If you were covered by the private drug insurance plan of the deceased, you must find out your coverage is affected. Given new circumstances, you may have to register to te Public Prescription Drug Insurance Plan.
The public prescription drug insurance plan administered by the Régie de l'assurance maladie du Québec offers basic coverage to individuals who are not eligible for a private prescription drug insurance plan.
Individuals under the age of 65 who are eligible for a private prescription drug insurance plan are obliged to join this plan and to enrol their spouse (see definitions) and children (see definitions) if they are not already insured under another private plan. Otherwise, these individuals must register with the public insurance plan.
The choice between a private and public insurance plan cannot be made prior to reaching the age of 65, nor is it possible to decide not to be covered by any prescription drug insurance plan, even for a short period of time. Quebecers must be covered by a prescription drug insurance plan at all times.
You may be eligible for a private insurance plan through:
- your employer or union
- your professional order or association
- your spouse (see definitions) or your parents
Premium
If you are covered by the public insurance plan, you must pay a premium, regardless of whether you purchase drugs. The amount to be paid depends on your net family income and varies from $0 to $616 per year for the period from July 1, 2018 to June 30, 2019. You must pay the premium to Revenu Québec each year when you file your income tax return. Certain individuals are exempt from paying the premium.
If you were covered by a private insurance plan for a portion of the year, you must pay the public plan premium only for the period during which you were not covered by the private plan.
If you were covered by a private plan for the entire year, you do not have to pay the public plan premium.
Finally, if you do not meet the obligation to maintain prescription drug insurance coverage, you will have to pay Revenu Québec an amount equal to the public plan premium for every full month during which you had no such coverage. This amount must be paid when you file your income tax return.
Deductible and Co-insurance
When a person insured under a private plan purchases drug covered by the plan, he or she must pay a part of the cost. This contribution generally includes a deductible (a fixed sum that must be paid at the time he or she first purchases a drug covered by the plan) and a co-insurance amount (a percentage of the cost of the medication to be paid after payment of the deductible). The terms and conditions vary depending on the insurer.
The maximum annual contribution is divised into maximum monthly contributions. When a person's maximum monthly contribution is reached, he or she may generally acquire covered prescription drugs until the end of the month at no cost.
The amount of the deductible and the percentage of the co-insurance are adjusted every year on July 1.
The amounts applicable for the period between July 1, 2018 and June 30, 2019 are the following:
| Adults between 18 and 64 |
$19.90 |
34.9% |
$90.58 |
$1,087 |
|---|
Holders of a claim slip issued by the Ministère du Travail, de l'Emploi et de la Solidarité sociale
|
$0 |
0% |
$0 |
$0 |
|---|
| Persons 65 years of age and older who do not receive the Guaranteed Income Supplement (see definitions) |
$19.90 |
34.9% |
$90.58 |
$1,087 |
|---|
| Persons 65 years of age and older who receive the Guaranteed Income Supplement at a rate between 1% and 93%. |
$19.90 |
34.9% |
$53.16 |
$638 |
|---|
Persons 65 years of age and older who receive the Guaranteed Income Supplement at a rate between 94% and 100%
|
$0 |
$0 |
$0 |
$0 |
|---|
Children of persons insured by the public plan
|
$0 |
$0 |
$0 |
$0 |
|---|
Documents to Be Provided to the Pharmacist
Upon purchasing prescription drugs, the insured person must present his or her health insurance card and, if applicable, his or her claim slip.
Covered Drugs
The public plan covers over 8,000 drugs, including a list of exception drugs. To find out which drugs are covered, please refer to the publication List of Medications available on the Régie website. The drugs listed in the “Exception Drugs” section are covered only under certain conditions.
Information Shown on the Pharmacist’s Invoice
Since September 15, 2017, pharmacists have been legally required to provide an itemized invoice. The invoice must indicate:
- the pharmacist’s professional fees for each service provided
- the cost of each medication or supply to be paid by the plan
- the wholesaler’s profit margin, where applicable
In addition, pharmacists are prohibited from selling a medication covered by the plan at a price other than the one that they paid. Any pharmacist who is in breach of this obligation is subject to a fine.
Individuals Reaching 18 Years of Age
Individuals reaching 18 years of age may, under certain conditions, continue to be covered by the public plan as a child. To extend their coverage, one of their parents must contact the Régie.
Individuals Reaching 65 Years of Age
Individuals reaching 65 years of age are automatically registered for the public plan, regardless of whether they are retired. However, if they are still eligible for a private plan covering prescription drugs, they may opt to participate in it. In this case, they must deregister from the public plan.
Death
When a person covered by the public prescription drug insurance plan dies, no steps need to be taken to cancel his or her registration if the death was declared to the Directeur de l'état civil . The Directeur will automatically notify the Régie de l'assurance maladie du Québec of the death and the Régie will terminate the deceased person's coverage under the public plan and cancel his or her health insurance card. Il the death occurred outside Québec , the Régie must be contacted.
Temporary Departure from Québec
Anyone who is insured under the public plan and leaves Québec temporarily remains covered without any action required on their part. However, medication purchased outside Québec is not covered under the plan.
Permanent Departure from Québec
Anyone who is insured under the public plan and leaves Québec permanently is no longer eligible for coverage under this plan as of the date of their departure , regardless of where they move. They must inform the Régie of their departure.
Change of Address
If you are insured under the public health insurance plan, you must notify the Régie if your addresses changes. If you are also covered by the public drug insurance plan, your change of address notification will be valid for both plans.
Changing Plans
Depending on life events, you may have to change drug insurance plans in mid-year, switching from one private plan to another or from a private plan to the public plan (or vice versa). If so, you must register for the new plan and then deregister from the old one. To avoid paying more than the maximum annual contribution, be sure to send your statement of contributions to your new insurer as soon as possible.
Coverage during a Waiting Period
Some private insurers apply a waiting period before individuals who start a new job or join an organization can benefit from the insurance coverage offered. During this period, however, these individuals must have access to prescription drug coverage. If they are not eligible for another private plan, they must register or maintain their registration for the public plan for the duration of their waiting period.
Spouse
A person living with another person of the same or opposite sex and who is in one of the following situations:
- He or she is legally married to or in a civil union with that other person
- He or she has been living with that other person for at least 12 months (a break-up of 90 days or less does not constitute an interruption of this period)
- He or she is living with that other person and they are the biological or adoptive parents of at least 1 child.
Child
A person who is either:
- under 18 years of age, or
- between 18 and 25, a full-time student at a post-secondary, college- or university-level educational institution, without a spouse and living with his or her parents
Guaranteed Income Supplement
An amount paid along with the Old Age Security pension by the Canadian government to certain people 65 years of age and older, depending on their income.
Since the clientele and conditions can vary depending on the services, the information is provided under each service.
Coverage under a prescription drug insurance plan has been compulsory since 1997.
