Health Insurance

Health Insurance

 

The basic plans A, B, C, D, the supplementary plans, and the insurance plans for retirees R1, R2, R3 all offer health insurance; some provide dental coverage. Insurance plan Z covers only the purchase of medications.

Insurance coverage varies from one plan to another. The Bulletin MÉDIC Construction for each plan gives a short description of the coverage offered and the reimbursable amounts. Specific conditions, limitations, and exclusions may apply; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

The health insurance coverage includes:

  • Hospital Costs
  • Medical reports
  • Authorized Medications
  • Eye Care
  • Paramedical Care
  • Hearing Aids
  • Laboratory Fees
  • Medical Supplies
  • Transportation by Ambulance
  • Services offered by pharmacists

Hospital costs may be reimbursed if the following conditions are satisfied:

  • The facility must be authorized to dispense medical care to injured or sick people (acute phase of sickness).
  • The facility must have an emergency room and an operating suite.
  • The costs must have been incurred in Québec. For hospitalization that occurs outside of Québec, see the section Medical Emergency Abroad.

Exclusions

  • Facilities that specialize in rehabilitation or convalescence
  • Facilities offering only short- or long-term residential care

Reimbursement of costs

The maximum reimbursable is $75 per day. The insured must pay the balance.

Hospitalization costs may be paid using the MÉDIC Construction card or by submitting a claim using the Health and professional care claim form.

Specific conditions, limits, or exclusions other than those mentioned above may apply to reimbursement of certain coverages; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal force.

The cost of filling out a form or a medical report is reimbursed only if the document has been requested by the Commission.

Here are the only situations for which MÉDIC Construction will reimburse these costs:

 

  • Medical report filled out for analysis of a salary insurance file including the initial application
  • Medical report filled out for analysis of a file in order to recognize a dependent child’s temporary or permanent disability
  • Medical report filled out for analysis of the file of an exceptional patient
  • Travel authorization filled out by the attending physician for a person waiting for hospital treatment, surgery, or a graft. This person must send MÉDIC Construction a copy of the authorization BEFORE he or she departs.

 

In all other cases, the cost of filling out a form or a medical report is not reimbursable.

Reimbursable medications are those obtained through a prescription made by a physician, a dentist, a podiatrist, a pharmacist, or a nurse duly authorized by the law to prescribe. These medications must also be included in the list of medications compiled by the Ministre de la Santé et des Services sociaux du Québec and listed in sections 8 and 60 of the Act Respecting Prescription Drug Insurance or on the list compiled by the Commission de la construction du Québec (CCQ).

If they are prescribed by the professionals mentioned above, the following products may be reimbursed:

  • Sclerosing injections for varicose veins. Reimbursement of all costs, including ultrasound, is limited to $50
  • Some insurance plans medications related to in vitro treatment. The attending physician must confirm in writing that the patient is having in vitro treatment. The cost of the treatment itself is not reimbursable

Important: 

Upon purchase of an original medication for which a generic medication exists, the reimbursement is calculated based on the lowest-price of the generic medication. 

In addition, the difference between the price of the original medication and that of the generic medication will be excluded from the annual family ceiling of $850 and will be entirely at the expense of the insured.

Starting January 1, 2020, patients that, for the first time, begin using biological medications for which a biosimilar version exits, will be required to use a biosimilar medication instead. 

For example:
Impact for the insured of purchasing an original medication versus purchasing a generic (or biosimilar) medication 

Medication  Price paid  Percentage of reimbursement  Amount reimbursed by MÉDIC  Amount paid by the insured  Amount added to the annual family ceiling 
Generic (or biosimilar)  $60  90%  $54  $6   $6 
Original $150 90% $54 (90% of $60) $96 $6

*Example for a plan with no deductible with 90% reimbursement.

In this example, the insured will spend $90 more per month if purchasing the original medication. If the insured takes this medication each month for a full year, it will be an additional expense of $1,080 per year.

If, for a medical reason, the insured cannot use a generic (or biosimilar) medication, they must send MÉDIC Construction a copy of their prescription on which their physician has noted “Do not substitute” and the reason code provided by the RAMQ. Subject to authorization by MÉDIC Construction, the reimbursement will then be revised and will be based on the price of the original medication. 

