HR Notes: December 2015

News

This year's Benefits Update contains updates/information on the following Benefits items:

For a PDF version of this HR Note, click here

Annual Review of the Benefit Plans

Supplemental Health Plan and Dental Care Plan

In 2015, claims for the Supplemental Health Plan and Dental Plan either met or exceeded contributions. The increase in Health Plan expenses is largely due to the introduction of new and expensive medications. All levels of dental services have increased as well. As a result, an increase in rates is required for each plan to cover projected future claims, as well as inflationary trends in health and dental care. This analysis has been presented to the Staff Benefits Advisory Committee.

Effective January 1, 2016, the contribution rates per pay for employees will be as follows:

Bi-Weekly Pays:

 

Supplemental Health Plan

Dental Care Plan

 

Present rates

As of 01/01/2016

Present rates

As of 01/01/2016

Single

$19.62

$21.74

$9.70

$11.10

Family

$38.65

$42.83

 $21.69

$24.82

Plus sales tax for Québec residents.

As always, the University will match these contribution rates.

Weekly Pays:

 

Supplemental Health Plan

Dental Care Plan

 

Present rates

As of 01/01/2016

Present rates

As of 01/01/2016

Single

$9.81

$10.87

$4.84

$5.55

Family

$19.32

$21.42

$10.84

$12.41

Plus 9% sales tax for Québec residents.

As always, The University will match these contribution rates.

Long Term Disability Plan

There is no change to the current rate of $0.901 per $100 of monthly earnings.

Life Insurance Plan

There is no change to the Optional Life Insurance Plan rates. Rates are available on the HR Benefits website.

Cost-Sharing for Post-Retirement Benefits

As previously announced in an HR Note send in March 2012, there will be a change to the cost-sharing for post-retirement benefits for the McGill Health and Dental plans for staff members retiring after May 31, 2016. This information has also been posted on the HR Benefits website - "When you retire". The changes are as follows:

HEALTH PLAN the retiree will pay 70% of the contributions, and the University will pay 30%.
DENTAL PLAN the retiree will pay 100% of the contributions.

The following chart shows the difference in the bi-weekly costs using the January 1, 2016 rates.

 

 

HEALTH

 

 

DENTAL

 

 

Retire before June 1, 2016

Retire after May 31, 2016

Cost Difference

Retire before June 1, 2016

Retire after May 31, 2016

Cost Difference

SINGLE COVERAGE

 

 

 

 

 

 

UNIVERSITY

 $21.74

 $13.04

 

 $11.10

 $0.00

 

RETIREE

 $21.74

 $30.44

 $8.70

 $11.10

 $22.10

 $11.10

FAMILY COVERAGE

 

 

 

 

 

 

UNIVERSITY

$42.83

$25.70

$24.82

$0.00

 

RETIREE

$42.83

$59.96

$17.13

$24.82

$49.64

$24.82

Plus 9% sales tax for Québec residents.

As per the chart above, for those retiring after May 31, 2016:

The cost for the Health Plan represents an additional bi-weekly cost of $8.70 ($226.20 annually) for single coverage, and an additional bi-weekly cost of $17.13 ($445.38 annually) for family coverage.

The cost of the Dental Plan represents an additional bi-weekly cost of $11.10 ($288.60 annually) for single coverage and an additional bi-weekly cost of $24.82 ($645.32 annually) for family coverage.

To determine if you are eligible for post-retirement benefits, please check the eligibility criteria on the HR website HR Benefits website - "When you retire"

Quebec's Bill 28: Impact on the McGill Health Plan

The Quebec government has recently approved the following changes regarding reimbursement of brand name drugs, and fees for pharmacists’ services.

1. Reimbursement of Brand Name Drugs Where a Generic Exists

This change will affect you if you choose to purchase a brand-name drug for which there is a lower-cost generic equivalent. Starting in early January 2016, if you choose to purchase a brand-name drug, you will have to pay a greater portion of the cost - unless your doctor's prescription note specifies that generic alternatives are not acceptable.

In the past, if you chose to purchase a brand-name drug for which a generic equivalent existed, the McGill Health Plan was legally required to pay the RAMQ reimbursement minimum of 66%, even if the lowest generic equivalent cost less.

As a result of new Quebec legislation, if you choose to purchase a brand name drug wher a lower-cost generic equivalent drug exists, your reimbursement will be based on the cost of the lower-cost generic.

What does this mean for you? If your doctor prescribes…

A brand name drug with a generic equivalent

Your reimbursement will be based on the lower-cost generic equivalent

A generic drug

You will be reimbursed at the same rate as before

A brand name drug with no generic equivalent

You will be reimbursed at the same rate as before

A brand-name drug prescribed as "no substitution" (i.e. your doctor specifies that generic alternatives are not acceptable)

You will be reimbursed at the same rate as before

Example of costs and reimbursements for a generic vs a brand name drug:

In the example below, you can see the cost of the brand-name drug Lipitor and its generic equivalent, as well as the amounts reimbursed by the Health Plan and the plan member's cost for each drug.

Costs for Lipitor and its generic equivalent, before and after Bill 28

Drug

Cost*

% reimbursed by Health Plan

Amount reimbursed by Health Plan

Amount paid by member

Amount applied to out-of-pocket maximum

1.Generic

(10mg X 90 pills)

$28.24

80% (unchanged)

$22.59

$5.65

$5.65

2.Brand-name Lipitor

(10mg x 90 pills)

$155.69

66%**

(before Bill 28)

$102.76

$52.93

$52.93

3.Brand-name Lipitor

(10mg x 90 pills)

$155.69

80% of generic

(after Bill 28)

$22.59

$133.10

$5.65

4. Brand-name Lipitor

(10mg x 90 pills)

("No substitution" prescription)

$155.69

80%

$124.55

$31.14

$31.14

As indicated in example 3 in the chart above, the amount applied towards your annual out-of-pocket maximum is based on the cost of the generic. Once your annual 'out-of-pocket maximum' is reached, reimbursement of brand-name drugs without 'no-substitution' prescriptions will still be reimbursed based on the cost of the generic.

You may want to refer to the RAMQ website to review your own personal situation regarding prescription drugs.

*This refers to the ingredient cost only; the dispensing fee and pharmacist’s markup would be in addition. Costs indicated were obtained from the RAMQ website.

**Because 80% of the generic ($22.59) was less than 66% of the brand-name drug cost, the plan was previously obliged by RAMQ to reimburse at 66% of the brand.

You can make a difference

By choosing to purchase generic prescription drugs, where possible, you can achieve savings by decreasing your out-of-pocket expenses, and reducing the claims paid from the Health Plan. Keep in mind that the Health Plan contribution rates are directly attributed to the claims paid from the Plan.

2. New Pharmacist Services

Quebec pharmacists can now provide several new professional services to their patients, of which the McGill Health Plan is required to reimburse the following four:

  • Prescribing a medication for the treatment of certain minor ailments/conditions when the diagnosis and treatment are known
  • Prescribing a medication when no diagnosis is required
  • Adjusting a prescription
  • Extending a prescription

Charges for these new services will be reimbursed under the Health Plan in accordance with the percentage covered by the Régie de l'assurance maladie du Québec (RAMQ).

Annual Flu Vaccinations

Active McGill staff under the age of 65, who are members of the University's Health and/or Dental Plans, as well as their eligible dependents (under age 65 and who are covered under these plans), can receive the flu vaccine free of charge at the Médisys downtown clinic. Get your flu shot while supplies last. For more information, go here.