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 5 000 drugs available on prescription. For the cost of these drugs to be reimbursed, they must be dispensed by a pharmacist. The public plan offers basic coverage to its insured persons. Private plans are required to offer at least the basic coverage, but some private plans offer broader coverage. Back

Children Children are persons who: are under age 18; are age 18 to 25 inclusive, are full-time students, do not have a spouse and are domiciled with their parents. The parents of a child who turns 18 must ask their private insurer or the Régie to extend their child's coverage, if he/she is a full-time student, does not have a spouse and is domiciled with his/her parents. Back

Claim slip (carnet de réclamation) A claim slip is a document that enables a person to obtain: certain drugs prescribed by a doctor; certain services, such as eye examinations and dental care. Claim slips are issued to recipients of last-resort financial assistance, but under certain conditions may also be issued to adults or families not receiving last-resort financial assistance benefits from the ministère de l'Emploi et de la Solidarité sociale. Back

Co-insurance The co-insurance is the percentage (or portion) of the drug costs that insured persons must pay once they have paid the deductible. In other words, when a person's drug costs exceed the deductible, the person pays only a portion of the remainder. The percentage of the co-insurance payable by persons covered by the public plan is adjusted on July 1 of each year. Back

Contribution by the insured person at the pharmacy Total of the deductible plus the co-insurance. The insured person pays that amount at the pharmacy. Back

Contribution paid to date (on the pharmacy receipt) The pharmacy receipt issued to persons covered by the public plan contains various types of information about their drug purchases for the month, including the contribution paid to date. The contribution paid to date is the total cumulative amount that a person covered by the public plan has paid for insured drugs since the beginning of the month. On the first day of each month, this amount automatically reverts to $0. The contribution paid to date can never exceed the person's maximum monthly contribution. Back

Deductible The deductible is a fixed amount that constitutes the first portion of the costs that insured persons must pay when obtaining insured drugs. For persons covered by the public plan, the deductible is a monthly amount that the person generally pays in full when making his or her first drug purchase during the month. The amount of the deductible is adjusted on July 1 of each year. For persons covered by a private plan, the deductible is generally a yearly amount. Certain private plans do not require the person to pay a deductible. Back

Excess amount In the case of certain covered prescription drugs, a maximum payable price (MPP) has been set. When they purchase these drugs, persons insured under the public plan may have to pay an additional amount, which appears on their invoice after "Excess amount." This excess amount corresponds to the difference between the price requested by the drug manufacturer and the maximum price reimbursed by the Régie. It is not taken into account when calculating the insured person's maximum monthly contribution. Moreover, persons insured under the public plan may also be required to pay an excess amount if they choose to purchase a costlier drug than the equivalent payable by the Régie. Back

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%). The amount paid depends on the person's income. The federal government informs the Régie of the person's situation. Depending on the amount of GIS received, persons age 65 or over who are insured under the public plan fall into one of the following categories: no GIS, 1% to 93% of GIS, 94% to 100% of GIS. The Régie sends this GIS information to the pharmacist, so that you will pay the proper amount when purchasing prescription drugs. However, two amounts appearing on your drug bills can help you determine what category you are in: the contribution paid to date and the remainder. By totalling these two amounts, you obtain your maximum monthly contribution. With this information, you can then refer to a table showing the costs for each category. Back

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. Back

Maximum annual contribution The maximum annual contribution is the maximum amount that a person covered by the public plan or by a private plan may be required to pay during the year when purchasing insured drugs, and consists of a deductible and a co-insurance amount. Once the person has reached his or her maximum annual contribution, the plan generally covers all the person's drug costs from then until the end of the year. Back

Maximum monthly contribution The maximum monthly contribution applies only to persons covered by the Public Prescription Drug Insurance Plan. Under the public plan, the maximum annual contribution is divided into maximum monthly contributions. The maximum monthly contribution is the maximum monthly amount that a person covered by the public plan may be required to pay when purchasing insured drugs, and consists of a deductible and a co-insurance amount. Once the person has reached his or her maximum monthly contribution, the public plan generally covers all the person's drug costs from then until the end of the month. Back

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. Back

Premium The premium is the amount that insured persons are required to pay to the Régie de l'assurance maladie du Québec or to a private insurer for their prescription drug insurance. Persons covered by the public plan pay their premium when filing their income tax return. The amount payable is determined on the basis of net family income. The maximum amount of the premium is adjusted on July 1 of each year. Employers who offer a private plan through employment must deduct the amount of the premium from the remuneration of all their eligible employees, unless those employees can prove that they are covered by another private plan. Back

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. Back

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. Back

Refill date (on the pharmacy receipt) The pharmacy receipt issued to persons covered by the public plan contains various types of information about their drug purchases during the month, including the refill date. The refill date is the date on which a person would theoretically have his or her prescription refilled, and is determined by the date of the previous drug purchase and the duration of the treatment. For example, the refill date for a 30-day prescription filled on September 1 would be October 1 (the 31st day after September 1). Back

Remainder (on the pharmacy receipt) The pharmacy receipt issued to persons covered by the public plan contains various types of information about their drug purchases during the month, including the remainder. The remainder is the amount that persons covered by the public plan may be required to pay when purchasing insured drugs, until they reach their maximum monthly contribution. Back

Residential and long-term care centre A subsidized private residential and long-term care centre receives government grants and complies with standards in force in the public sector. A non-subsidized private residential and long-term care centre is independent of the public sector and it does not receive government grants. Back

Spouse Two persons (of the opposite sex or the same sex) are considered spouses if they: are married or have entered into a civil union; have been living together for 12 months (separations of less than 90 days do not interrupt the 12-month period); or are living together (regardless of for how long) and together have had or have adopted a child. Back

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. Persons who have only the supplemental coverage offered by a private plan must also have the basic coverage provided by the public plan and must therefore pay the public plan premium. Back

Uninsured employee benefit plan A plan under which an employer undertakes to guarantee the payment of certain benefits to member employees if a risk covered by the plan occurs. Back