The Bulletin MÉDIC Construction for each plan gives the amounts that may be reimbursed.

Exclusions

  • Certain injectable products for relieving arthritis pain (for example, Synvisc and Monovisc) and lancets for taking capillary blood samples for diabetes cases are not eligible for direct reimbursement as medications in pharmacies with the MÉDIC Construction card. These products may be reimbursable as medical supplies under certain conditions. For injectable products for relieving arthritis pain, medical recommendation and prior authorization by MÉDIC Construction will be required. For this purpose, the form Claim form for medical expenses and professional care must be attached to the cost estimate that will be sent to MÉDIC Construction.
  • All over-the-counter medications that are not reimbursable by the “Régie de l’assurance maladie du Québec” (RAMQ) are not reimbursable by MÉDIC Construction, even if they are prescribed by a health professional.
  • Products and medications administered or sold for treatments in private clinics are not reimbursable (ophthalmology, dermatology, all “scope”-type treatments, etc.).
  • All costs related to services covered by the Régie de l’assurance maladie du Québec (RAMQ), also called “accessory costs.”
  • Physicians’ fees for beauty treatments and the cost of the materials used for injections or applications are not reimbursable.

Section 94 of the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction defines the various exclusions.

Reimbursement of costs

The deductible and the co-insurance to be paid by insureds vary depending on the plan that they hold. This information is given on the MÉDIC Construction card.

Authorized medications purchased in Québec may be paid using the MÉDIC Construction card. Otherwise the insured must pay the total cost and submit a claim with the MÉDIC Construction application, by using MÉDIC online at sel.ccq.org or by sending the form Claim form for medical expenses and professional care by mail. This form must also be used to request reimbursement of medications purchased outside of Québec.

It is important to note that specific conditions, limitations, or exclusions other than those mentioned above may apply to reimbursement of certain coverages; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

Eye exam, including supplies and procedures required for this exam, and the following products prescribed by an optometrist or an ophthalmologist may be reimbursed:

  • Corrective glasses
  • Prescribed contact lenses
  • Prescribed disposable lenses
  • Frames
  • Prescribed sunglasses (corrective glasses)
  • Intraocular lenses (for cataracts) excluding costs of surgery (see paragraph Surgical Vision Correction)
  • Prescribed half-frame eyeglasses
  • Prescribed reading glasses
  • Fresnel lenses
  • Prescribed safety eyeglasses

Among the non-refundable items are:

  • All glasses that are not prescribed or adjusted to the vision (sunglasses, reading glasses, safety glasses, etc.)
  • Products or solutions related to the use of lenses
  • Clip-on sunglass lenses
  • Magnifying lamp
  • Photophobia glasses

Limitations to reimbursement

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts. It is important to check the plan under which the insured is covered, as some insurance plans do not offer eye-care coverage.

Important:

Since September 1, 2019, a new RAMQ program offers a $250 reimbursement every 24 months for purchases of corrective glasses and contact lenses for children under 18 years of age. Therefore, MÉDIC Construction reimburses the amount in excess of $250 up to the eligible reimbursement limit under the insured’s insurance plan.

For an eye exam, the maximum reimbursement is calculated over a period of 24 consecutive months for the workers and their spouse, and over a period of 12 consecutive months for dependent children. These periods start on the date on which the exam is paid in full (see example below).

Only insured workers may be reimbursed for the purchase of safety glasses. The maximum reimbursement is calculated on a period of 12 consecutive months from the date of purchase. The date of purchase is the date of the invoice indicating that final payment was made – that is, that the balance to pay is $0.

For the reimbursement of other eligible costs (glasses, contact lenses, prisms, etc.), the maximum reimbursement is calculated on a fixed time period of 24 months. This period starts from the date of purchase. The date of purchase is the date of the invoice indicating that the final payment has been made – that is, that the balance to pay is $0.

The example below illustrates how the calculation is done.

Mr. Jones purchases glasses and pays the $300 bill in full on February 15, 2020. During the January to June 2020 insurance period, his insurance plan covers $400 per 24-month period for the purchase of glasses and $70 per 24-month period for eye exam. The table below shows the costs claimed by Mr. 

