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.
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 |
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.
The following elements were confirmed:
1. All groups with fewer than 125 certificates are protected by a formula applied uniformly throughout the industry.
2. The thresholds per certificate were established under the assumption that a group should
not face a rate increase of more than 20% based on poor experience.
not face a rate increase of more than 20% based on poor experience.
3. Groups of 125 certificates and more are free to negotiate with insurers the form of protection they wish, and its cost
4. Beginning in 1999, insured groups of 125 participants and over have been protected by a pooling threshold of $50,000 for the cost of drugs covered under the Basic Plan.
5. Pooling protects a group’s insurance file against the aggregate of drug costs exceeding a certain threshold per certificate; the threshold varies according to the size of the group.
6. Medications covered in these calculations are those that are submitted and reimbursed during the year insofar as they are eligible under the definition in each insurer’s contracts.
| 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.
| 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.
| 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.
| 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)
| 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)
| 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)
| 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)
| 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.
Compensation formula
The compensation formula applies 80% up to the maximum annual disbursement prescribed by the government and 100% on the remainder.
| 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 |
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)
1. For groups with fewer than 125 certificates, pooling continues to apply for insured and uninsured plans. The eligible medications are those covered by the private plan.
2. For groups from 125 to 249 certificates, pooling applies to insured plans only. As for groups of fewer than 125 certificates, the eligible medications are those covered by the private plan.
3. The pooling parameters have been modified in function of a projection of the volume of future claims using a 2006/2005 growth ratio by levels as an hypothesis for inflation in drug costs. The growth ratio retained for each level is subject to a minimum of 10% and a maximum of 200%. This hypothesis takes into account the variations currently observed in the market.
4. Thus, the pooling thresholds have been changed in accordance with a reasonable increase rate of about 15% with the exception of the more than 250 certificates level where the increase is 20%.
5. For insured plans of 250 certificates and over, the pooling threshold is now $60,000. As in the past, only the cost of drugs that are covered by the basic plan continues to be eligible. No explicit charge applies.
6. The terms and conditions of pooling allow for a loss ratio of 90%.
7. The compensation formula of 80% of the first $4,520 and 100% of the remainder is based on a maximum annual disbursement of $904.
8. The compensation formula so-called “pyramidal” is maintained for compensation by levels, which makes it possible to avoid the difficulties a given stratum would have, in absorbing an exceptional volume of large claims, by sharing them among the entire pooled population based on a cumulative approach level by level.
9. The thresholds for groups have been established so that rate increases for a group with poor experience following a very large claim will remain below 20% before inflation in drug costs.
By increasing the pooling parameters for 2007, we are able to limit increases before inflation in the cost of medications as follows:
By increasing the pooling parameters for 2007, we are able to limit increases before inflation in the cost of medications as follows:
| 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% |
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)
Since the introduction of the pooling model, the thresholds have been increased to reflect increases in drug costs. For 2009, they were adjusted at a rate of 15%.
This scenario proposes merging the first two strata, fewer than 9 and of 10-24, and to establish the pooling threshold at $4,400.
The pooling parameters have been modified according to a projection of the volume of future claims using an average trend between the years 2004 and 2006 as hypothesis for inflation in drug costs. The growth ratio used for each stratum is subject to a minimum of 10% and a maximum of 200%. This hypothesis takes into account the current variations observed in the market.
The Terms and Conditions calculated conform to the current reasonability test after adjustments.
A per certificate pooling approach continues to apply.
All plans are subject to the following conditions:
The compensation formula of 80% of the first $4,635 and 100% of the remainder is based on the annual minimum disbursement of $927.
The terms and conditions of pooling assume a loss index of 90%.
Thresholds for groups have been set so that the rate increases for a group with poor experience following a very large claim will be less than 20% before inflation in the cost of medications.
The parameters of the 20% Test have been brought up to date for the review of the Terms and Conditions for 2009 as follows:
To reflect a recent market analysis, the proportion of certificates making claims was judged to be too low and raised from 62.5% to 80%.
The calculation posits total premiums paid using an average claim per certificate that is no longer adjusted as if it were an average claim per individual, since that had the effect of overestimating the premium.
