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Normandin Beaudry

The Act Respecting Prescription Drug Insurance

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There, in black and white

NB Bulletin Vol. 10 N. 4, March 2007

This bulletin follows our December 2006 bulletin (Vol. 9, no 13).

On December 13, 2005, the Quebec government adopted Bill 130, an Act to amend the Act respecting prescription drug insurance. The bill’s measures will have an impact on the administration of private group insurance plans. Some provisions came into effect on the date the bill was adopted, some took effect in 2006, and others will come into effect in 2007.

Definition of eligible spouse and children

The various questions recently raised by our clients have prompted us to provide some clarification on this matter.

Since August 30, 2006, the Act respecting prescription drug insurance has stipulated that plan members are obligated to provide coverage to their spouses if the spouse lives with them. The Act also stipulates that spouseless children between the ages of 18 and 25 who attend an educational institution on a full-time basis must now be living with their father, mother or tutor to be considered as an eligible dependent child under a group insurance plan.

According to the Régie de l’assurance maladie du Québec’s (RAMQ) interpretation, members of a private group insurance plan will no longer be allowed to provide coverage to their spouses or children between the ages of 18 and 25 if they are not living with them. However, this restriction does not apply to a child studying away from home and who normally lives with his parents.

Application of the Act with respect to medications not on the list

Since the Act was implemented in 1997, RAMQ has focused on the idea that Quebec’s Act respecting prescription drug insurance would govern only prescription drugs included on the list of prescription drugs covered by RAMQ, and that reimbursement of other drugs (not included on the list) under private group insurance plans would not be subject to the Act (e.g.: out-of-pocket maximum for participants, reimbursement percentage, etc.).

RAMQ recently modified its interpretation with respect to drugs not included on the list, indicating that the Act requires private insurance plans which cover them to apply the conditions that are, at a minimum, as generous as those provided for in the Act to all drugs.

The majority of private group insurance plans insurers do not currently administer plans in this manner. The application of this new interpretation will not only add to their administrative burden, but also result in an increase in insurance costs for policyholders and members.

Several insurers oppose RAMQ’s new interpretation of the law and are banding together and working with the Canadian Life and Health Insurance Association Inc. (CLHIA) to prevent the application of this interpretation.

Rest assured that we will keep you informed of any developments on this subject.

 

Please feel free to contact us for additional information.

514.285.1122
 
630, René-Lévesque Blvd. West, 30th floor
Montreal, Quebec, H3B 1S6