Employees arriving in Quebec from outside Canada, or returning to Quebec after a long absence, only become eligible for Quebec Medicare after a waiting period of up to three (3) months (see Eligibility/RAMQ for more information).
Since all staff are required to have basic health care coverage, from the date of hire and for up to the duration of the 3-month waiting period, Manulife offers Provincial Plan Replacement coverage to employees, who are under age 65 and their eligible dependents who are also under age 65.
What is Provincial Plan Replacement (PPR) coverage?
- PPR duplicates provincial health care by providing health care benefits similar to those provided to residents of Quebec through the Quebec Health Insurance Plan.
- PPR satisfies the requirement that all McGill employees have basic health care coverage, allowing you and your dependents to participate in McGill's Supplemental Health plan.
- Coverage is subject to a lifetime maximum of $1,000,000 for each person insured.
- Coverage extends to active employees under age 65, and to their under-65 dependents only.
The plan contract is 37822 and the division number is 258.
Questions concerning PPR coverage can be addressed directly to Manulife at 1-800-268-6195.
- Applying for coverage
- Cost of coverage
- Claiming expenses
- Coverage termination
- Arrivals from other provinces
- Extended PPR coverage
Applying for coverage
To be eligible for Provincial Plan Replacement (PPR) coverage, the employee and their dependents must be:
- Applying for the Quebec Health Insurance Plan managed by RAMQ.
- Registered for coverage under the McGill Supplemental Health Plan.
How to apply
- Complete the Application for Provincial Plan Replacement Coverage (Section 2- Family Information), providing all required information for all covered individuals.
- If you are expecting a child while enrolled for PPR coverage: Select family coverage and indicate "unborn child' as the child's name and the expected delivery date as the date of birth.
- Sign and date the form (Section 3 - Authorization).
- Include a copy of the confirmation of registration for Quebec provincial health care letter(s) from the RAMQ.
- Forward the completed and signed application & the RAMQ letters to the Human Resources Service Centre without delay.
If you are applying for coverage for dependents who have arrived after your initial 3-month waiting period and are responsible for the cost of coverage, include a personal cheque made payable to McGill University for the cost of the coverage you need.
- Human Resources will send the application to Manulife for consideration.
- PPR coverage can only be confirmed once Human Resources receives Manulife's approval.
- The employee will receive from Human Resources notification of Manulife's review (letter from Manulife).
Please note that any medical expenses incurred before coverage has been approved may not be covered.
Cost of coverage
The University covers the cost of premiums for new employees who are not covered by a Provincial Health Insurance Plan. The employee incurs no expense for coverage during the initial three (3) month waiting period.
If the employee has any dependents arriving other than during this initial 3-month waiting period, or if the employee requires and is eligible for this coverage other than during the initial 3-month period, the employee will be responsible for the entire cost of their coverage. Refer to the application for provincial plan replacement coverage for information on costs.
PPR coverage for an unborn child
If you are expecting a child during the 3 month waiting period for Quebec Provincial Health Care, you must:
- Apply for family Provincial Plan Replacement Coverage
- Indicate "unborn child" in the name of the dependent section
- Indicate the expected delivery date as the date of birth
The plan contract is 37822 and the division number is 258.
All claims must be received by our insurer within 90 days of the end of the benefit year, March 31st and no later than 90 days following the last day of coverage (termination of the PPR contract). Claims received after this date will not be paid.
Plan members may be required to pay their health care practitioner directly for services rendered and then submit a claim to Manulife Financial for reimbursement.
- Sign in to the Manulife Plan Member Secure site. Under Group Benefits and Retirement select My Group Benefits.
- If you are already registered on the Plan Member Secure Site, enter your plan contract number (85210), your member certificate number (McGill ID) and your password.
- If you are not already registered, scroll down to 'Get started' and follow the instructions.
- You will need to keep your receipts for at least one year.
- For questions about the online claims submission process, contact Manulife directly at 1-800-268-6195.
- Download the Manulife Mobile on the App Store, or on Google Play.
- By downloading the app, you will be able to:
- Submit claims from your smartphone.
- View your most recent claims.
- Explore claim details.
- Visit your favourite app store to download it now and enjoy the convenience of managing your benefits on the go
Paper submissions can be made by mail or in person. Download and print a Health Claim Form or Dental Claim Form.
Be sure to include:
- The plan member certificate number (your McGill ID number).
- The name and date of birth of claimant.
- The total amount submitted.
- Referral or prescription from the treating physician where necessary (consult the Supplemental Health Plan as to whether the service you incurred requires a referral/doctor's prescription).
- Attach the original receipt(s) and keep a copy for your personal records, then sign, date and forward the completed form directly to Manulife.
Claims can be mailed to the following addresses:
Group Claims Department
PO Box 2580, STN B
Montreal, Qc H3B 5C6
Group Claims Department
PO Box 5000, STN B
Montreal, Qc H3B 4B5
At the Pharmacy
Payment for drug expenses will be processed through the Deferred Drug Card Program.
You will be required to pay for the cost of the medication up front, at which time your pharmacist will submit an electronic claim directly to Manulife for processing. You will automatically receive payment by direct deposit (into the bank account McGill has on file) for the total amount covered by the McGill Supplemental Health Plan. There is no need to submit a paper claim, or update your bank account with Manulife.
Health care providers, such as physiotherapists and chiropractors, can submit plan member claims directly to Manulife at the point of care. In many instances, plan members will only have to pay the amount not covered by the plan for approved claims. For more information, speak to your health care provider.
PPR coverage terminates when:
- The plan member turns 65 (including their dependents)
- The employee (and their dependents) is accepted for coverage by the Provincial Health Plan (RAMQ)
- Employment terminates
- The University will cease paying coverage beyond the initial three-month waiting period.
New arrivals from another Canadian province
Employees arriving from another Canadian province must apply for Quebec Provincial Health Care. However, they do not need to apply for Provincial Plan Replacement Coverage, as the employee's other provincial health care plan will cover them for the first three months they are in Quebec. Please confirm with your province. For more information, refer to the Quebec government's website.
Extended Provincial Plan Replacement (PPR) coverage
If you and/or your spouse and dependents require Provincial Plan Replacement Coverage longer than the initial three-month period, you may apply for Extended Provincial Plan Replacement Coverage.
Coverage is similar to initial PPR coverage, however you are responsible for the entire cost of this coverage.
1. Complete the application for Provincial Plan Replacement Coverage
- On Page 3, provide information for all family members requiring coverage. Under coverage Information, select the box "Temporary Health Coverage for a Returning Canadian Employee or a New Canadian Resident.
- On Page 4, under the Pricing Chart, select the coverage level you require. Under Authorization, sign and date the application form.
2. Attach a personal cheque made payable to McGill University for the required amount. (Payment must be made for periods of 3 months.)
3. Forward the completed & signed application form to the HR Service Centre WELL BEFORE the end of the initial 3-month period of coverage (this will allow time to process your request).
If additional periods of extended coverage are required, please provide an explanation of the steps being taken to arrange eligibility for RAMQ coverage. Manulife needs to know that you are actively pursuing eligibility for RAMQ coverage. If you have any questions, please contact the HR Service Centre at (514) 398-4747 or hr.hr [at] mcgill.ca