Régie de l'assurance maladie du Québec
The public prescription drug insurance plan administered by the Régie de l'assurance maladie du Québec offers basic coverage to persons who are not eligible for a private prescription drug insurance plan.
Person under the age of 65 who are eligible for a private prescription drug insurance plan are obliged to joint this plan and to register their spouse (see definitions) and their children (see definitions) if they are not already insured under another private plan. Otherwise, these persons 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, even for a short period of time. Citizens of Québec must at all times be covered by a prescription drug insurance plan.
Persons may be eligible for a private insurance plan through:
Person covered by the public insurance plan must pay a premium regardless of whether they purchase drugs. The amount to be paid varies depending on their net family income (between $0 and $660 per year for the period from July 1, 2016 to June 30, 2017). The premium must be paid to Revenu Québec each year upon filing of their income tax return. Certain persons are exempt from payment of the premium.
A person who has been covered by a private insurance plan for a portion of the year must only pay the public plan premium for the rest of the year.
Persons covered by a private plan throughout the year do not have to pay the public plan premium.
When a person insured under the public plan purchases drug covered under this plan, he or she must assume part of the cost. This contribution includes the monthly premium (see definitions) and a co-insurance (see definitions). If no purchase is made during a given month, co contributions is required on the part of the insured person.
The maximum annual contributuon is divised into maximum monthly contributions. When a person's maximum monthly contribution is reached, he or she may generally acquire covered drug until the end of the month at no cost.
The amount of the premium and the percentage of the co-insurance are adjsuted on July 1 of each year.
The amounts applicable for the period between July 1, 2016 and June 30, 2017 are the following:
Documents to be provided to the pharmacist
Upon purchase, the insured person must present his or her health insurance card and if applicable, his or her claim slip.
The public plan covers over 7,000 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 only covered under certain conditions.
Persons reaching 18 years of age
Persons reaching 18 years of age may, under certain conditions, continue to be covered by the public plan as a child. In order to extend the coverage, one of their parents must contact the Régie.
Persons reaching 65 years of age
Persons reaching 65 years of age are automatically registered for the public plan, regardless of whether they are retired. However, if still eligible for a private plan covering prescription drugs, they may opt for it. In this case, they must deregister from the public plan.
When a person covered by the public prescription drug insurance plan dies, so 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
Persons insured under the public plan who leave Québec temporarily remain covered whitout any action on their part. However, medication purchased outside Québec is not covered under plan.
Permanent departure from Québec
When persons insured under the public plan leave Québec permanently, they are no loger 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
Persons covered by the public healthcare insurance plan must notify the Régie of their change of address. If they are also covered by the public prescription drug insurance plan, the notification will be valid for both.
Persons may have to change prescription drug insurance plans in the course of a year and switch from a private plan to another private plan, or from a private plan to the public plan or vice versa. In this case, they must deregister from one plan and register for the new one. The must also forward their statement of contributions to their new insurer as soon as to avoid exceeding the maximum annual contribuyion set out by law.
Coverage during the waiting period
Private insures may apply a waiting period to persons just starting a job or joining an organization. They must however be covered by a prescription drug insurance plan during this period. If they are not eligible for another private plan, they must register or keep their registration for the public plan for the duration of their waiting period.
A percentage of the cost of a drug that the insured person must pay once the deductible has been paid.
Person (of the same or opposite sex) who are in one of the following situations:
Person who is either:
Fixed amount payable by the insured person upon the first purchase made each month, which represents the first portion of the cost of the covered drugs that the insured person must pay.
Guaranteed income supplement
An amount paid along with the old age security pension by the Canadian government to certain persons 65 years of age and older, depending on their income.
Since 1997, coverage by a prescription drug insurance plan has been compulsory.
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