About the pooling plan
All group insurers in Quebec contribute to a pooling plan that protects private sector plan sponsors against the financial impact of large claims for drug costs. Based on pooling results for previous years, the Quebec Drug Insurance Pooling Corporation submitted a report to Quebec’s Health and Social Services minister. The report details 2023 pooling parameters and has been approved by all industry members.
How does it affect Clients?
Pooling levels and fees are designed to cover predicted costs for claims and operating expenses associated with prescription drugs. While the overall pooling structure remains similar:
- the pooling level is increasing from:
- $8,000 to $10,000 for groups with less than 25 certificates
- $16,500 to $18,000 for groups 25 to 49 certificates
- all other pooling levels remain unchanged
- pooling factors remain unchanged for groups with less than 49 lives, increasing for groups 50 to 249 and decreasing for groups above 250 lives.
- eligible amounts remain the paid claim amounts and the compensation formula is calculated as 100% of the amount in excess of the threshold
- eligible medications remain those covered by the private plan
- a per certificate pooling approach still applies
2023 pooling parametersi
Size of group (no. of certificates) |
Threshold per certificate 2023 |
Annual factor Without dependant(s) |
Annual factor With dependant(s) |
Fewer than 25 |
$10,000 |
$276.00 |
$771.00 |
From 25 to 49 |
$18,000 |
$188.00 |
$527.00 |
From 50 to 124 |
$32,500 |
$100.00 |
$339.00 |
From 125 to 249 |
$55,000 |
$66.00 |
$224.00 |
From 250 to 499 |
$80,000 |
$50.00 |
$169.00 |
From 500 to 999 |
$105,000 |
$36.00 |
$142.00 |
From 1,000 to 3,999 |
$130,000 |
$31.00 |
$123.00 |
From 4,000 to 5,999 |
$300,000 |
$15.00 |
$60.00 |
6,000 and over |
Free market – Groups not subject to Quebec Industry Pooling |
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Questions? We’re here to help.
Please contact your Sun Life Group Benefits representative.
iTerms and conditions and pooling parameters from http://mutualisation.ca/en/pooling/terms-and-conditions-of-pooling/
