Public plan premium
Generally speaking, persons covered by the public plan Public plan
The Public Prescription Drug Insurance Plan is administered by the Régie de l'assurance maladie du Québec and is intended for persons who are not eligible for a private group insurance plan covering prescription drugs, for persons age 65 or over, and for recipients of last-resort financial assistance and other holders of a claim slip (carnet de réclamation). Children of persons registered for the public plan are also covered by that plan. must pay a premium (between $0 and $660 from July 1, 2016 to June 30, 2017), whether or not they purchase prescription drugs.
The premium is collected every year by Revenu Québec when income tax returns are filed. For example, your premium for 2016 will be collected in the spring of 2017 when you file your income tax return for the 2016 taxation year. You will also have to complete Schedule K of your Québec income tax return.
The amount of the annual premium varies depending on your net family income. This amount is in effect from July 1 to June 30 of the following year, and the maximum amount of the premium is adjusted on July 1 of each year.
You are exempt from paying the premium if your situation is one of the following:
- you hold a claim slip Claim slip (carnet de réclamation)
The Ministère du Travail, de l'Emploi, de la Solidarité sociale issues claim slips to recipients of last-resort financial assistance and, in certain conditions, to adults or families not receiving last-resort financial assistance benefits. Holders of claim slips can obtain certain drugs prescribed by a doctor and certain services, such as eye examinations and dental care. (carnet de réclamation) issued by the Ministère du Travail, de l'Emploi et de la Solidarité sociale
- you are age 65 or over and receive 94% to 100% Rate
Rate calculated according to the Act respecting prescription drug insurance. of the Guaranteed Income Supplement (GIS)
- you have parents who are insured under the public plan, are under age 18 or between ages 18 and 25, are spouseless, live with your parents, and are a full-time student in an educational institution at the secondary, college or university level
When doing your income tax return, you must indicate whether you were covered during the year by a private plan or by the public plan.
If you were covered by a private plan during the entire year, you won’t have to pay the public plan premium. However, if you were covered by a private plan Private plan
Private plans are usually available in the form of group insurance or employee benefit plans. Persons may be eligible for a private plan through employment, through membership in a professional order or association, or through their spouse or parents. Persons who are eligible for a private plan are required to join that plan. during just part of the year, you will have to pay the public plan premium for the rest of the year.
If you are age 65 or over and have basic coverage with a private insurer Basic coverage with a private insurer
Basic coverage is the minimum prescription drug insurance coverage that all Quebecers must have and includes all drugs appearing on the List of Medications, published by the Régie de l'assurance maladie du Québec and listing over 8 000 drugs available on prescription. For the cost of these drugs to be reimbursed, they must be dispensed by a pharmacist. (that is, at least equal to public plan coverage), you are not required to pay the public plan premium. However, if you have only supplemental coverage Supplemental coverage
Supplemental coverage is offered by certain private plans to persons age 65 or over. This coverage does not replace the basic coverage, but may add to such coverage, for example, by paying for uninsured drugs or by paying a portion of costs not
reimbursed to persons who have only the basic coverage. A private insurer offering supplemental coverage acts as the second payer for prescription drugs., you must be covered by the public plan and therefore pay the premium for the basic coverage provided by the Régie.
Private plan premium
Generally, persons insured under a private plan must pay a premium, whether or not they purchase prescription drugs.
The amount of the premium is negotiated between the policy holder Policyholder
A policyholder is the intermediary representing a group of people in the context of a group insurance contract. It may be an employer, a professional order or association, a union or a group of employees. and the insurer with whom the holder has chosen to do business. In most cases, the premium is collected in the form of regular payroll deductions. Since January 1, 2007, your employer is required to collect the insurance premium and hand over the amount to the insurer or plan administrator.
You may be exempt from having the premium deducted if you can prove to your employer that you are already covered by another private prescription drug insurance plan. You will have to provide one of the following documents:
- a copy of your group insurance card
- a form completed by your spouse’s employer or a letter prepared by this employer on the company or organization letterhead
- a letter or certificate from the professional association or order to which you belong
- a signed document in which you declare being covered by another private plan
Even if you provided proof of coverage under another private plan and this exempts you from having the premium deducted from your salary, your employer may periodically check to make sure that your situation has not changed.
In certain cases, even if you prove that you are insured elsewhere, you will have to join your employer’s plan if this is a condition of employment.