Following industry practice, a credibility factor has been accorded to experience based on group size. The credibility formula used is the square root of the number of certificates divided by 75. This formula was determined based on a poll of insurers participating in pooling.
Specific conditions for plans with fewer than 250 certificates: :
The strata of fewer than 10 certificates and for 10 to 25 certificates have been combined.
Eligible medications continue to be those covered by the private plan.
The compensation formula, based on risk sharing, remains the so-called pyramidal formula of compensation by levels, which makes it possible to avoid the difficulties of a given stratum having to absorb an exceptional volume of large claims by sharing them across the entire pooled population using a cumulative approach by level.
Specific conditions for to plans of 250 certificates and over:
Only the cost of medications covered by the basic plan (RGAM) is pooled.
The method of compensation, based on market share, remains unchanged.
The proposed pooling parameters for 2009 satisfy the adjusted 20% Test, as follows:
| Size | Threshold 2009 | Incidence* of claims above the treshold | Rate increase |
| Fewer than 10 | 4 400$ | 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.
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.
| 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’
All plans are subject to the following conditions:
Given that the lowest threshold level (set at $4,800) exceed the amount of expenses required to reach the annual out of pocket maximum, the compensation formula becomes 100% of the amount in excess of the threshold.
The pooling parameters have been modified according to a projection of the volume of future claims using an average trend between the years 2005 and 2007 as hypothesis for inflation in drug costs. The growth ratio used for each stratum is subject to a minimum of 10% and a maximum of 80%. This hypothesis takes into account observed variations in the occurrences of large claims over size of groups observed in the market.
Thresholds for groups have been set, so that the rate increases for a group with poor experience following a very large claim, will be less than 20% before inflation in the cost of medications.
The terms and conditions of pooling assume a loss index of 90%.
A per certificate pooling approach continues to apply.
Specific conditions for plans with fewer than 250 certificates:
Eligible medications are those covered by the private plan.
The compensation formula, based on risk sharing, remains the so-called pyramidal formula of compensation by levels, which makes it possible to avoid the difficulties of a given stratum having to absorb an exceptional volume of large claims by sharing them across the entire pooled population using a cumulative approach by level.
The thresholds of the groups were established so that the tariff increases of a group that would experience bad experience, following a very large claim, are less than 20% before inflation on the cost of drugs.
The 20% Test parameters were updated for the revision of the 2009 Terms and Conditions as follows:
To reflect a recent market analysis, the proportion of certificates claiming used judged to be too low was adjusted from 62.5% to 80%.
The calculation considers the total premiums paid using an average claim per certificate that is no longer adjusted as if it were an average claim per individual because this had the effect of overestimating the premium.
As with industry practice, a credibility factor is given to the experience depending on the size of the group. The credibility formula used is the square root of the number of certificates divided by 75. This formula was determined from a survey of insurers participating in the pool.
Conditions specific to plans with less than 250 certificates :
The strata of less than 10 certificates and 10 to 24 certificates are combined.
Eligible drugs remain those covered by the private plan.
The compensation formula, based on the distribution of risk, remains a so-called pyramid compensation formula that avoids the difficulties for a given stratum to absorb an unusual volume of large claims by sharing them by the entire population Pooling, using a cumulative approach per tranche.
Conditions specific to plans with 250 or more certificates :
Only the costs of medicines covered by the general scheme are pooled.
The participant must establish the appropriate pooling charge according to his experience.
The method of compensation based on market share remains unchanged.
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.
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.
| 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.
All plans are subject to the following conditions:
Given that the lowest threshold level (set at $5,000) exceed the amount of expenses required to reach the annual out of pocket maximum, the compensation formula becomes 100% of the amount in excess of the threshold.
Thresholds for groups have been set, so that the rate increases for a group with poor experience following a very large claim, will be less than 20% before inflation in the cost of medications.
The terms and conditions of pooling assume a target loss index of 90%.
A per certificate pooling approach continues to apply.
Specific conditions for to plans of 250 certificates and over:
Eligible medications are those covered by the private plan.
The compensation formula, based on risk sharing, remains the so-called pyramidal formula of compensation by levels, which makes it possible to avoid the difficulties of a given stratum having to absorb an exceptional volume of large claims by sharing them across the entire pooled population using a cumulative approach by level.
