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Pooling – Drug Insurance in Quebec 2012 Terms and Conditions

News Release

Pooling System

The pooling system was implemented following the introduction of the Quebec general drug insurance plan in 1997. The Quebec Drug Insurance Pooling Corporation (QDIPC) was then set up to coordinate the pooling process between the various life and health insurance industry stakeholders. The primary objective of pooling is to allow holders of group insurance contracts to protect themselves against the financial impact of substantial drug claim expenses.

Current features:

  • Pooling only applies to Quebec certificates. 
  • Groups of less than 1,499 plan members are subject to the same standard formula applied in the industry, whether the group is insured or not. 
  • Pooling thresholds per certificate have been established according to the assumption that a group should not have a rate increase of more than 20% before inflation after an important claim. 
  • All insurers and administrators of administrative services only (ASO) plans must participate in the pooling system. 
  • All drugs purchased in Canada are subject to pooling.

Recommendations for 2012

For 2012, the QDIPC recommended maintaining the coverage for groups of up to 1,499 certificates, while updating the thresholds and costs. However, for insured groups of 250 or more certificates, Industrial Alliance recommends using the same $39,000 threshold that applies to groups of 125 to 249 certificates in order to better protect and stabilize future pricing. Industrial Alliance offers several pooling options for groups of more than 250 certificates that are on a retention or ASO basis.

Size of group
(number of
certificates)
Threshold per
QDIPC certificate

Threshold per
certificate at
Industrial Alliance
Net annual cost
per individual
certificate
Net annual cost
per family
certificate
Less than 25  $5,100 $5,100 $137 $377
25 to 49 $13,500
$13,500 $63 $175
50 to 124 $24,000 $24,000 $28 $77
125 to 249  $39,000 $39,000 $13 $36
250 to 499  $60,000 $39,000 $13
$36
500 to 999 $80,000 $39,000 $13
$36
1,000 to 1,499  $100,000 $39,000
$13
$36

It is important to note that these new parameters are reflected as of now in 2012 renewals.

For more information about pooling, please contact your benefits advisor or your Industrial Alliance group account executive.