When two
persons become separated or
divorced, they must usually take
certain steps to make sure they
are covered by the right
prescription drug insurance
plan.
The law
considers two persons
(of the opposite sex or the
same sex) to be spouses if
they:
are
married or have entered into a
civil union;
have
been living together for 12
months. It should be
noted that separations of less
than 90 days do not interrupt a
12-month period during which two
persons are considered to have
lived together. For example,
persons who separate temporarily
(for less than three months) are
still considered a couple;
are
living together (regardless of
for how long) and together
have had or have adopted a
child.
In some
cases, a separation or divorce
has no effect on the
prescription drug coverage of
the persons involved, such as
when the former spouses are
covered by the public plan or by
their respective private plans.
A person who maintained private plan coverage for his or her spouse is no longer entitled to do so in the event of separation or divorce.
Steps to take
First, the
person who does not want to
maintain his or her former
spouse's coverage must ask the
insurer to change his or her
coverage.
The former
spouse, who is then without
coverage, must determine whether
he or she is eligible for a
private plan. Eligibility is
usually available through
employment or through membership
in a professional order or
association to which he or she
belongs.
If the person
is eligible for a private plan,
he or she must join that plan,
at least for the prescription
drug portion. Prescription drug
coverage is most often included
in a plan covering other health
care (called a health
insurance plan), but is
sometimes offered alone.
Persons who
have no access to a private plan
must
register for the public
plan by
contacting the Régie.
About the children of a couple that separates
If the parents do not share the same domicile, the child must be covered by the private plan of the parent with whom he/she is domiciled. If that parent is not eligible for a private plan, the child must have coverage under the private plan of the other parent. A person may be eligible for a private plan through employment or through membership in a professional order or association.
If both parents are ineligible for a private plan, they must be registered for the public plan, under which their child will be covered as well.
However, if one of the parents becomes the spouse of a person eligible for a private plan, that parent must be covered by that plan, as must the parent's child if he/she is domiciled with the couple.
Maximum
annual contribution
There is a
maximum annual amount that
insured persons may be required
to pay for their drug purchases.
As a general rule, the private
insurer or the Régie sees to it
that this maximum is not
exceeded. However, persons who
change insurance plans and
believe they will reach their
maximum annual contribution
before the end of the year must
themselves inform their new
insurer of the amount of their
contributions.
