HomePoolingTerms and Conditions of Pooling

Terms and Conditions of Pooling

Pooling is based on terms and conditions that vary according to the covered group, i.e. on the number of certificates in the group (one certificate corresponds to one member, with or without dependents). These terms and conditions incorporate two parameters, namely:

the pooling threshold: this is the amount per certificate above which claims are pooled among participating insurers and employee benefit plan administrators;

To be eligible, the claims must have been submitted and paid during the year in question and be for medications covered by the private plan;

the annual pooling factor: for insured groups, this is a portion of the insurance premium reserved for compensation of the pooled amounts; for non-insured groups, it is an assessment paid to the Compensation Table for the purpose of pooling.

How do we define terms & conditions ?

A larger group is better able to absorb high claims from the sum of premiums or contributions paid. Therefore, the more certificates the group has, the higher the pooling threshold and the lower the annual factor.

The methods of mutualisation are established and validated on the basis of a test of reasonableness (Monte Carlo test) based on multiple actuarial assumptions. These assumptions take into account past claims, cost, and use of drugs.

Terms & conditions for 2021

The Quebec Drug Insurance Pooling Corporation (Corporation) establishes the terms and conditions of pooling for 2021.

Size of group
(no. of certificates)
Threshold per certificate 2021 Annual factor
Without dependants
Annual factor
With dependants
Fewer than 25 $8,000 $251,00 $691,00
Between 25 and 49 $16,500 $165,00 $455,00
Between 50 and 124 $32,500 $94,00 $258,00
Between 125 and 249 $47,500 $68,00 $187,00
From 250 to 499 $72,000 $49,00 $135,00
From 500 to 999 $95,000 $40,00 $111,00
From 1 000 to 3 999 $120,000 $35,00 $95,00
From 4 000 to 5 999 $300,000 $16,00 $44,00
6 000 and over Free market Free market Free market

Adopted by the Board of the Quebec Drug Insurance Pooling Corporation on October 13th, 2020.

Download PDF version

All plans are subject to the following conditions:

The compensation formula uses paid claims per certificate exceeding the threshold, including claims paid as second payors.

The terms and conditions of pooling reflect a target loss ratio of 93% for segments below $50,000 and 90% for higher segments.

Eligible drugs are those covered by the private plan.


Terms & conditions for 2020

The Quebec Drug Insurance Pooling Corporation (Corporation) establishes the terms and conditions of pooling for 2020.

Size of group
(no. of certificates)
Threshold per certificate 2020 Annual factor
Without dependants
Annual factor
With dependants
Fewer than 25 $8,000 $211,00 $581,00
Between 25 and 49 $16,500 $137,00 $376,00
Between 50 and 124 $32,500 $74,00 $205,00
Between 125 and 249 $47,500 $52,00 $142,00
From 250 to 499 $72,000 $34,00 $94,00
From 500 to 999 $95,000 $27,00 $74,00
From 1 000 to 3 999 $120,000 $23,00 $62,00
From 4 000 to 5 999 $300,000 $11,00 $31,00
6 000 and over Free market Free market Free market

Adopted by the Board of the Quebec Drug Insurance Pooling Corporation on October 15th, 2019.

Download PDF version

All plans are subject to the following conditions:

The compensation formula uses paid claims per certificate exceeding the threshold, including claims paid as second payors.

The terms and conditions of pooling reflect a target loss ratio of 93% for segments below $35,000 and 90% for higher segments.

Eligible drugs are those covered by the private plan.


 Terms & conditions for 2019

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.

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

Adopted by the Board of the Quebec Drug Insurance Pooling Corporation on October 10th, 2018.

Download PDF version

All plans are subject to the following conditions:

The compensation formula uses 100% of paid claims per certificate exceeding the threshold.

The terms and conditions of pooling reflect a target loss ratio of 93% for segments below $35,000 and 90% for higher segments.

Eligible drugs are those covered by the private plan.

As of January 2019, claims paid as a second payor will be subject to pooling.


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