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In 1996, the pooling plan that was set up was intended to protect clients in the private sector against the financial impact of very large claims for medications brought about by the elimination of the “Outpatient Circular”. The main characteristics of the plan submitted at that time appear on the following pooling table, adopted for 1997 and 1998, and retained in 1999.
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1997-1998-1999
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $750 | $50 | $137 |
Between 10 and 24 | $1,200 | $32 | $86 |
Between 25 and 49 | $3,000 | $8 | $21 |
Between 50 and 124 | $6,000 | $3 | $7 |
125 and over | Free market | Free market | Free market |
[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]The pooling factors had been established to cover the anticipated costs in 1997 (claims and operating costs of the system), with a margin of 10%, meaning that a loss ratio of 90% was expected for each stratum.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]The following elements were confirmed:
not face a rate increase of more than 20% based on poor experience.
[/vc_column_text][vc_empty_space][/vc_column][/vc_row][vc_row][vc_column][eltdf_tabs tabs_layout=”eltdf-tabs-with-title”][eltdf_tab title=”Year 2000″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $850 | $73 | $200 |
Between 10 and 24 | $1,500 | $36 | $97 |
Between 25 and 49 | $3,750 | $17 | $44 |
Between 50 and 124 | $7,500 | $7 | $17 |
125 and over | Free market* | Free market* | Free market* |
* Considering the pooling of amounts exceeding $50,000 for insured plans.
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2001″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $1,000 | $95 | $260 |
Between 10 and 24 | $1,750 | $52 | $141 |
Between 25 and 49 | $4,400 | $25 | $66 |
Between 50 and 124 | $8,850 | $11 | $25 |
125 and over | Free market* | Free market* | Free market* |
* Considering the pooling of amounts exceeding $50,000 for insured plans.
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2002″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $1,200 | $108 | $296 |
Between 10 and 24 | $2,000 | $63 | $169 |
Between 25 and 49 | $5,000 | $29 | $77 |
Between 50 and 124 | $10,000 | $13 | $30 |
125 and over | Free market* | Free market* | Free market* |
* Considering the pooling of amounts exceeding $50,000 for insured plans.
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2003″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $1,500 | $123 | $335 |
Between 10 and 24 | $2,500 | $87 | $229 |
Between 25 and 49 | $6,000 | $38 | $92 |
Between 50 and 124 | $12,000 | $16 | $43 |
Between 125 and 249* | $20,000 | $7 | $17 |
250 and over** | $50,000 | No charge | No charge |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2004″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $1,700 | $121 | $334 |
Between 10 and 24 | $2,500 | $80 | $221 |
Between 25 and 49 | $6,000 | $27 | $74 |
Between 50 and 124 | $12,000 | $10 | $28 |
Between 125 and 249* | $20,000 | $3 | $8 |
250 and over** | $50,000 | No charge | No charge |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2005″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $2,000 | $127 | $351 |
Between 10 and 24 | $2,900 | $85 | $236 |
Between 25 and 49 | $6,900 | $35 | $97 |
Between 50 and 124 | $13,800 | $15 | $41 |
Between 125 and 249* | $23,000 | $4 | $12 |
250 and over** | $50,000 | No charge | No charge |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2006″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $2,000 | $130 | $358 |
Between 10 and 24 | $3,000 | $88 | $244 |
Between 25 and 49 | $7,500 | $38 | $104 |
Between 50 and 124 | $15,000 | $16 | $44 |
Between 125 and 249* | $25,000 | $7 | $18 |
250 and over** | $50,000 | No charge | No charge |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2007″][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor No dependants |
Annual factor With dependants |
Fewer than 10 | $2,100 | $130(1) | $358(1) |
Between 10 and 24 | $3,300 | $95 | $261 |
Between 25 and 49 | $8,500 | $45 | $125 |
Between 50 and 124 | $17,000 | $21 | $58 |
Between 125 and 249* | $28,000 | $8 | $23 |
250 and over** | $50,000 | No charge | No charge |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
(1) The factors remain at the 2006 level despite an increase in the threshold.
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Compensation formula
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The compensation formula applies 80% up to the maximum annual disbursement prescribed by the government and 100% on the remainder.
