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:

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;

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.

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

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.

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

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.

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

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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