Presentation of the new plan
Details of the coverage
Health insurance
Reimbursement of medication
Module A
Module B
Module C
70 %
80 %
90 %
patented
patented
patented
80 %
90 %
100 %
generic
generic
generic
68 %
68 %
68 %
original*
original*
original*
up to the RAMQ
maximum** / 100 %
of what remains
of the first
$2,500 / 100 %
of what remains
of the first
$2,500 / 100 %
of what remains
Currently
80 % patented
90 % generic
68 % original*
of the first
$2,000 / 100 %
of what remains
* Medication for which a generic drug exists
** Currently, the RAMQ maximum is attained when the member has disbursed $963, or
between approximately $3000 and $4800 of total expenditures depending on the
reimbursement percentage
2
Health insurance
Reimbursement of paramedical care
Module A
Module B
Module C
Currently
70 %
80 %
90 %
80 %
Maximum **
Group 1
Maximum **
$600
$900
Chiropractor only *
Group 1
Acupuncturist, chiropractor,
dietician, occupational therapist,
homeopath, osteopath,
physiotherapist, podiatrist,
physical rehabilitation therapist.
$400
Max. eligible per
visit $50,
namely a $35
reimbursement
Max. eligible per
visit $50,
namely a $40
reimbursement
Annual maximum
$400 / specialist
for all
Groups 1 and 2
Max. eligible per
visit $50,
namely a $45
reimbursement
Group 2
Massotherapist
(with a referral)
* Minimum set out in the CEGEP collective agreement
** Maximum annual reimbursement per insured person
3
Maximum payable
per visit
$35
Massotherapists
are not covered
Health insurance
Reimbursement of paramedical care
Module A
Group 3
Speach therapist,
resource teacher
Group 4
Psychologist, social worker,
psychoanalyst, psychiatrist
Module B
Module C
80 %
90 %
Maximum *
Group 3
Maximum *
Group 3
$600
$900
Max. eligible per
visit $50,
namely a $40
reimbursement
Max. eligible per
visit $50,
namely a $45
reimbursement
Maximum *
Group 4
Maximum *
Group 4
$900
$1,400
Max. eligible per
visit $75,
namely a $60
reimbursement
Max. eligible per
visit $75,
namely a $67,50
reimbursement
* Maximum annual reimbursement per insured person
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Currently
80 %
Maximum payable
per visit
$35
Annual maximum
$400 for all
50 %
of the first $1,400 /
100 % of
what remains:
annual maximum
$2,100
Health insurance
Other modifications
Module A
Module B
Module C
Currently
70 %
80 %
90 %
80 %
Eligible expenses
$300 per day
Maximum payable
Eligible expenses
$300 per day
Maximum payable
Eligible expenses
$300 per day
Maximum payable
$10,000 per year
$10,000 per year
$10,000 per year
Not covered
Not covered
Not covered
Glasses or contact lenses
Not covered
Not covered
Not covered
Not covered
Eye examination
Not covered
Eligible expenses
Eligible expenses
Not covered
$50 per 24 months
$50 per 24 months
Maximum
2 pairs per year
Maximum
2 pairs per year
Maximum
2 pairs per year
$100 eligible
$100 eligible
$100 eligible
per pair
per pair
per pair
Nursing care
Naturopathy
Vision care
Corrective shoes
5
Unlimited
Maximum payable
$35 per traitment
2 visits
per year
Maximum
2 pairs per year
Health insurance
Module A
Module B
Module C
100 %
Travel Insurance
Currently
100 %
$2,000,000 life
Medical emergency
same
Trip cancellation
$5,000 per trip
Hospitalization
covered
and long-term care
Other expenses
70 %
80 %
90 %
covered
covered
covered
80 %
Orthopedic devices and shoes
Plantar orthoses
Vaccines
Rehabilitation centre
Treatment for addiction
Transportation by ambulance
etc.
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covered
Dental care
Option 1
Option 2
Available with
modules A, B ou C
Currently
Available with
module C
Deductible
None
None
$25
Preventive care
80 %
80 %
70 %
Diagnosis and prevention
Basic care
Minor restorative services
and oral surgery
Major restorative services
Endodontics et periodontics
Reimbursement
Annual maximum per insured
Examination
Fee schedule
80 %
80 %
70 %
Not covered
80 %
70 %.
$1,000
$1,000
idem
9 months
9 months
6 months
Current ACDQ
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idem
A minimum
36-month
participation
period is
required before
one can reduce
the scope of
one’s coverage.
Life insurance
Module A
Basic life
Module B
Module C
Currently
1 or 2 x salary (optional)
2 x salary
Life insurance for the member*
Life for dependants
Member’s spouse*
$10,000
$5,000
Member’s child
Accidental death
or dismemberment
for the member
Replaced by
Critical illness
Insurance
same
$4,000
2 x salary
or
4 x salary
Additional life
for the member
1 to 10 multiples of $25,000
1 to 7 multiples
for the spouse
1 to 10 multiples of $25,000
of $20,000
* If one is under 65 years old, lesser amount over 65 years old
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Critical illness insurance
 New coverage for the member
– Maximum indemnity: $25,000 life
(A clause regarding pre-existing conditions applies)
 A non-taxable lump sum payment is paid to the member if he or she
receives a diagnosis of one of the diseases that is covered
– The amount varies depending upon the kind of disease
% of the amount of
insurance
Examples of diseases covered
Multiple sclerosis
100 %
Alzheimer’s disease
100 %
Stroke
50 %
Heart attack
35 %
Cancer
35 %
Heart bypass
35 %
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Premiums
Premiums * (Rounded to nearest $, per pay period)
Health insurance and dental care
Plan
Module A
Module B
Module C
Module A
+
Dental 1
Individual:
$32
$41
$48
$41
$50
$57
$60
$39
SingleParent:
$55
$70
$81
$72
$87
$98
$105
$66
Couple:
$65
$83
$95
$83
$101
$113
$119
$77
Family:
$88
$111
$128
$115
$138
$155
$164
$104
Coverage
* The 9% provincial tax must be added to these prices.
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Module B
+
Dental 1
Module C
+
Dental 1
Module C
+
Dental 2
Currently
To sum up
The principal changes :
 Three modules with three different percentages for the reimbursement
of medication and other expenses: 70%, 80% and 90%
 Combination of paramedical care into four groups, one of which
includes massotherapy
 Dental care: the choice becomes an individual one for each member
and consists of a basic option or an enhanced option
 Life insurance: the coverage in the event of accidental death or
dismemberment is replaced by critical illness insurance coverage
No changes to short and long term disability insurance
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Conclusion
 The proposed plan enables each member to make their own
choices
 Members may alter their choices in the course of their career
 The plan preserves the principle of solidarity of a group
insurance, since the risks continue to be pooled
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