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Provincial Plan Replacement Coverage

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

The Quebec government requires that new arrivals to Quebec 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 Program with Manulife Financial

From the date of hire, for up to the duration of the 3-month waiting period, McGill University offers its employees (who are under age 65) coverage under Manulife Financial's Provincial Plan Replacement Coverage program.  Eligible dependents (under age 65) may also be covered during this 3-month waiting period.

Manulife's Provincial Plan Replacement Coverage (PPR) Program 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.

Cost of coverage
The employee incurs no expense for coverage during the 3-month waiting period as the Univerity covers the entire cost.
If the employee has any dependents arriving other than during this 3-month waiting period, the employee will be responsible for the entire cost of their coverage.

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. The employee's other provincial health care plan will cover them for the first three months they are in Quebec. (It is recommended however that the employee confirm their other province's health care coverage.) For more information, please refer to the Quebec government's website.

What is Provincial Plan Replacement Coverage?                                                     

Duplicates provincial health care: it provides health care benefits during the waiting period that are similar to those provided to residents of Quebec through the Quebec Health Insurance Plan.  See the RAMQ website for more information
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.
Coverage is subject to a lifetime maximum of $1,000,000 for each person insured
Coverage extends to active employees and their dependents only - who are UNDER age 65.
Please refer to the Manulife brochure.

PPR coverage for an unborn child             

If you are expecting a child during the 3 month waiting period for Quebec Medicare, you must do the following to ensure the child is automatically covered from birth under the PPR plan: 

  • 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.
                                                                    

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

Extended PPR coverage     

  • Extended PPR coverage may be available if coverage is required longer than the initial 3-month waiting period.
  • The employee is responsible for the entire cost of this coverage.
  • Refer to Extended PPR coverage for more details.

 Questions about coverage?           Address specific questions concerning PPR coverage directly to Manulife at 1-800-268-6195  

 

Applying for Coverage                                                                                                  

To be eligible for Provincial Plan Replacement (PPR) coverage, the employee and their dependents must have:

1. Registered with the RAMQ for Quebec Provincial Health care.

  • For information on how to register, please refer to the RAMQ website. 
  • The Régie can be contacted by phone at: (514) 864-3411.

2. Registered for coverage under the McGill Supplemental Health Plan.

 How to Apply

Complete the application form - 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 Univerity for the cost of the coverage you need.

 

Pending Approval

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.

Claiming expenses under the Provincial Plan Replacement Coverage benefit                                                                                                                                                                                  

The plan contract and division numbers for this coverage are: Policy 37822  -  Division 258
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.
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.

Preparing the claim   

1. Use a regular health benefit claim form      

2. When completing the claim form you will need to indicate: 

  • Plan contract number: Beside 85210, indicate 37822-258
  • Plan member certificate number: Indicate both your McGill ID number and your PPR certificate number (indicated on Manulife's confirmation of PPR coverage letter)

3. Attach the original receipts.

4. Keep a copy of the claim (including receipts) for your files.

5. Mail the claim to Manulife at the address indicated on the claim form.                                                       

Questions on how to apply?   Contact the Human Resources Service Centre at (514) 398-4747.