 

Normally, the legitimacy of a group under the applicable laws is validated when the contract is issued. Here’s how: Read more

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