HEALTH INSURANCE COMBINATION PLAN

You know there are gaps in the provincial health insurance plan because you regularly have to pay out-of-pocket for health care, including dental exams, medications and prescription glasses. Now imagine what it would cost you if an unforeseen health problem arose.

First, the main protections of dental insurance and prescription drugs. Next, the basic plan's vision care and travel insurance will be explained in detail below.

Dental care

Fortunately, by taking advantage of the affordable protection offered by the best insurers, You'll have peace of mind knowing that coverage will help cover your healthcare costs – no matter what happens. Insurers offer preventive dental care and basic dental care. You only pay for the coverage that best meets your needs.

Refund

Reimbursement depends on each insurer. As an example:

• Reimbursement of 70% of the first $575
• Maximum of $400 / year / person
• $2 per person, per contract year for dental care following an accident

Recall exams

Review every 9 months/per person

 

Drawbacks

Oral surgery, periodontics services and endodontics services (root canal treatments) are not covered

Major catering services are not covered

 

Please note:s

• Coverage of basic services paid according to the stipulated fees. In fact, the price of oral and dental procedures from the order of dentists in your province
• “Contractual year” means the 12-month period following the effective date of the agreement, and each 12-month period thereafter.
• “Compensation period” means the 12-month period following the date on which a loss covered by a particular benefit first occurs and each 12-month period thereafter.
• " Calendar year " means each 12-month period beginning on January 1 and ending on December 31.

Prescription Drugs Basic Formula

Covers expenses not covered by the provincial drug insurance plan. Indeed, including the annual deductible and coinsurance payment up to the prescribed maximum.

For generic drugs

Generic drugs (brand name drugs allowed; benefit paid according to the cost of equivalent generic drugs)

 

Exclusions

Smoking cessation products, over-the-counter medications, ovulation inducers, oral contraceptives, anti-dysfunction medications, and medications that do not require a prescription

 

Reimbursement of eligible prescription drug costs

Most insurers reimburse the first $750 of eligible prescription drugs. 70% refund
for a maximum of $525 per calendar year, per person

 

Maximum per contract year/per person

Most insurers reimburse the first $750, reimbursement of 70% for a maximum of $525 per calendar year,
per person

Supplementary health insurance, formula combination

Quebecers pay on average nearly $2 per year for medical expenses, not covered by the RAMQ.

Supplemental health insurance fits easily into the monthly budget. In addition, the premium may be eligible for the medical expense tax credit.

This protection covers:

• Lifetime maximum of $250 per insured
• Chiropractors, chiropodists (podiatrists), podiatrists, osteopaths, naturopaths, massage therapists, dietitians, and acupuncturists. In principle, up to $25 per session and 20 sessions per insured person, per contractual year,
• X-rays by the chiropractor: maximum of $35 per insured, per contract year
• Psychologist, psychotherapist or clinical counselor. In particular, up to $80 for the first session. Then, $65 for the following sessions and 15 sessions per insured.
• Physiotherapist: maximum of $250 per insured, per contract year

What are the other services?

• Home nursing services and care. Prosthetics and permanent medical equipment: maximum of $4 per insured, per contract year
• Custom orthotics: maximum of $225 per person per contract year
• Speech therapist: maximum of $65 for the first visit, $45. More precisely, for certain visits and 10 visits per insured person, per contractual year
• Dental care following an accident: maximum of $2 per insured, per contract year
• Ambulance transport: no maximum for ground transport and air ambulance transport
• Hearing aids: maximum of $400 per insured person, per period of four consecutive years of benefits.
• CT scans: maximum of $200 per insured, per contract year
• Ultrasound: maximum of $50 per insured, per year
• Audiologist: maximum of $500 per insured, per year
• Magnetic resonance imaging: maximum of $500 per insured, per contract year
• Laboratory analyses. A maximum of $100 per person, per contractual year is provided. In other words, blood and urine tests and throat swabs, carried out following an accident. With this in mind, this plan gives entitlement for the purposes of diagnosis or treatment of an illness
• Prostate Specific Antigen (PSA) Test – maximum of $75 per person, per contract year. Among other things, payment of costs incurred for tests necessary for the diagnosis or treatment of an illness,

Vision Care, combination formula

Coverage for optometric expenses. For example, prescription lenses and frames, laser surgery and visits to the optometrist.

• $150 per period of 2 consecutive years of compensation. Coverage for expenses incurred for prescription lenses and frames, contact lenses and laser surgery.

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• If you purchase your frames or prescription lenses from one of our partners, the maximum compensation mentioned above will increase to $250. 100% coverage of one visit to the optometrist per benefit year.

Travel insurance, basic formula

 Coverage for emergency hospital and medical expenses. It should be noted that the insured must travel outside the province or territory where he or she resides. No doubt, 24 hour assistance is also provided.

The basic formula travel insurance represents this coverage:

 

• Insurance for medical expenses in the event of an emergency, up to $5 per insured for trips of 000 days or less. (A $000 deductible applies to each claim.)
• Possibility of purchasing 8 or 21 additional days of coverage in the form of an Add-on.
• Travel insurance may be limited or excluded for an illness or condition that first appeared in the 9-month period preceding the effective date of departure.