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 $640 from July 1, 2015 to June 30, 2016), whether or not they purchase prescription drugs.
The premium is collected every year by Revenu Québec when income tax returns are filed. For example, the premium for 2014 was collected in the spring 2015, when income tax returns for the 2014 taxation year are filed. Persons who pay a premium to the public plan must complete Schedule K of their Québec income tax return.
The amount of the annual premium varies depending on 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.
Certain persons insured under the public plan don't pay a premium. These include:
- holders of a claim slip Claim slip (carnet de réclamation)
The Ministère de l'Emploi et 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 de l'Emploi et de la Solidarité sociale;
- persons age 65 or over receiving 94% to 100% Rate
Rate calculated according to the Act respecting prescription drug insurance. of the Guaranteed Income Supplement GIS (Guaranteed Income Supplement)
The Guaranteed Income Supplement (GIS) is an amount added to the Old Age Security Pension (OASP) and is paid at the same time as that pension to certain persons age 65 or over. A person may receive the maximum GIS (100%), a partial GIS or no GIS (0%), depending on the family income. In each case, the contribution to the public plan differs. (GIS);
- children of persons insured under the public plan, if they are under age 18 or if they are between ages 18 and 25, are full-time students in an educational institution recognized by the Ministère de l'Éducation, du Loisir et du Sport, do not have a spouse, and live with their parents.
When doing their income tax return, taxpayers must indicate whether they were covered during the year by a private plan or by the public plan.
Persons who were covered by a private plan during the entire year don't pay the public plan premium.
However, those who 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 part of the year must pay the public plan premium for the rest of the year.
Persons age 65 or over who have basic coverage Basic coverage
Basic coverage is the minimum prescription drug insurance coverage that all Quebecers must have and includes all drugs listed on the List of Medications, published by the Régie de l'assurance maladie du Québec and listing over 7 000 drugs available on prescription. For the cost of these drugs to be reimbursed, they must be dispensed by a pharmacist. (at least equal to public plan coverage) are not required to pay the public plan premium.
However, those who 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. are required to have the basic coverage of the public plan and must therefore pay the premium applicable to their situation.
Private plan premium
Persons insured under a private plan must pay a premium, whether or not they purchase prescription drugs. In most cases, they pay the premium in the form of regular payroll deductions throughout the year.
The amount of the premium is negotiated between the policyholder 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 Insurer (of persons)
A legal person that holds a permit issued by the Autorité des marchés financiers authorizing it to transact personal insurance in Québec and that assumes, in return for a premium paid, the financial consequences resulting from one or more risks specified in the contract signed by the parties., and the group plan sponsor chooses the insurer.