Jones and the reimbursements that he obtained.

Date of purchase  Eye care  Cost claimed  Reimbursement obtained 
February 22, 2018 Purchase of glasses  $250  $250 
January 29, 2019 Eye exam  $70  $70 
February 3, 2020 Eye exam  $70 No reimbursement
February 15, 2020 Purchase of glasses  $300 $150

Why is the claim for the eye exam performed on February 3, 2020 not reimbursable, and why is the purchase of eyeglasses made on February 15, 2020 not reimbursable in full? 

Reimbursement for the cost of Mr. Jones’s eye exams and eyeglass purchases is now based on a 24-month period. For the February 3, 2020 eye exam, no reimbursement is possible because 24 months have not passed since the last exam. As for the eyeglasses purchases, because Mr. Jones already received a $250 reimbursement (for the purchase he made on February 22, 2018), only $150 is available to him to reach the $400 maximum allowed for this period ($400 – $250 = $150).

To obtain a better reimbursement, Mr. Jones should have waited until February 23, 2020 to purchase his glasses. In this case, the 24-month period would have gone from February 23, 2018, to February 23, 2020. Because Mr. Jones had not made any claim for reimbursement of glasses during this period, $400 would have been available to reimburse his purchase. Mr. Jones would therefore have received full reimbursement for his $300 purchase, instead of only $150.

On the other hand, Mr. Jones would have had to wait until January 30, 2021 to receive a reimbursement for an eye exam.

Vision Correction Surgery

Some plans provide specific lifetime reimbursements of cost of vision correction surgery, whether it is performed by laser or by incision. However, these amounts exclude the cost of intraocular lenses, which is reimbursable under your plan’s eyeglasses and contact lenses coverage. This information can be found in the Bulletin MÉDIC Construction.

Reimbursement of costs

There are four ways to make a claim for eye care:

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will only have to pay the balance exceeding the reimbursable amount. 
  • Insureds may submit their claims with the MÉDIC Construction application.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires 
d’avantages sociaux dans l’industrie de la construction
has legal value.

Paramedical care involves the treatments received from certain health and alternative-medicine professionals.

It is important to note that some insurance plans do not offer this coverage; others offer coverage to the insured only (not to dependents).

Health professionals

The health professional must be a member of a professional order recognized by the government of Québec. Treatments by the following health professionals may be reimbursed:

  • Acupuncturists
  • Audiologists
  • Chiropractors (including x-rays)
  • Speech therapists
  • Physiotherapists and physical rehabilitation therapists
  • Podiatrists
  • Psychologists
  • Social workers

It should be noted that remedial education and occupational therapy treatments for dependent children younger than 18 years are covered by assistance to workers services in the CONSTRUIRE en santé program of MÉDIC Construction.

Le supplementary plan for electricians and the supplementary plan for pipefitters cover treatments received from an occupational therapist.

The professional orders recognized by MÉDIC Construction are:

In certain cases, foot care provided by a member of one of the following associations may be recognized.

Limitations to reimbursement for professional care

  • Only one treatment per day per category of professional may be reimbursed. For example, an insured who receives two physiotherapy treatments in a single day will be reimbursed for only one.
  • Psychologist, social worker: Only one treatment is reimbursable for all treatments received in the same day from these professionals.
  • Costs incurred for any sort of assessment (neuropsychological, cognitive, learning or intellectual capacities, educational assessment or exemption test) are not reimbursable by the Construire en santé program or by MÉDIC Construction. When the assessment is performed by a psychologist or a neuropsychologist who is a member of the Ordre des psychologues, it is reimbursable. However, the reimbursement is limited to the amount allocated by the worker’s plan for one session with a psychologist. Exclusion: A psychosocial assessment made to obtain a report for adoption of a child is not reimbursable, regardless of the practitioner who performs the assessment.

Alternative-medicine professionals

Alternative-medicine professionals must be members of an organization recognized by MÉDIC Construction. Treatments by the following health professionals may be reimbursed:

  • Naturopaths 
  • Osteopaths 
  • Massage therapists 
  • Kinesiologists 
  • Kinotherapists 
  • Orthotherapists

The Bulletins MÉDIC Construction indicate the amounts that may be reimbursed for each plan. 

