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.