The insurance limit will safeguard its plan from large claims.
The Concordia Student Union (CSU) has approved a $50,000 cap on prescription drug coverage for every student under its health insurance plan.
In a special council meeting on Wednesday, Aug. 22, the union voted to introduce the cap following the recommendation of its health insurance provider, Alliance pour la santé étudiante au Québec (ASEQ).
In a letter to the union, the ASEQ said the $50,000 maximum is necessary to safeguard the health plan from abnormally large claims. “We are not aware of any students who have made claims to this level,” the organization said. “While the risk is abstract, it is not zero, and an overall limit is therefore recommended as a precautionary measure.”
“Recent developments in pharmaceuticals have led [ASEQ] to reassess the risk for the CSU,” the letter said. “Specifically, we are concerned about new specialty medications, including biological medications, which can be extremely expensive.”
Under the new rules, students who take prescription drugs will only be reimbursed up to $50,000, after which point they will have to cover any extra costs. The cap applies to all prescription drugs covered by the health plan.
Under the previous regulations, one abnormally high prescription drug claim could have led to a fee increase for every student, from 5 per cent for a claim over $25,000, to 35 per cent for a claim over $300,000.
The letter from the ASEQ further states that the CSU was the last student union in Quebec without such a cap on prescription drug claims. CSU Finance Coordinator John Hutton said the previous administration was approached by the ASEQ in January to change its regulations, but action was never taken.
Hutton said this limit is well above any claim a student is likely to make. According to documentation provided by the CSU, the highest claim made by any student since 2012 was $33,572.89 in the 2013-14 academic year, followed by $16,810.99 in 2014-15.
“This policy will not mean that people will be denied healthcare,” said Hutton. “It means that when the insurance plan the student has is insufficient to cover [their condition], it will give them opportunities to activate what’s called a compassionate care clause that a lot of pharmaceutical companies are required to have.” Such clauses offer coverage for drugs not covered by public healthcare or insurance, with the exact terms and conditions varying from company to company.
“We are there to help make sure compassionate care clauses get activated,” said Hutton.
Although the new rules also prevent intentional exploitation of the system, Hutton said this was never the primary goal of the cap.
Other forms of insurance provided by the CSU already have limits. According to the ASEQ, the union’s dental plan has an annual maximum of $750, and its travel plan can cover claims up to $5 million.
All Canadian undergraduate students who have not opted out are covered by the plan. International students are covered by a different plan, which is not administered by the CSU.
Students can learn more about the CSU’s health and dental plan on the union’s website.
Graphic by @spooky_soda