Limitations on reimbursement for alternative-medicine treatments

  • Massage therapist, kinesiologist, kinotherapist, orthotherapist, osteopath, naturopath:
    • One treatment per day per category of professional is reimbursable. For example, if an insured person receives two osteopathy treatments in one day, only one may be reimbursed.
    • A limit of 10 treatments per person per insurance period is applied for all treatments given by these 6 types of professionals. For example, during a single insurance period an insured person may have 4 treatments with a massage therapist, 2 with a naturopath, and 4 with an osteopath; the maximum number of 10 reimbursable treatments has now been reached. The other limitations and conditions regarding reimbursement of these treatments continue to apply.
  • Massage therapist, kinesiologist, kinotherapist, and orthotherapist:
    • A medical referral with specific diagnosis from the attending physician must be provided for treatments received from these professionals. This referral is valid for 12 months starting from the date of the physician’s signature. If treatments continue beyond these twelve months, a new referral must be provided.

Exclusions

Treatments received from the following professionals are not reimbursable: dermatologist, dietician, homeopath, respiratory therapist, general practitioner, medical specialist, pediatrician, physiatrist, phytotherapist, posturologist, psychoanalyst, psychotherapist, somatotherapist, sports therapist. Other exclusions may apply.

Reimbursement of costs

There are four ways to make a claim for paramedical care:

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will only have to pay the balance exceeding the reimbursable amount. 
  • Insureds may submit their claims with the MÉDIC Construction application.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires 
d’avantages sociaux dans l’industrie de la construction
has legal value.

In addition to hearing aids, all accessories and repair costs involved are reimbursable (earpiece, tube, mould, etc.). The batteries are also reimbursable up to a maximum of $50 per person per period of 12 consecutive months; a proof of purchase of the hearing aid must be supplied.

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Limitation to reimbursement

For hearing aids, the maximum amount reimbursable is calculated over a period of 36 consecutive months. The period considered corresponds to the 36 months preceding the date of purchase. The date of purchase is the date of the invoice indicating that the final payment has been made – that is, that the balance to pay is $0. The example given for the limitation of reimbursement for eye care illustrates, adjusting the period to 36 months and the maximum reimbursable, how the reimbursement is calculated. 

Reimbursement of costs

A claim for hearing aids must be made using the Health and Professional Care Claim Form.

Specific conditions, limitations, and exclusions other than those mentioned above may apply; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal standing.

Diagnostic imaging tests (X-ray, scan, ultrasound) are included among the reimbursable laboratory fees. Reimbursable laboratory and medical imaging costs are those incurred for tests made under 
medical recommendation by laboratory or radiology professionals and used for the purpose of diagnosis. 

Exclusions

The following items are among those not reimbursed by MÉDIC Construction:

  • Medical check-ups, membership fees, and consultations in private clinics
  • “Scope”-type tests or treatments (gastroscopy, colonoscopy, arthroscopy, etc.)
  • Costs of materials used for biopsies
  • Ovulation or pregnancy tests purchased in the pharmacy
  • Test requested by a third party (an employer, SAAQ, CNESST, another insurance company)
  • Holo-energetic test
  • Test done in sexo-physiological analysis laboratories (DNA test, LAPS, etc.)
  • Infertility and impotence treatments

Professional fees charged for blood sample collection are not reimbursable.

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Limitations on reimbursement

The insured must provide a receipt mentioning the lab tests done and the reason for these tests. 

For laboratory fees, the maximum reimbursement is calculated over a period of 12 consecutive months. The period considered corresponds to the 12 months preceding the date of purchase. The date of purchase is the date of the invoice indicating that the final payment has been made – that is, that the balance to pay is $0. The example given for the limitation of reimbursement for eye care illustrates, adjusting for the maximum reimbursable, how the reimbursement is calculated per 12-month period.

Reimbursement of costs

There are four ways to make a claim for laboratory fees.

