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Provincial Plan Replacement Coverage

Employees arriving in, or returning to Quebec after a long absence, must apply for Quebec Medicare

If you are arriving from outside Canada or are a returning Canadian: The Quebec government requires that new arrivals to Quebec from outside Canada or Canadians returning after an extended absence and who no longer qualify for provincial health benefits must satisfy a waiting period of up to three (3) months before becoming eligible for the Quebec Health Insurance Plan (Medicare.

Provincial Plan Replacement Coverage

McGill University offers its employees and their dependents, who are new arrivals to Quebec (from outside Canada) or returning Canadians, coverage during the 3-month waiting period under Manulife Financial's Provincial Plan Replacement Coverage program. The employee incurs no expense for this coverage as the University covers the entire cost for the 3-month period.

Provincial Plan Replacement Coverage (PPR) provides health care benefits similar to those provided to Quebec residents under the Quebec Provincial Health Insurance Plan. It covers emergency and non-emergency health care expenses up to the same levels and subject to the same limitations and user fees as those under the Quebec Health Insurance Plan.

If you are coming from another Canadian province: you must apply for Quebec Medicare, however, you do not need to apply for Provincial Plan Replacement Coverage. Your other province's health care plan will cover you for the first three months you are in Quebec. (It is recommended however that you confirm your other province's health care coverage.)

Provincial Plan Replacement Coverage - the Plan:

  • Protects the non-resident and his/her family from the financial impact of an unexpected major illness or accidents.
  • Promotes proper health maintenance by ensuring access to regular medical care when it is needed.
  • Satisfies the requirement that all employees have basic health care coverage, normally provided by the provincial health care plan, so that the non-resident and his/her dependents will be able to participate in McGill University's Supplemental Health plan.

Provincial Replacement Coverage (PPR)

 

Includes:

  • Hospitalization in an approved hospital facility up to the hospital's normal ward rate.
  • Necessary hospital services and supplies (inpatient and outpatient).
  • Medication prescribed and administered by a doctor during a hospital stay.
  • Services provided by a doctor normally covered by the provincial plan.
  • Diagnostic laboratory tests and x-rays ordered by a doctor.
  • Eye examinations performed by a licensed opthamologist or optometrist (age restrictions apply).
  • Dressings, casts and anesthesia used for surgical procedures.
  • Expenses for specific dental procedures if performed by a dental surgeon in a hospital.

Does Not Include:

  • Medical expenses incurred due to:
    • participation in high-risk sports activities,
    • alcohol or drug addiction,
    • cosmetic surgery,
    • experimental treatments,
    • organ transplants,
    • surgery for sterilization or sterilization reversal,
    • medical exams for use by a third party,
    • chronic care or a stay in the chronic care unit of a general hospital, nursing home or health spa,
    • treatments/consultations/drugs related to artificial insemination or in vitro fertilization.

Important remarks

  • Coverage extends to active employees and their dependents only and is subject to an annual maximum of $250,000 per person with a lifetime maximum of $1,000,000.
  • Expenses for treatment or services received outside Quebec will be covered up to the amount to which you would be entitled under the Quebec Health Insurance Plan.
  • Any costs over the limits imposed by the Quebec Health Insurance plan are the responsibility of the employee.
  • Pre-approval is required for planned hospital stays and surgery. In the case of emergency hospitalizations, Manulife Financial must be notified within five (5) calendar days of the date charges are incurred. Failure to notify Manulife Financial in either situation will result in the employee having to pay 20% of the costs incurred up to a maximum of $5,000.

Registering for Provincial Plan Replacement Coverage (PPR)

In order to be eligible for Provincial Plan Replacement Coverage, the employee and their dependents, must have registered for Quebec Medicare and for coverage under the McGill Supplemental Health Plan. See sections Registering for Quebec Medicare and Registering for coverage under the McGill Benefit Program.

To apply the employee must:

  • Fill out the application form - Application - Provincial Plan Replacement Coverage - (Section 2- Family Information), providing all required information for all covered individuals.
  • Sign and date the form (Section 3- Authorization).
  • Forward the application to the HR Service Centre with proof of registration letter(s) from the RAMQ.

Registering for coverage with the Quebec Health Insurance Plan (Quebec Medicare)

It is important that new arrivals to Quebec and returning Canadians register for provincial health coverage with the Régie de l'assurance-maladie du Québec upon arrival:

To register with the Régie de l'assurance-maladie du Québec, the employee must visit their office at:

425 Blvd de Maisonneuve Ouest
3rd floor, Bureau 303
Montreal, Qc H3A 3G5

The Régie may be contacted by phone at: (514) 864-3411

When registering with the Régie, the employee will need:

  • proof of residence(please see below for acceptable documents);
  • work permit, including the names of accompanying family members;
  • identification for employee and their family members(marriage certificate, birth certificates, passports, and additional travel documents);
  • student visas for any family members who are entering the country as students.

  • Proof of residence documents accepted

  • residential lease (the entire document;
  • deed of purchase of residential property (the entire document;
  • employer’s attestation issued not more than 30 days prior to the application date and confirming that the person holds employment in Quebec for more than six months

Registering for coverage under the McGill Benefit Program

To qualify for coverage under the McGill Supplemental Health Plan, the employee and and their eligible dependents must qualify for provincial health care benefits.

When they register with the Régie, they will be given a letter confirming their registration and the effective date of their provincial health care coverage. It is important that they provide a copy of this letter when they enroll in the McGill Employee Benefits Program. This letter will serve as proof of their registration with the Régie.

Submitting claims under Provincial Plan Replacement Coverage

The benefit year is from January 1 to December 31. All claims must be received by our insurer within 90 days of the end of the benefit year — that is, by March 31st. Claims received after this date will not be paid.

Please note that members may be required to pay the health care practitioner directly for services rendered and then submit a claim to Manulife Financial.

Claims are to be sent to:

Manulife Financial
Group Claims Department
P.O. Box 2580, Stn B
Montreal, Qc H3B 5C6

 

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