Pooling – Drug Insurance in Quebec 2013 Terms and Conditions

Pooling System

A pooling system for drug-related risks was implemented for insurers and benefits administrators following the introduction of the Quebec Basic Prescription Drug Insurance Plan (BPDIP) 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 carriers. The primary objective of pooling is to allow policyholders of group insurance contracts to protect themselves against the financial impact of significant drug claim expenses.

Current features:

• Pooling only applies to Quebec certificates. 
• Groups of fewer than 3,000 plan members are subject to the same standard formula that is applied across the industry, whether the group is insured or not. 
• All insurers and administrators of administrative services only (ASO) plans must participate in the pooling system. 
• Pooling parameters are determined using a test for reasonability. 
• All drugs purchased in Canada are subject to pooling, but only those that appear on the BPDIP list of medications are pooled for groups of more than 249 certificates.

Pooling parameters for 2013

For 2013, the QDIPC extended coverage for groups of up to 2,999 certificates, while updating the thresholds and costs. It should be noted, however, that Industrial Alliance will apply the threshold and costs for groups of 50 to 124 certificates ($25,000) for insured groups of 125 or more certificates in compliance with the pooling parameters set by the Canadian Drug Pooling Corporation. Industrial Alliance also offers several pooling parameters for groups that are on a retention or ASO basis.

It is important to note that these new parameters are reflected as of now in 2013 renewals.

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