[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text]
Year | Threshold | Maximum disbursement |
1997-1998-1999 | $3,750 | $750 |
2000 | $3,750 | $750 |
2001 | $3,750 | $750 |
2002 | $3,750 | $750 |
2003 | $4,110 | $822 |
2004 | $4,195 | $839 |
2005 | $4,285 | $857 |
2006 | $4,285 | $857 |
2007 | $4,405 | $881 |
2008 | $4,520 | $904 |
[/vc_column_text][/vc_column][vc_column width=”1/4″][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row][vc_column][eltdf_tabs tabs_layout=”eltdf-tabs-regular”][eltdf_tab title=”Year 2008″][vc_column_text]For 2008, the Corporation’s Board of Directors recommends an increase in the pooling thresholds for all levels and, as a result, that the annual factors be adjusted accordingly.
Size of group, determined by the number of certificates | Threshold per certificate | Annual factor dependants | Annual factor With dependants |
Fewer than 10 | $2,400 | $154 | $425 |
Between 10 and 24 | $3,800 | $111 | $308 |
Between 25 and 49 | $9,800 | $51 | $142 |
Between 50 and 124 | $19,000 | $21 | $58 |
Between 125 and 249* | $32,000 | $8 | $23 |
250 and over** | $60,000 | No charge | No charge |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
[/vc_column_text][vc_empty_space][vc_column_text]
By increasing the pooling parameters for 2007, we are able to limit increases before inflation in the cost of medications as follows:
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Size | Threshold 2008 | Incidence of claims above the treshold | Rate increase |
Fewer than 10 | $2,400 | 8,1% | -3% |
Between 10 and 24 | $3,800 | 3,4% | 9% |
Between 25 and 49 | $9,800 | 0,6% | 14% |
Between 50 and 124 | $19,000 | 0,3% | 11% |
Between 125 and 249 | $32,000 | 0,1% | 9% |
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2009″][vc_column_text]PROPOSED TERMS & CONDITIONS FOR 2009
Size of group, determined by the number of certificates | Threshold per certificate 2009 | Annual factor dependants | Annual factor With dependants |
Fewer than 25 | $4,400 | $127 | $350 |
Between 25 and 49 | $11,300 | $60 | $165 |
Between 50 and 124 | $21,000 | $23 | $64 |
Between 125 and 249* | $37,000 | $7 | $19 |
250 and over** | $60,000 | No charge explicite | No charge explicite |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
[/vc_column_text][vc_empty_space][vc_column_text]
Specific conditions for plans with fewer than 250 certificates: :
Specific conditions for to plans of 250 certificates and over:
[/vc_column_text][vc_column_text]The proposed pooling parameters for 2009 satisfy the adjusted 20% Test, as follows:
Size | Threshold 2009 | Incidence* of claims above the treshold | Rate increase |
Fewer than 10 | 4 400$ | 3,09% | 8% |
Between 10 and 24 | 4 400$ | 3,09% | 8% |
Between 25 and 49 | 11 300$ | 0,57% | 13% |
Between 50 and 124 | 21 000$ | 0,23% | 20% |
Between 125 and 249 | 37 000$ | 0,05% | 20% |
250 and over | 60 000$ | n.a. | n.a. |
* THE INCIDENCE SHALL BE CALCULATED FOR EACH THRESHOLD, WITHOUT TAKING INTO ACCOUNT THE GROUP SIZE AS THE NUMBER OF CERTIFICATES IN WHICH THE CLAIM EXCEEDS THE THRESHOLD DIVIDED BY THE TOTAL NUMBER OF CERTIFICATES EXPOSED TO RISK.
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2010″][vc_column_text]PROPOSED TERMS & CONDITIONS FOR 2010
In 2009, the Quebec Drug Insurance Pooling Corporation (Corporation) pursued its work on an in-depth review of the terms and conditions of pooling in order to ensure terms and conditions that will be fair and respond to industry needs. An industry consultation followed in the fall of 2009. Then, taking into account comments received during this consultation, the Corporation established a two year plan for the extension of coverage to non insured plans no later than January 1, 2011.
