Provincial plan replacement coverage

Applying for coverage

Eligibility

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

1. Applying for the Quebec Health Insurance Plan managed by RAMQ.
2. Registered for coverage under the McGill Supplemental Health Plan.

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

How to apply

Complete the Application for Provincial Plan Replacement Coverage

1. Section 1 - Employer Information: Enter your certificate number (Your McGill ID) only. Do not modify the other pre-filled fields.
2. Section 2 - Family Information: Provide all required information for all covered individuals. Ensure that the coverage start date matches your appointment date. If you are expecting a child while enrolled for PPR coverage, select family coverage and indicate "unborn child" as the child's name in the dependent section and the expected delivery date as the date of birth.
3. Under Coverage Information, select the appropriate box.
4. Under the Provincial Plan Replacement – Pricing Chart, on the third page of the form, select the coverage level that you require (i.e. family status and number of months of extended coverage).
5. Section 3 - Authorization, sign and date the application form.

Provide the completed and signed application, along with the RAMQ confirmation of application letter to McGill University's Human Resources Service Centre without delay using one of the following means:

• You may attach these documents to your Benefit Enrolment Event in Workday or;
• Upload them through JIRA or;
• Send them by email to hr.hr [at] mcgill.ca.

Include a copy of the confirmation of registration for Quebec provincial health care letter(s) from the RAMQ.

If you are applying for coverage for dependents who have arrived after your initial 3-month waiting period, please see the Extended PPR coverage tab for more details.

Pending approval

Once your documents have been successfully received for their review, your application will be considered pending.

• Human Resources will send the application to Manulife for assesment.
• 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 is approved may not be covered. You may wish to obtain private coverage until your PPR coverage is approved.

Once approved, you may set up your Manulife ID to submit any eligible medical expenses you have incurred. You must keep Human Resources informed of any updates regarding the status of your RAMQ application. If you require more than three months of coverage, please consult the Extended PPR Coverage tab.

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 the Quebec Health Insurance Plan, you must: 

• Apply for family Provincial Plan Replacement Coverage
• Indicate "unborn child" as the child's name in the dependent section
• Indicate the expected delivery date as the date of birth

Claiming expenses

You may submit any Provincial Plan Replacement claims with the same tools and processes for the Supplemental Health Plan. You may find the instructions on the Submitting a Supplemental Health Claim webpage. 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.

Additional instructions

• Online or Mobile App claim:  use the Out of Country/Province Provider type.
• Paper Claim : Use the Plan Contract number 37822 and division number 258 

All claims must be received by our insurer within 90 days of the end of the benefit year, March 31^st 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.

Coverage termination

PPR coverage terminates when:

• The plan member turns 65 (including their dependents)
• The employee (and their dependents) is accepted for coverage by the Quebec Health Insurance 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 the Quebec Health Insurance Plan. 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.

The Extended PPR coverage is similar to the initial coverage, however you are responsible for the entire cost of this coverage. Please note that your application for the Extended PPR coverage will not be submitted to our insurance carrier, Manulife Financial, until we receive the required payment.

Instructions to apply for Extended Provincial Plan Replacement Coverage:

1. Complete the Application for Provincial Plan Replacement Coverage
   • Section 1- Employer Information: Enter your certificate number (Your McGill ID) only. Do not modify the other pre-filled fields.
   • Section 2 - Family Information: Provide all required information for all covered individuals. Ensure that the coverage start date matches your appointment date. If you are expecting a child while enrolled for PPR coverage, select family coverage and indicate "unborn child" as the child's name in the dependent section and the expected delivery date as the date of birth.
   • Under Coverage Information, select the appropriate box.
   • Under the Pricing Chart - Benefit Extension Pricing, on the last page for the form, select the coverage level that you require (i.e. family status and number of months of extended coverage).
   • Section 3 - Authorization, sign and date the application form.
2. Send the completed and signed Extended PPR application form to McGill University's Human Resources Service Centre by email at hr.hr [at] mcgill.ca BEFORE the end of your initial 3-month coverage period. This will allow sufficient time to process your request and help ensure there is no gap in coverage.
3. Submit the required payment to McGill University for Extended PPR Coverage
   • After submitting your completed application via email to the HR Service Centre, they will provide you with instructions on how to make your payment to McGill University through Interac e-Transfer, which is the most efficient and preferred method.
   • Alternatively, payment may be made by personal cheque, bank draft or money order, made payable to McGill University for the required amount. These forms of payment must be delivered in person to the following address between 8:30 a.m. to 5:00 p.m: 680 Sherbrooke St West, Suite 1520, Montreal, QC, H3A 2M7.
   • HR Service Centre will not forward your completed application for the Extended Provincial Plan Replacement Coverage to our insurance carrier, Manulife Financial, until the required payment has been received.

If additional periods of extended coverage are required, please provide an explanation of the steps being taken to arrange eligibility for RAMQ coverage. Please note that total coverage cannot extend over 24 months. 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