[vc_row content_width=”grid”][vc_column][vc_column_text]For insurers and administrators of employee benefit plans[/vc_column_text][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column][vc_column_text]Ed. Note: This information bulletin does not have the force of law. It presents the point of view of the Quebec Drug Insurance Pooling Corporation on various subjects, based on the Prescription Drug Insurance Act[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column][vc_text_separator title=”What is the Scope of Section 60 of the Regulation under the Act Respecting Insurance with Regard to Prescription Drug Insurance and Risk Pooling ?”][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column el_class=”pie”][vc_column_text css=”.vc_custom_1461630827901{border-bottom-width: 1px !important;padding-bottom: 20px !important;border-bottom-color: #e4e4e4 !important;border-bottom-style: solid !important;}”]
Following a thorough review, the Regulation under the Act Respecting Insurance was revised and came into effect on August 12, 2009. Section 60 of this new regulation defines the concept of a “group” as it applies to group insurance.
In this bulletin, the Quebec Drug Insurance Pooling Corporation considers it important to advise its members of this definition, which is different than the definition of a “group” contained in section 15.1 of the Act respecting Prescription Drug Insurance. The purpose of this bulletin is to clarify the reading of these sections in the context of prescription drug insurance and the industry’s risk pooling system.
[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column el_class=”pie”][vc_column_text]
What this implies for risk pooling
In Quebec, it may happen that certain groups do not meet the requirements of the Act respecting Prescription Drug Insurance (the Act), but do meet the requirements of the Regulation under the Act Respecting Insurance. Such groups may therefore offer group insurance without, however, providing prescription drug insurance.
Since the requirement to pool the risks related to medications arises from the Act, only those groups eligible for group insurance under the Act are required to comply with the risk pooling system set up by the Quebec Drug Insurance Pooling Corporation (the Corporation).
[/vc_column_text][vc_column_text]The primary role of the Corporation is to ensure that the pooling process operates properly. In this context, the Corporation points out that it is of the utmost importance that only the definition of a “group” as found in section 15.1 of the Act governs the exchange of information between the Corporation and participants in the pooling process for establishing the terms and conditions of pooling from year to year, despite the existence of section 60 of the Regulation under the Act Respecting Insurance.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column][vc_text_separator title=”A look at the definitions”][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column][eltdf_tabs tabs_layout=”eltdf-tabs-regular”][eltdf_tab title=”Section 60 of the Regulation under the Act Respecting Insurance”][vc_column_text]
L’article 15.1 de la Loi offre une définition qui restreint la nature des groupes de personnes à qui le secteur privé peut offrir des garanties de base en vertu du régime général d’assurance médicaments.
[/vc_column_text][vc_column_text]
Section 60 of the Regulation under the Act Respecting Insurance1 reads as follows:“A specified group of persons is a group whose members share common activities or interests before a group insurance plan is offered to them, including socio-economic or cultural interests.
The group may be composed of such persons as, for example,
Despite the foregoing, a specified group of persons may not be constituted for the sole purpose of entering into a group insurance contract, and group insurance may be offered to the members of the group only as a benefit complementary to membership.”
1 From the text of the Regulation under the Act Respecting Insurance, updated to November 1, 2010.[/vc_column_text][/eltdf_tab][eltdf_tab title=”Section 15.1 of the Act Respecting Prescription Drug Insurance”][vc_column_text]Section 60 of the Regulation above offers a different definition than the definition of a group found in section 15.1 of the Act2. It is important to recall here the terms of section 15.1:
“15.1. For the purposes of this Act, a ‘group with private coverage within the meaning of section 15.1’ means a group formed for purposes other than contracting insurance coverage for its members and composed of persons eligible for the basic plan who
1° “15.1. For the purposes of this Act, a ‘group with private coverage within the meaning of
section 15.1’ means a group formed for purposes other than contracting insurance
coverage for its members and composed of persons eligible for the basic plan who
applicable to the group, which includes coverage for the cost of pharmaceutical
services and medications.”
2 From the text of the Act Respecting Prescription Drug Insurance, updated to November 1, 2010. [/vc_column_text][/eltdf_tab][/eltdf_tabs][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column][eltdf_tabs tabs_layout=”eltdf-tabs-regular”][eltdf_tab title=”In the next issue”][vc_column_text]In the Corporation’s Information Bulletin No. 2011 – 5, read about “Recent changes in the parameters of the risk pooling system”.[/vc_column_text][/eltdf_tab][/eltdf_tabs][/vc_column][/vc_row][vc_row content_width=”grid”][vc_column][vc_empty_space][/vc_column][/vc_row]