For the year 2010, the Corporation’s Board of Directors’ recommendation is to maintain the actual model. However, while the number of bands is maintained, the pooling thresholds and the corresponding annual factors have been adjusted to reflect market trends.[/vc_column_text][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate 2010 | Annual factor dependants | Annual factor With dependants |
Less than 25 | 4 800$ | 128$ | 354$ |
Between 25 and 49 | 12 400$ | 60$ | 163$ |
Between 50 and 124 | 23 000$ | 23$ | 63$ |
Between 125 and 249* | 37 000$ | 10$ | 27$ |
250 and over** | 60 000$ | No explicit charge*** | No explicit charge*** |
* Insured groups only – Private plan coverage
** Insured groups only – Basic Prescription Drug Insurance Plan (RGAM)
*** For information purposes only: Estimated charges are $3 for ‘without’ and $8 for ‘with’
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
Specific conditions for plans with fewer than 250 certificates:
The 20% Test parameters were updated for the revision of the 2009 Terms and Conditions as follows:
Conditions specific to plans with less than 250 certificates :
Conditions specific to plans with 250 or more certificates :
[/vc_column_text][vc_column_text]The proposed pooling parameters for 2010 satisfy the 20% Test, as follows:
Size | Threshold 2010 | Incidence* of claims above the treshold | Rate increase |
Fewer than 25 | 4 800$ | 3,24% | 7% |
Between 25 and 49 | 12 400$ | 0,59% | 13% |
Between 50 and 124 | 23 000$ | 0,26% | 19% |
Between 125 and 249 | 37 000$ | 0,06% | 18% |
250 and over | 60 000$ | n.a. | n.a. |
*The incidence is calculated for each threshold in considering groups of all sizes, as the number of certificates presenting a claim exceeding the threshold divided by the total number of certificates exposed to risks.
[/vc_column_text][/eltdf_tab][eltdf_tab title=”Year 2011″][vc_column_text]PROPOSED TERMS & CONDITIONS FOR 2011
In 2010, the Quebec Drug Insurance Pooling Corporation (Corporation) pursued its work on the review of the terms and conditions of pooling in order to ensure terms and conditions that will be fair and respond to industry needs. According to the plan elaborated in 2009 by the Corporation, as of January 1, 2011, coverage is extended to administrative services only type (ASO) plans to include plans up to 1,499 certificates.[/vc_column_text][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate 2011 |
Annual factor No dependants |
Annual factor With dependants |
Fewer than 25 | 5 000 $ | 136,00 $ | 374,00 $ |
Between 25 and 49 | 13 000 $ | 63,00 $ | 175,00 $ |
Between 50 and 124 | 24 000 $ | 24,00 $ | 66,00 $ |
Between 125 and 249 | 39 000 $ | 9,00 $ | 26,00 $ |
Between 250 and 499 | 60 000 $ | 4,00 $ | 11,00 $ |
Between 500 and 999 | 80 000 $ | 2,00 $ | 5,50 $ |
Between 1000 and 1499 | 100 000 $ | 0,75 $ | 2,25 $ |
1 500 et plus | Free market | Free market | Free market |
For all eligible plans, the method of declaring claims to the Pooling Manager remains unchanged.
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
Specific conditions for to plans of 250 certificates and over:
Conditions specific to plans with more than 249 certificates and less than 1 500 certificates :
Groups of 1,500 certificates and over:
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2012″][vc_column_text]TERMS & CONDITIONS FOR 2012
In 2011, the Quebec Drug Insurance Pooling Corporation (Corporation) recommends that the terms and conditions of pooling be adjusted to reflect observed trends in the evolution of the volume of claims submitted to the pool.[/vc_column_text][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate 2012 | Annual factor dependants | Annual factor With dependants |
Fewer than 25 | $5 100 | $137,00 | $377,00 |
Between 25 and 49 | $13 500 | $63,00 | $175,00 |
Between 50 and 124 | $24 000 | $28,00 | $77,00 |
Between 125 and 249 | $39 000 | $13,00 | $36,00 |
Between 250 and 499 | $60 000 | $7,00 | $20,00 |
Between 500 and 999 | $80 000 | $5,50 | $15,25 |
Between 1 000 and 1 499 | $100 000 | $4,50 | $12,75 |
1 500 et plus | Free market | Free market | Free market |
For all eligible plans, the method of declaring claims to the Pooling Manager remains unchanged.
