QDIPC (Quebec Drug Insurance Pooling Corporation) has published its 2024 update of Quebec group insurance pooling terms and conditions, and Empire Life has begun to apply the new pooling thresholds and fees. This will affect all 2024 renewal calculations and quotes that involve Quebec plan members.
What's changing?
Please see QDIPC’s increased pooling thresholds in the table below.
| Group size (certificates) | Existing Threshold | New Threshold |
|---|---|---|
| From 125 to 249 | $55,000 | $60,000 |
| From 250 to 499 | $80,000 | $90,000 |
| From 500 to 999 | $105,000 | $115,000 |
| From 1,000 to 3,999 | $130,000 | $150,000 |
Increased pooling factors
Please see QDIPC’s increased pooling factors in the table below, which also highlights the changed pooling thresholds.
2024
| Group size (certificates) | Threshold per certificate | Annual factor (no dependants) | Annual factor (with dependants) |
|---|---|---|---|
| Fewer than 25 | $10,000 | $282 | $788 |
| From 25 to 49 | $18,000 | $202 | $565 |
| From 50 to 124 | $32,500 | $113 | $382 |
| From 125 to 249 | $60,000 | $76 | $256 |
| From 250 to 499 | $90,000 | $59 | $200 |
| From 500 to 999 | $115,000 | $44 | $176 |
| From 1,000 to 3,999 | $150,000 | $37 | $145 |
| From 4,000 to 5,999 | $300,000 | $16 | $63 |
About QDIPC pooling
High-cost drugs pose a significant risk to the financial health of group insurance plans. Without pooling, many plans would not be able to bear the cost of high dollar claims. QDIPC requires all insurers and private employee benefit plan administrators to pool drug claims for plan members in Québec. Pooling levels and fees are designed to cover the predicted claim costs and operating expenses associated with prescription drugs.
QDIPC guidelines
As per the Terms and Conditions of Pooling, although only Quebec certificates are subject to pooling, the size of an eligible group, and consequently the pooling factor, is determined by the number of certificates in force in Canada on December 31 of the year in question. You can read more about the QDIPC guidelines here.