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Pooling – Drug Insurance in Quebec 2014 Terms and Conditions

News Release

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 Canadian Drug Insurance Pooling Corporation coordinates the pooling process among various life and health insurance companies. The primary objective of pooling is to allow group insurance policyholders to protect themselves against the financial impact of significant drug claim costs.

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 unlike past years, pooling will apply to the private plan formulary for all groups independent of size effective January 1, 2014.

Pooling parameters for 2014

Industrial Alliance will continue to apply the threshold and costs for groups of 50 to 124 certificates for insured groups of 125 or more certificates in compliance with the pooling parameters set by the Canadian Drug Insurance Pooling Corporation. Industrial Alliance also offers several pooling parameters for groups that are funded 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  $6,000 $6,000 $163 $449
25 to 49 $15,500
$15,500
$83 $230
50 to 124 $27,500 $27,500 $40 $110
125 to 249  $42,000 $27,500
$40 $110
250 to 499  $60,000 $27,500
$40
$110
500 to 999 $80,000 $27,500
$40
$110
1,000 to 1,499  $100,000 $27,500
$40
$110
1,500 to 2,999 $100,000 $27,500
$40
$110

These new parameters are included in 2014 renewals.

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