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
Specific conditions for plans with fewer than 250 certificates:
Specific conditions for plans over 249 certificates but less than 1,500 certificates:
Groups of 1,500 certificates and over
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2013″][vc_column_text]TERMS & CONDITIONS FOR 2013
In 2013, the Quebec Drug Insurance Pooling Corporation (Corporation) recommends that the terms and conditions of pooling be adjusted to reflect observed trends in the evolution of the volume of claims submitted to the pool. Due to the arrival in the market of expensive prescription drugs, pooling will be extended in 2013 to include groups of up to 2,999 certificates.[/vc_column_text][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate 2013 | Annual factor No dependants |
Annual factor With dependants |
Fewer than 25 | $5,100 | $137,00 | $377,00 |
Between 25 and 49 | $13,500 | $65,00 | $181,00 |
Between 50 and 124 | $25,000 | $29,00 | $81,00 |
Between 125 and 249 | $39,000 | $16,00 | $45,00 |
Between 250 and 499 | $60,000 | $10,00 | $27,00 |
Between 500 and 999 | $80,000 | $7,40 | $20,40 |
Between 1 000 and 2 999 | $100,000 | $5,75 | $15,75 |
3 000 and over | Free market | Free market | Free market |
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
Specific conditions for plans with fewer than 250 certificates:
Specific conditions for plans over 249 certificates but less than 2,999 certificates:
Groups of 3,000 certificates and over
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2014″][vc_column_text]Terms & Conditions for 2014
In 2014, the Quebec Drug Insurance Pooling Corporation (Corporation) recommends that the terms and conditions of pooling be adjusted to reflect observed trends in the evolution of the volume of claims submitted to the pool. Moreover, as of January 1, 2014, pooling will apply to the private plan formulary for all groups independent of size.[/vc_column_text][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate 2014 | Annual factor No dependants |
Annual factor With dependants |
Fewer than 25 | $6,000 | $163,00 | $449,00 |
Between 25 and 49 | $15,500 | $83,00 | $230,00 |
Between 50 and 124 | $27,500 | $40,00 | $110,00 |
Between 125 and 249 | $42,000 | $21 | $58,00 |
Between 250 and 499 | $60,000 | $12,50 | $33,75 |
Between 500 and 999 | $80,000 | $7,75 | $21,50 |
Between 1 000 and 2 999 | $100,000 | $5,50 | $14,75 |
3 000 and over | Free market | Free market | Free market |
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
Groups of 3,000 certificates and over:
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2015″][vc_column_text]In 2015, the Quebec Drug Insurance Pooling Corporation (Corporation) recommends that the terms and conditions of pooling be adjusted to reflect observed trends in the evolution of the volume of claims submitted to the pool especially taking into account the important volume of catastrophic claims as well as the impact of new medication for hepatitis C.[/vc_column_text][vc_column_text]
Size of group, determined by the number of certificates | Threshold per certificate 2015 | Annual factor No dependants |
Annual factor With dependants |
Fewer than 25 | $7,500 | $170,00 | $470,00 |
Between 25 and 49 | $17,000 | $95,00 | $263,00 |
Between 50 and 124 | $30,000 | $50,00 | $138,00 |
Between 125 and 249 | $45,000 | $29,00 | $81,00 |
Between 250 and 499 | $65,000 | $17,75 | $48,75 |
Between 500 and 999 | $85,000 | $10,50 | $28,75 |
Between 1 000 and 2 999 | $110,000 | $7,50 | $20,50 |
3 000 and over | Free market | Free market | Free market |
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
Groups of 3,000 certificates and over:
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2016″][vc_column_text]In 2016, the Quebec Drug Insurance Pooling Corporation (Corporation) recommends that the terms and conditions of pooling be adjusted to reflect observed trends in the evolution of the volume of claims submitted to the pool especially taking into account the important volume of catastrophic claims as well as the impact of new medication for hepatitis C.[/vc_column_text][vc_column_text]
