D1 – Version 3 – 17 décembre 2019

TP-1.D.K-V (2 0 1 9 -12)

Premium Payable Under the Québec
Prescription Drug Insurance PlanTPage 1KSchedule

If any of the situations listed below applied to you in 2019, you do not have to complete this schedule or pay a premium, but you must enter the number
corresponding to your situation in box 449 of your return. If you wish to pay your spouse’s premium, complete this schedule.
You were covered throughout the year by basic prescription drug insurance
provided by a group insurance plan (see line 447 in the guide):• of which you were a member;• of which your spouse, your father or your mother was a member.
You received social assistance payments or payments underthe Aim for Employment Program throughout the year.
Your spouse has provided the required information about you in section 2 of Part Bof his or her Schedule K and has chosen to pay your premium (if applicable).
Throughout the year, one of the following applied to you:• the situation described on line 53 below;• the situation described on line 55 below; or• the situation described on line 56 below.
You were born before January 1, 1954, you did not have a spouse in 2019,
and the amount of net federal supplements on line 148 of your return
is more than $10,314.1

You were born before January 1, 1954, you had a spouse throughout 2019, and either:• your spouse was born before January 1, 1959, but after
December 31, 1954, and the amount of net federal supplementson line 148 of your return is more than $5,701;129• your spouse was born after December 31, 1959,
and the amount of net federal supplements on line 148 of your return
is more than $9,633.1
31
You did not have a spouse on December 31, 2019, and the amounton line 275 of your return is $16,460 or less.
32
You were born before January 1, 1954, and situation 33 applied to you(see line 447 in the guide).
33
You had a spouse on December 31, 2019, and the amount on line 275
of your return plus the amount on line 275 of your spouse’s returntotals $26,670 or less.
34
You were born in 1954 and situation 35 applied to you(see line 447 in the guide).
35

14161820
22
24
26

27

You were born before January 1, 1954, you had a spouse throughout 2019,
your spouse was also born before January 1, 1954, and the amountof net federal supplements on line 148 of your return is more than $6,178.1 28

A

1. In addition, all your medications were free throughout 2019 because of the amount
you received as a Guaranteed Income Supplement.

Income used to calculate the premium

Amount from line 275 of your return
Amount from line 275 of your spouse’s return (spouse on December 31, 2019)
Add lines 36 and 37.
If you had a spouse on December 31, 2019, enter $26,670; otherwise, enter $16,460.
If you had a spouse on December 31, 2019, and you had a dependent child(see line 447 in the guide for the definition), enter $3,470.
If you had more than one dependent child, enter $6,675.
If you did not have a spouse on December 31, 2019,
but you had a dependent child (see line 447 in the guide for the definition),enter $10,210. If you had more than one dependent child, enter $13,680.
Add line 41 and, as applicable, line 42 or line 44.
Subtract line 46 from line 40. If the result is negative, enter 0.
In this case, you do not have to pay a premium.

B.

36+ 37= 40.

46.

Income used to calculate the premium = 48

.

41

.

+ 42.

+ 44
= 46.
.

.

Number of months for which you do not have to pay a premium

Did any of the following apply in 2019?
If so, check Yes for each applicable situation and check the month(s) for which the situation(s) applied to you(for at least one day). Do not check the same month more than once.
Yes
You were covered by basic prescription drug insurance provided by a group insurance plan (see line 447 in the guide)of which you, your spouse, your father or your mother was a member, and this plan covered the cost of medications.
50
You held a valid claim slip issued by the Ministère du Travail, de l’Emploi et de la Solidarité sociale.
51
You received social assistance payments or payments under the Aim for Employment Program.
52
You were under 18 and not married.
53
You were at least 18 but under 26, attended an educational institution on a full-time basis and, at the time, did not have aspouse (see line 447 in the guide).
54
You were an Indian registered with Indigenous Services Canada (ISC)or were recognized as an Inuk by that department.
55
You were a beneficiary under the James Bay and Northern Québec Agreement or the Northeastern Québec Agreement.
56
You were in a residential and long-term care centre governed by the Act respecting health services and social services.
57
You had a functional impairment that occurred before you turned 18 (see line 447 in the guide).
58
One of the situations described under “Other situations” at line 447 in the guide applied to you.
59
Number of months checked
Number of months checkedfrom January to June 60+
from July to December 61=Add boxes 60 and 61.
1You

Complete section 2 (on the next page) if you wish to pay your spouse’s premium.