Conditions specific to plans with more than 249 certificates and less than 1 500 certificates :
Only the costs of medicines covered by the general scheme are pooled.
Groups of 1,500 certificates and over:
For groups insured and non-insured of 1,500 certificates and over, claims are no longer pooled.
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.
| 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.
All plans are subject to the following conditions:
Given that the lowest threshold level (set at $5,100) exceed the amount of expenses required to reach the annual out of pocket maximum, the compensation formula becomes 100% of the amount in excess of the threshold.
Thresholds for groups have been set, so that the rate increases for a group with poor experience following a very large claim, will be less than 20% before inflation in the cost of medications.
The terms and conditions of pooling assume a target loss ratio of 95% for bands with a threshold lower than $70,000 and of 90% for all other bands.
A per certificate pooling approach continues to apply.
Specific conditions for plans with fewer than 250 certificates:
Eligible medications are those covered by the private plan.
Specific conditions for plans over 249 certificates but less than 1,500 certificates:
Only the costs of medications covered by the basic plan (RGAM) are pooled.
Groups of 1,500 certificates and over
For groups insured and non-insured of 1,500 certificates and over, pooling terms and conditions do not apply.
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.
| 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 |
All plans are subject to the following conditions:
Given that the lowest threshold level (set at $5,100) exceed the amount of expenses required to reach the annual out of pocket maximum, the compensation formula becomes 100% of the amount in excess of the threshold.
The terms and conditions of pooling assume a target loss ratio of 95% for bands with a threshold lower than $70,000 and of 90% for all other bands.
A per certificate pooling approach continues to apply.
Specific conditions for plans with fewer than 250 certificates:
Eligible medications are those covered by the private plan.
Specific conditions for plans over 249 certificates but less than 2,999 certificates:
Only the costs of medications covered by the basic plan (RGAM) are pooled.
Groups of 3,000 certificates and over
For groups insured and non-insured of 3,000 certificates and over, pooling terms and conditions do not apply.
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.
| 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 |
All plans are subject to the following conditions:
Given that the lowest threshold level, set at $6,000, exceed the amount of expenses required to reach the annual out of pocket maximum, there is no adjustment required to account for standard coinsurance (80%/100%). Consequently, the compensation formula becomes 100% of the amount in excess of the threshold.
The terms and conditions of pooling assume a target loss ratio of 95% for bands with a threshold lower than $70,000 and of 90% for all other bands.
A per certificate pooling approach continues to apply.
Eligible medications are those covered by the private plan.
Groups of 3,000 certificates and over:
Groups insured and non-insured of 3,000 certificates and over are free to obtain pooling protection as they see fit.
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.
| 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 |
All plans are subject to the following conditions:
Eligible amounts are paid claims amounts and the compensation formula is calculated as 100% of the amount in excess of the threshold.
The terms and conditions of pooling assume a target loss ratio of 95% for bands with a threshold lower than $70,000 and of 90% for all other bands.
A per certificate pooling approach continues to apply.
Eligible medications are those covered by the private plan.
Groups of 3,000 certificates and over:
Groups insured and non-insured of 3,000 certificates and over are free to obtain pooling protection as they see fit.
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.
| 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 |
All plans are subject to the following conditions:
Eligible amounts are paid claims amounts and the compensation formula is calculated as 100% of the amount in excess of the threshold.
The terms and conditions of pooling assume a target loss ratio of 95% for bands with a threshold lower than $70,000 and of 90% for all other bands.
A per certificate pooling approach continues to apply.
Eligible medications are those covered by the private plan.
Groups of 3,000 certificates and over:
Groups insured and non-insured of 3,000 certificates and over are not submitted to specific pooling criteria.
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.
| 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 |
All plans are subject to the following conditions:
Eligible amounts are actual paid claims amounts.
The compensation formula is calculated as 100% of the amount in excess of the threshold.
The terms and conditions of pooling assume a target loss ratio of 90%.
A per certificate pooling approach continues to apply.
Eligible medications are those covered by the private plan.
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.
| 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 |
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.
The Quebec Drug Insurance Pooling Corporation recommended Terms and Conditions for 2018 are derived each year after consultation with the industry. Adopted by the Board of the Quebec Drug Insurance Pooling Corporation on October 23, 2017.