Size of group (no. of certificates) |
Threshold per certificate 2016 |
Annual factor Without dependants |
Annual factor With dependants |
Fewer than 25 | $8,000 | $177,00 | $488,00 |
Between 25 and 49 | $18,000 | $101,00 | $279,00 |
Between 50 and 124 | $32,500 | $55,00 | $150,00 |
Between 125 and 249 | $47,500 | $36,00 | $99,00 |
Between 250 and 499 | $67,500 | $23,25 | $64,00 |
Between 500 and 999 | $90,000 | $16,50 | $45,00 |
Between 1 000 and 2 999 | $115,000 | $12,50 | $34,25 |
3 000 and over | Free market | Free market | Free market |
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
Groups of 3,000 certificates and over:
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2017″][vc_column_text]The Quebec Drug Insurance Pooling Corporation (Corporation) establishes the terms and conditions of pooling for 2017 with adjustments to reflect observed trends in the evolution of the volume of claims submitted to the pool especially taking into account the important volume of catastrophic claims as well as the impact of new medication for hepatitis C.[/vc_column_text][vc_column_text]
Size of group (no. of certificates) |
Threshold per certificate 2017 | Annual factor Without dependants |
Annual factor With dependants |
Fewer than 25 | $8,000 | $198,00 | $546,00 |
Between 25 and 49 | $18,000 | $120,00 | $330,00 |
Between 50 and 124 | $32,500 | $70,00 | $192,00 |
Between 125 and 249 | $47,500 | $50,00 | $136,00 |
Between 250 and 499 | $72,000 | $32,00 | $89,00 |
Between 500 and 999 | $95,000 | $24,00 | $67,00 |
Between 1 000 and 3 999 | $120,000 | $19,00 | $52,00 |
4 000 and over | Free market | Free market | Free market |
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2018″][vc_column_text]The Quebec Drug Insurance Pooling Corporation (Corporation) establishes the terms and conditions of pooling for 2018 with adjustments to reflect observed trends in the evolution of the volume of claims submitted to the pool more specifically taking into account the important volume of catastrophic claims as well as the impact of new medication for hepatitis C.[/vc_column_text][vc_column_text]
Size of group (no. of certificates) |
Threshold per certificate 2018 | Annual factor Without dependants |
Annual factor With dependants |
Fewer than 25 | $8,000 | $198,00 | $546,00 |
Between 25 and 49 | $18,000 | $122,00 | $335,00 |
Between 50 and 124 | $32,500 | $72,00 | $197,00 |
Between 125 and 249 | $47,500 | $50,00 | $136,00 |
Between 250 and 499 | $72,000 | $31,00 | $85,00 |
Between 500 and 999 | $95,000 | $23,00 | $63,00 |
Between 1 000 and 3 999 | $120,000 | $19,00 | $51,00 |
4 000 and over | Free market | Free market | Free market |
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
[/vc_column_text][/eltdf_tab][eltdf_tab title=”YEAR 2019″][vc_column_text]The Quebec Drug Insurance Pooling Corporation (Corporation) establishes the terms and conditions of pooling for 2019 with adjustments to reflect observed trends in the evolution of the volume of claims submitted to the pool more specifically taking into account the important volume of catastrophic claims.[/vc_column_text][vc_column_text]
Size of group (no. of certificates) |
Threshold per certificate 2019 | Annual factor Without dependants |
Annual factor With dependants |
Fewer than 25 | $8,000 | $192,00 | $529,00 |
Between 25 and 49 | $16,500 | $122,00 | $337,00 |
Between 50 and 124 | $32,500 | $64,00 | $177,00 |
Between 125 and 249 | $47,500 | $44,00 | $120,00 |
Between 250 and 499 | $72,000 | $28,00 | $77,00 |
Between 500 and 999 | $95,000 | $22,00 | $60,00 |
Between 1 000 and 3 999 | $120,000 | $18,00 | $50,00 |
4 000 and over | Free market | Free market | Free market |
[/vc_column_text][vc_column_text]All plans are subject to the following conditions:
[/vc_column_text][/eltdf_tab][/eltdf_tabs][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space height=”120px”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]
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