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will only have to pay the balance exceeding the reimbursable amount. 
  • Insureds may submit their claims with the MÉDIC Construction application.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain coverage; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

**IMPORTANT**

For the purchase or rental of any therapeutic apparatus, supplies, or equipment, the insured must send a medical recommendation with specific diagnosis. In the case of a rental, the prescription must also specify the duration of the rental.

In all cases, an estimate of costs is required so that the CCQ can determine whether the costs are reimbursable.

To obtain a reimbursement, you must send a receipt indicating that the payment has been made in full (balance to be paid $0) to MÉDIC Construction. The percentage of reimbursement allocated to you depends on the insurance plan under which you are covered at the time when the purchase is completed.

The following items may be reimbursable when the required supporting documents are supplied to MÉDIC Construction.

Note: The list of medical supplies below follows the alphabetical order in the French list.

  • Shoe adjustment (correction made to a shoe to modify a foot anomaly)
    MÉDIC Construction reimburses a maximum of six adjustments per insurance period; the maximum allowable per adjustment is $30.
  • Traction device (to stretch the neck) and rigid or semi-rigid cervical collar 
    If these items are required following an automobile accident or a work-related accident, the reimbursement must be claimed from the Société de l'assurance automobile du Québec (SAAQ) or the Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST) and not from MÉDIC Construction.
  • Blood-pressure device (sphygmomanometer to measure blood pressure) 
    The maximum eligible for reimbursement is $100 per family per 60 months. The example given for the limitation on reimbursement for eye care illustrates, adjusting the period to 60 months, how the reimbursement is calculated.
  • Anti-enuresis apparatus (Ledoux Réflexe or Méthode Urino-arrêt incontinence warning device)
  • Orthopedic apparatus: orthosis for forearm (“tennis elbow”), ankle (anklet), elbow, corset (black belt, white belt), finger (Murphy ring), shoulder (brachial harness), knee (patellar orthotic, orthoprene, knee pad, LP support), wrist (epicondylar bracelet), back (lumbar support, lumbar belt, pedal tibia, abdominal belt), body (immobilizer, splints) 
    Document to provide: the receipt must indicate the type of orthotic (rigid, semi-rigid, flexible). Exclusions: sport orthotics, accessories for workplace comfort.
  • Respiratory apparatus for treatment of certain diseases (examples for an adult: asthma, emphysema, cystic fibrosis, COPD; for a child, sleep apnea) 
    The insured must provide a complete medical file (including a medical recommendation with precise diagnosis and duration of treatment) to MÉDIC Construction to obtain authorization to rent or purchase the apparatus.
  • TENS apparatus 
    The maximum eligible is $65 per month for rental and $500 for purchase of a TENS apparatus. Certain accessories related to the use of the TENS apparatus may be reimbursed (e.g., electrode gel, electrodes).
  • Hernial band (inguinal belt, inguinal support) 
  • Support or bath bar 
    Maximum eligible is $200 per 12-month period for purchase and installation. The example given for the limitation on reimbursement for eye care illustrates, adjusting the period to 12 months, how the reimbursement is calculated. 
  • Compression stockings (Airway, Delilah, Futuro, Jobst, Parke Davis, Profore, Segretta, Sigvaris, Valcofit, Varisma, Venosan) 
    A maximum of four pairs per 12-month period is reimbursable. The period considered corresponds to the 12 months preceding the date of purchase (counting the days).
  • Crutches, cane (purchase or rental as applicable) 
    Document to provide: the medical recommendation must indicate the duration that the crutches or cane is needed and a description of the circumstances requiring the use of the crutches or cane. The maximum reimbursement varies depending on the insurance plan but does not exceed $30 per event. Ice studs, rubber tips, and underarm pads are reimbursable.
  • Medical alert bracelet for allergies, diabetes, epilepsy, hypoglycemia, and cardiovascular diseases 
    The maximum eligible is $30 per person per 24-month period. The period considered corresponds to the 24 months preceding the date of purchase (counting the days).
  • Cane – see “Crutches”
  • Orthopedic shoes 
    The purchase of custom-made orthopedic shoes, upon presentation of all documentation required by the CCQ and under the following conditions:
    • Prior authorization by the CCQ
    • Shoes made by a professional authorized under the law and obtained from a laboratory recognized by the CCQ
