What is private health insurance?
Private health insurance is insurance that a person or an employer purchases from a private insurer. It is therefore not provided by the provincial or federal government.
A private plan provides coverage to a group of employees (or members). It is also called a “group insurance plan” or “group benefits plan”.
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What is public health insurance?
The Régie de l’assurance maladie du Québec (RAMQ) administers public health insurance in Quebec.
The RAMQ offers coverage to Quebecers who do not have access to private insurance, that is to say:
persons not eligible for a personal plan (for example, self-employed workers);
people aged 65 or over;
financial assistance recipients or claim slip holders;
the children of persons insured by the public plan.
What are the requirements for a private health insurance plan in Quebec?
Quebecers covered by a private plan must include their spouse and children in their coverage – unless another secret plan covers them.
Those who have access to several private plans can choose the one they consider the most advantageous. This may be the plan provided by their employer, professional association, or spouse.
In Quebec, private drug insurance plans must meet minimum requirements (which may be exceeded). They concern:
the medications covered (for example, the RAMQ medication list);
The financial contribution required from the participants. For example, the plan’s reimbursement percentage and the maximum contribution for drugs on the RAMQ list is a question.
What happens to your insurance when you retire?
If you are still eligible for a private plan upon retirement, you are required to participate in it. This obligation ends when you turn 65.
If you do not have access to a private plan, you must register with the RAMQ.
What happens to your insurance after age 65?
At age 65, Quebecers are automatically registered with the RAMQ public drug insurance plan.
If you continue to be eligible for a private plane, you have a choice to make. You can choose to be covered:
only by the public program (if the personal plan is a condition of employment, you must choose between options 2 and 3);
by the general procedure (first payer) and an individual plan offering supplementary coverage (second payer); Where
only through a private plan offering at least a basic range.
The RAMQ will send you to notice six months before your 65th birthday.
What happens if you switch from one diet to another?
Are you thinking of switching from a private plane to the RAMQ public plane? The list of covered drugs may be more restrictive. In addition, you will undoubtedly notice differences in the collection of deductibles and the percentage of reimbursement.
The reverse is also true if you go from public to private.
You might also see differences in coverage or the list of drugs covered. Except for the minimums required in Quebec, the provisions of private drug insurance plans can vary considerably. As of July 2020, the minimum coverage is 63%. The maximum annual contribution is $1,144 for drugs on the RAMQ list.
What happens if you use drugs subject to an exception or a special authorization? These are drugs for which your doctor has had to make special arrangements to ensure coverage. In this case, you may have to redo these steps to be covered by a new plan.
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Does the RAMQ check if you have health insurance?
In Quebec, you must be covered by insurance for your prescription drugs. The RAMQ regularly checks whether people who do not have a private plan are registered with the public program.
If your situation changes, you must notify the RAMQ. For example, suppose you lose your job and, therefore, your benefits (including your group insurance). It would help if you then informed the RAMQ that:
your situation has changed;
you are no longer covered by private insurance.
