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Posted by Martin Papillon, FSA, FCIA, MBA, November 21 2018
Savings strategies
The QDIPC Insurance Pooling terms and Conditions for 2019


The Quebec Drug Insurance Pooling Corporation (QDIPC) is a non-profit organization providing a pooling system for major claims. The pooling system administered by QDIPC is the sole risk-sharing framework implemented in accordance with the Act Respecting Prescription Drug Insurance and recognized by the Quebec government for this purpose. The system covers close to 30,000 insurance contracts representing more than 1 million insured certificates.

Good news for the QDIPC Insurance pooling terms and conditions for 2019

The following insurance pooling terms and conditions will apply in 2019:

insurance terms

These new insurance terms and conditions reflect a broad pooling cost reduction for 2019, ranging from 2% to 12% depending on group sizes. The only exception is for groups with 25-49 insured members, where QDIPC elected to lower the pooling threshold from $18,000 to $16,500 instead of reducing the applicable premium.

This is good news for plan sponsors and members, as pooling costs are included in the calculation of renewal rates for health care benefits.

Catastrophic claims point to future increases

The reduction of pooling costs will obviously be welcome as it will have a downward impact on premium rates. However, plan sponsors should not table on further reductions in the future, but rather expect increases… In fact, the positive experience of 2017 was mainly the result of a better than expected experience for hepatitis C treatments. For this medical condition, the number of claims and the cost of reimbursed medications have been declining since 2015, a development that had not been anticipated in the pricing.

In contrast, the number of claims exceeding $200,000 has been steadily rising since 2012, as shown in the chart below:

insurance terms

As can be seen, the number of catastrophic claims went from 8 in 2012 to 57 in 2017, while the related claims rose from $3.7 million to $25.4 million over the same period. The thorny issue of catastrophic claims will undoubtedly be on the federal government’s radar as it is working on a national drug insurance plan. Therefore, implementing cost management measures is more relevant than ever for the sustainability of group insurance plans.

Keep watching the AGA Benefit Solutions blog for further developments!


Martin Papillon is a Fellow of the Canadian Institute of Actuaries and holds an MBA from HEC Montréal. Throughout his career, he has been working in the group insurance and retirement sector. Before joining AGA in 2013, he held advisory and senior management positions with world-class consulting actuarial firms.
Martin Papillon, FSA, FCIA, MBA