RAMQ modifies financial parameters for drug insurance

The changes are effective July 1, 2009, and will be relevant to Quebec employees and retirees who receive group health insurance.

The maximum premium for those insured under the basic drug plan is $585 per year, up from $570. It applies to those who are not covered by group private plans and, in most cases, to those insured persons age 65 or over.

The monthly deductible for persons covered by RAMQ will increase to $14.95, up from $14.30.

Co-insurance (the portion paid by RAMQ once the deductible is satisfied) will be reduced to 68%, down from 69%. For a private group insurance plan, the minimum co-insurance is now also 68%.

The maximum contribution is equal to the total of the deductible and co-insurance paid by the insured. In the public plan, the maximum contribution is applied on a monthly basis; it is $79.53, up from $77.21. For private group plans, the maximum contribution is applied on an annual basis; the corresponding annual amount is $954 as opposed to $927 prior to July 1, 2009.

The impact of these changes for private plans mirroring RAMQ coverage(a reduction in co-insurance from 69% to 68%), combined with an increase in maximum contribution from $927 to $954, will translate into an average reduction of approximately 2% in drug costs.

If the drug coverage applicable to employees who are not age 65 is more generous, there will be no financial impact to the plan. However, if the plan reimburses the RAMQ co-payments paid by employees who are age 65 or over and are covered by RAMQ, plan sponsors could expect an average increase in drug costs of approximately 3%.

The application of the prescribed financial parameters is not always detailed in group plan texts. These changes to financial parameters should be reviewed to see its applicability to one’s benefits provisions.

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