unlimited exposure

Drug Coverage in Quebec

Situation

Effective January 1, 1997 all Quebec residence (with Medicare) will be covered by a drug plan.

Those not covered through a private group plan will be covered through the public plan provided by RAMQ with premiums collected along with provincial income tax.

All employers that provide accident, sickness or disability benefits must also provide drug coverage as outlined below:

covering all drugs listed on the Quebec Government Drug plan at prices negotiated by the Quebec Government,
provide at least 75% reimbursement of eligible expenses (maximum 25% co-insurance),
have an annual deductible of $100 or less per individual,
limit member's annual out-of-pocket expenses (co-insurance and deductible) to $750 from all sources,
cover all eligible plan members regardless of age, health status,
participation is compulsory for all eligible plan members not covered elsewhere,
any eligibility waiting period must be waived for drug benefits.

Problems

Quebec severely restricts the ability of plan sponsors to manage the cost of the major component of medical benefits.

Formulary management and claim maximums are not permitted for residences of Quebec.
Defined contribution health plan (health spending account) is not permitted for residences of Quebec.
Quebec residences are not permitted to participate in other benefits unless they are provided the drug coverage mandated by RAMQ.
Individual drug coverage that replaces RAMQ is prohibited.

Solutions

It is your choice whether to give your Quebec staff the plan that their politicians have designed or not. Unfortunately, they have raised the stakes to an all-or-nothing gambit. Even though RAMQ does not have the time to verify that employers are complying with the law it is best not to risk non-compliance.

Exclude Quebec staff from the benefits plan and pay them an amount in lieu of benefits.
Create a special medical plan for Quebec staff, if you have 2 or more employees.
Modify your national plan to comply with RAMQ.