Month(s)JanuaryFebruary
March
AprilMay
JuneJulyAugust
September
OctoberNovember
December
62

Continued on the next page.

T9K1 ZZ 84577549
Form prescribed by the President and Chief Executive OfficerKD1 – Version 3 – 17 décembre 2019

TP-1.D.K-V (2 0 1 9-12)

TIn 2019, did any of following apply to your spouse on December 31?
If so, check Yes for each applicable situation and check the month(s) for which the situation(s) applied to your spouse(for at least one day). Do not check the same month more than once.
YesYour spouse was covered by basic prescription drug insurance provided by a group insurance plan (see line 447 in the guide) of which you,your spouse, your spouse’s father or your spouse’s mother was a member, and this plan covered the cost of medications.
64
Your spouse held a valid claim slip issued by the Ministère du Travail, de l’Emploi et de la Solidarité sociale.
65
Your spouse received social assistance payments or payments under the Aim for Employment Program.
66
Your spouse was under 18 and not married at the time.
67
2Yourspouse

Your spouse was at least 18 but under 26, attended an educational institution on a full-time basis
and, at the time, did not have a spouse (see line 447 in the guide).
68
Your spouse was an Indian registered with ISC or was recognized as an Inuk by that department.
69
Your spouse was a beneficiary under the James Bay and Northern Québec Agreement or the Northeastern Québec Agreement.
70
Your spouse was in a residential and long-term care centre governed by the Act respecting health services and social services.
71
Your spouse had a functional impairment that occurred before he or she turned 18 (see line 447 in the guide).
72
One of the situations described under “Other situations” at line 447 in the guide applied to your spouse.
73
Number of months checked
Number of months checkedfrom January to June 74+
from July to December 75=Add boxes 74 and 75.

CPage 2Month(s)JanuaryFebruary
MarchAprilMayJuneJuly
AugustSeptember
OctoberNovemberDecember76

Premium payable under the Québec prescription drug insurance plan

If the amount on line 48 (income used to calculate the premium):• is $5,000 or less, complete only column A of the table corresponding to your situation;• is more than $5,000 but not more than $14,673, complete only column B of the table corresponding to your situation;• is more than $14,673, enter $636 on line 84.
Individual without a spouse on December 31
Individual with a spouse on December 31
ABA
B
Amount from line 48 (see the instructions above)77– 780,000 00
5,000 00 –0,000 00
5,000 00
Subtract line 78 from line 77.
= 79=×× 80
6.48%
9.74%
3.26%
4.89%
= 81
=
Multiply line 79 by line 80.
+ 82
000 00324 00 +000 00
163 00= 83=
Add lines 81 and 82 (maximum $636).
Amount from line 83 of column A or B, as applicable
Amount from line 84
× Number of months entered in box 62.
Subtract line 85 from line 84.
Number of months entered in box 60
Number of months entered in box 61
Add the results.
Subtract line 88 from line 87.
Enter the amount from line 86 or line 89, whichever is less.

× $51.33
× $53.00 +=÷ 12=.

84
85
86
87.

.
.
.

6 2 6. 0 0

88

.

= 89.

.

90

.

+ 97

.

Premium payable under the Québec prescription drug insurance plan = 98.

If you wish to pay your spouse’s premium, complete lines 91 through 97.
Amount from line 84
Amount from line 91
Subtract line 92 from line 91.

.

÷ 12

× Number of months entered in box 76=

Number of months entered in box 74
Number of months entered in box 75
Add the results.
Subtract line 95 from line 94.

× $51.33
× $53.00

.

+=91
92
93
94

.
.

.
.

6 2 6. 0 095

.

= 96

.

Enter the amount from line 93 or line 96, whichever is less.
Add lines 90 and 97.Carry the result to line 447 of your return.

.

Enclose a copy of this schedule with your return.

T9K2 ZZ 84577550

K