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Normandin Beaudry

The changes made to the Quebec's Act respecting prescription drug insurance

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There, in black and white

NB Bulletin Vol. 10 N. 8, July 2007

This bulletin follows those issued in December 2006 and March 2007 concerning amendments made to Quebec’s Act respecting prescription drug insurance.

The Régie de l’assurance maladie du Québec (RAMQ) published a bulletin (available in French only) entitled "Info assurance médicaments", which provided an explanation of its interpretation of the definition of eligible dependents. According to this interpretation, the definition of eligible dependents under a private group insurance plan must reflect the definition set out in the Act and thus may not be more generous.

Since August 30, 2006, to be eligible under a private plan, spouses, disabled children and children between the ages of 18 and 25 who are full-time students and who do not have spouses must be domiciled with the member covering them as a dependent.

In addition, the following rules will apply with respect to eligible children effective October 1, 2007:

  • If the father and mother do not share the same domicile, the parent with whom the child is domiciled must cover the child.
  • If the parent with whom the child is domiciled does not have access to a private group insurance plan but the other parent qualifies for coverage under a private plan, the other parent must cover the child. If this parent is exempted from his/her employer’s plan to be covered as a dependent under his/her new spouse’s plan, he/she must discontinue coverage under his/her new spouse’s plan and enrol in his/her employer’s plan to ensure that coverage is provided to the child.
  • If the father and mother do not have access to a private group insurance plan and the spouse of the parent with whom the child is domiciled is required to cover that parent, the spouse must also cover the child.
  • The child of a child covered as a dependent under the private plan of one of his/her parents may also benefit from the same protection if the parent’s plan offers this type of coverage. If not, the child of the child must enrol in the public plan.

  • Keep in mind that the amendments to the Act also stipulate that the RAMQ may request the submission of group insurance contract texts to verify compliance.

Amendments to private group insurance plans

The majority of private group insurance plans terminate coverage for dependent children when these children reach the age of 21 if they are not full-time students. According to the RAMQ’s interpretation, going forward, coverage for dependent children must be terminated at the age of 18 if they are not full-time students. These individuals must enrol in the public plan if they do not otherwise have access to a private group insurance plan.

The definition of eligible dependents must also include the notion of a shared domicile with the member for the spouse and dependent children between the ages of 18 and 25 who are full-time students. Most private plans do not include this notion.

These two amendments to private insurance plans raise the following questions:

  • Quebec’s Act respecting prescription drug insurance and regulation respecting the basic prescription drug insurance plan govern only the "prescription drug" component of private group insurance plans. Will insurers be able to apply a different definition of eligible dependents for prescription drugs only?
  • Will the new definition of eligible dependents apply to all employees or only those residing in Quebec?
  • Will the RAMQ and insurers accept maintaining the current definition of dependent children with coverage that becomes supplementary to the public plan at age 18 if the child is no longer a student?

  • These questions were put forward by insurers and employers, who must provide answers to them if there is no change in the RAMQ’s position. We will keep you informed of any clarifications or amendments communicated by the RAMQ.

Premium waiver form

In our bulletin of December 2006, we notified you that effective January 1, 2007, it was mandatory for employers to deduct from the pay of each eligible employee, the prescription drug insurance premium for the group insurance plan offered to their employees. Employers were exempt from making these deductions only when an employee demonstrated that he/she was covered under another group insurance plan.

The RAMQ recently made available on its website a premium waiver form for coverage under the basic prescription drug insurance plan.

When this form is completed and signed by an employee who wishes to waive health insurance coverage under the group private insurance plan offered by his/her employer, the employee is not required to provide additional proof of coverage under another private plan. For these situations, we recommend that you use this form, which is available only in French by clicking here.

If you require our assistance to translate it, please contact your Normandin Beaudry consultant.

"Info assurance médicaments" bulletin

Other portions of the "Info assurance médicaments" bulletin explaining the RAMQ’s interpretation of other sections of the Act respecting prescription drug insurance will be available on the RAMQ website in the coming months. These explanations will likely clarify the RAMQ’s interpretation as regards to medications not on the list, which we touched on in our bulletin of March 2007.

Rest assured that we will keep you informed of any developments on this subject and their impacts on your group insurance plans.

 

Please feel free to contact us for additional information.

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