Ralph Moss Ltd.
BILL 33 AS PASSED INTO LAW
Quebec's Bill 33 proposing a universal drug plan was passed
into law on June 19th. It included major amendments to the
initial version that has been tabled May 15th in the national
Assembly.
The key provisions of the law as adopted are:
- A mandatory basic drug plan for all Quebec residents.
- The government, through the RAMQ (Regie d'assurance
maladie du Quebec), will offer basic plan coverage to
those age 65+, welfare recipients and all individuals not
eligible for group plan coverage, including their
dependents.
- The RAMQ plan parameters for seniors aged 65 and over who
do not receive a guaranteed income supplement are:
Premium: $175/adult
Quarterly deductible: $25
Coinsurance: 25%
Quarterly maximum user fees: $187.50
Recipients of welfare and guaranteed income supplement will
have the same deductible and coinsurance but will see their
premiums vary from $0 to $175 and their quarterly maximum user
fees reduced to $50 or $125 depending on their annual revenues.
Children of RAMQ insured have completely free drug coverage: no
premiums and no user fees.
· Group drug coverage offered by the private sector must meet
certain minimum requirements of the basic general plan. These
are:
- All drugs that are listed and periodically reviewed by the
government (on the recommendation of the Pharmacology committee)
must be covered.
- The maximum coinsurance for the listed drugs is fixed at
25%.
- The originally planned limitations on annual deductibles
have been lifted. However, total annual user fees for the
listed drugs (deductible and coinsurance) have to be
capped at a maximum of $750 per adult.
- The originally planned exclusion of any form of user fees
for children has also been lifted. NOTE: These user fees
have to be accounted for within the $750 annual limit of
the insured adult.
- Coverage of unlisted drugs is not subject to any form of
constraints in terms of deductible, coinsurance and
maximum user fees.
· Private insurers may not offer the same basic individual
drug coverage as RAMQ. However, they may offer complementary
individual plans.
- All employees and their dependents eligible for group
coverage must enroll in their group plan, unless they can
prove they are covered by another group plan. Insurers
cannot exclude any eligible group member or dependent
from a plan due to age or health status.
- The law states that any insurer and employer offering
accident, disability or health coverage must also offer
basic drug coverage.
- Residents over age 65 who are eligible for coverage in a
private drug plan (i.e., a retiree plan) and choose to
enroll in that plan, are free to do so. The group plan
must accept them.
- There are no regulatory provisions regarding group
pricing of risk premiums or administrative services in
the private sector. The premium divisibility requirement
between basic plan coverage and complementary coverage
has been dropped.
- All insurers must agree on high risk pooling practices
between themselves before November 1st, or the government
will intervene to regulate them.
Some uncertainties on the implications of certain provisions
of the law remain. We anticipate that these will only be
clarified when regulations related to Bill 33 are adopted, at the
end of the summer. One of the most discussed uncertainties is the
group eligibility requirement for temporary and part-time
workers, if it is to be regulated.
Ralph Moss Home
Page
Send E-Mail.
This page, and all contents, are Copyright © 1996 by Ralph
Moss Ltd., Markham, Ontario, Canada.