The Costs – Maximum Annual Contribution

There is a maximum annual amount that insured persons may be required to pay for their drug purchases. This maximum amount, which has been set at $954 for all insured persons in Québec, includes the deductible and the co-insurance. Please note that this amount is lower or even nil for certain clienteles of the public plan.

Under the public plan, the maximum annual contribution is divided into maximum monthly contributions. Thus, persons who reach their maximum monthly contribution can generally obtain their insured drugs free of charge until the end of the month.

Here is how your contribution is calculated
(amounts in effect from July 1, 2009 to June 30, 2010). In the table below, click on the profile that applies to you to see an example of an invoice corresponding to your situation.

	Maximum MONTHLY contribution	Maximum ANNUAL contribution
Persons age 18 to 64 not eligible for a private plan	$79.53	$954
Holders of a claim slip (issued by the Ministère de l'Emploi et de la Solidarité sociale)	$0	$0
Persons age 65 or over:
No GIS	$79.53	$954
1% to 93% of GIS	$49.97	$600
94% to 100% of GIS	$0	$0
Free of charge for children insured under the public plan:
If they are under age 18	$0	$0
If they are 18 to 25, full-time students, without a spouse and live with their parents	$0	$0

For certain covered drugs, insured persons may have to pay an excess amount, which is not taken into account when calculating the monthly contribution. This excess amount corresponds to the difference between the price requested by the drug manufacturer and the maximum price paid by the Régie.

Changing plans

Persons who change insurance plans (from a private plan to the public plan or vice versa, or from one private plan to another) must themselves take certain steps to make sure they don't exceed their maximum annual contribution.

They must, within six months of the transfer, ask their original insurer to provide them with a statement of their contributions for the current year. Some insurers, including the Régie de l'assurance maladie du Québec, issue the statement automatically, while others issue it only on request. Here is a model statement , intended for persons transferring from a private plan to the public plan.

They must send their statement of contributions to their new insurer, which will be able to take it into account in making sure their maximum contribution is not exceeded.

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