Régie de l'assurance maladie du Québec
If you are 65 years of age or older and are registered with a private drug insurance plan, you have a choice between maintaining your registration with that plan or registering with the public plan of the Régie de l’assurance maladie du Québec.
A private insurance plan is generally a private group insurance plan or a benefit plan, which offers basic coverage for prescription drugs. In Québec, everyone must be covered by prescription drug insurance at all times, either through a private plan or through the public drug insurance plan (see definitions). Private plans may be available through an employer or a union;
Employers’ obligationsEmployers that offer an insurance plan do not have to make it accessible to all of their employees. They may establish eligibility criteria for the plan and choose to exclude part-time employees for instance. However, they may not refuse to include a person under the drug insurance plan on the basis of criteria related to age, sex or state of health, nor refuse coverage of the employee’s spouse or children for the same reasons. PremiumPersons insured under a private plan must pay a premium, whether or not they purchase prescription drugs. If the plan is offered through their employer, this premium is usually deducted directly from their pay throughout the year. Persons covered under the public prescription drug insurance plan for a portion of the year must pay the premium associated with this plan for the period of time during which they were not covered under a private plan. Persons who have been insured under a private plan for the entire year pay no premium related to the public plan. ContributionWhen insured persons purchase prescription drugs covered under a private plan, they must pay part of the cost of these drugs. This contribution usually includes an annual deductible (see definitions), the terms and conditions of which vary depending on the insurer. Prescription drugs coveredAlthough the prescription drugs covered vary from one private plan to another, all private plans cover the 7,000 prescription drugs listed by the Régie de l’assurance maladie du Québec. Persons reaching 18 years of agePersons may under certain conditions continue to benefit from a parent’s private plan, as that parent’s child, after they turn 18. In order to obtain an extension of coverage, the parent must contact his or her insurer. Persons reaching 65 years of ageWhen persons turn 65, they are automatically registered under the public prescription drug insurance plan, regardless of whether they are retired or not. However, if they are still eligible under a private prescription drug insurance plan, they may choose to participate in that plan. Thus they may choose to be covered only under the public plan, or
Changing plansA person may have to shift from one insurance plan to another in the course of the year, either from one private plan to another, or from a private plan to the public plan or vice versa. In this case, persons must take steps to register under the new plan and cancel their participation in a previous plan. They must also inform their new insurer of the status of their contributions as soon as possible in order to ensure that they do not exceed the legally prescribed maximum annual contribution. Coverage during a waiting periodSome private insurers apply a waiting period before persons who start a new job or join an organization can benefit from the insurance coverage offered in this context. During this period of time, persons must have access to prescription drug coverage. If they are not eligible for another private plan, they must register or maintain their registration under the public plan throughout the waiting period.
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Note A private insurance plan is generally a private group insurance plan or a benefit plan, which offers basic coverage for prescription drugs. In Québec, persons who meet the eligibility criteria of a private drug insurance plan must join unless covered by another private plan