    • Shoes made from a foot mold of the person concerned, following a medical diagnosis and taking account of a structural malformation that cannot be corrected by another type of orthopedic shoes.
    Document to provide: medical recommendation (renewable each year) by a physician or a podiatrist must indicate the reason for wearing exclusively this type of shoes. A $150 deductible for insureds and their spouse and a $100 deductible for dependent children is applicable to the purchase of each pair of orthopedic shoes. In addition, a maximum of 2 pairs per 12-month period may be reimbursable. The period considered corresponds to 12 months preceding the date of purchase (counting the days).
  • Wheelchair 
    Document to provide: the medical recommendation must indicate duration the wheelchair is needed and, in the case of an accident, the date, place, and circumstances of the incident. The maximum reimbursement varies depending on the insurance plan but may not exceed $2,000 per 12 months for all rental, purchase, repair, and maintenance costs. In addition, rental fees are limited to a maximum of $150 per month. The period considered corresponds to the 12 months preceding the date of the purchase.
  • Supplies for incontinence 
    Certain supplies for incontinence may be reimbursed in the case of paraplegia or quadriplegia. In the other cases, MÉDIC Construction will study the file in order to determine eligibility.
  • Supplies for ostomies (colostomy, ileostomy, urostomy) 
    Document to provide: the medical recommendation must indicate the date of surgery. In the case of a temporary ostomy, MÉDIC Construction must know the planned date for the next surgery. In the case of a permanent ostomy, the Régie de l'assurance maladie du Québec (RAMQ) defrays part of the expenses and MÉDIC Construction reimburses the balance. To obtain this reimbursement, the accumulated receipts that you send to MÉDIC Construction must have a value higher than that reimbursed by the RAMQ.
  • Supplies related to treatment of diabetes 
    Upon medical recommendation, MÉDIC Construction will study the file in order to determine the amount to be reimbursed to patients with diabetes or who are insulin-dependent. Certain supplies (e.g., needle, syringe, lancet, test strips) may be reimbursed. Certain equipments are not reimbursable (e.g., hypo alarm, data manager).
  • Hospital bed 
    Document to provide: the medical recommendation must indicate duration the hospital bed is needed and, in the case of an accident, the date, location, and circumstances of the incident. MÉDIC Construction will study the file in order to determine the amount to be reimbursed for the rental or purchase. The mattress and pillows may, under certain conditions, be reimbursable. The maximum reimbursement varies depending on the insurance plan but may not exceed $2,000 per 12 months for all costs related to rental fees, purchase of the bed, purchase of the mattress, repairs, and maintenance. In addition, rental fees are limited to a maximum of $150 per month. The period considered corresponds to the 12 months preceding the date purchase.
  • Walker 
    Document to provide: the medical recommendation must indicate the duration the walker is needed and a description of the circumstances requiring the use of a walker. Certain accessories (e.g., walker skis) may be reimbursed. The cost of a walker for a handicapped child is usually reimbursed by the RAMQ; MÉDIC Construction will not pay the balance of the cost if the RAMQ reimburses only a part of the cost.
  • Orthotics: see “Orthopedic apparatus”
  • Podiatric orthotic (moulded orthopedic device designed to immobilize part of the foot in order to correct a malformation; this device is made by an orthotist, podiatrist, or chiropodist) 
    Document to provide: a medical  recommendation, which must be written by a physician or podiatrist and must be renewed every 12 months. For dependent children, one pair per 12-month period is reimbursable. For the insured or their spouse, two pairs per 36-month period are reimbursable. The period considered corresponds to the 12 or 36 months preceding the date of purchase (counting the days), respectively. The maximum reimbursement varies depending on the insurance plan but does not exceed $350 per pair. The cost of repairing an orthotic is reimbursable.
  • Fibreglass cast
    Document to provide: the medical  recommendation must give a description of the accident (date, location, circumstances). MÉDIC Construction will study the file to determine whether the cost of the cast is reimbursable.
  • Injectable products for arthritis
    Certain injectable products for relieving arthritis pain (e.g., Synvisc, Monovisc) may be reimbursable with a medical recommendation. Prior authorization by MÉDIC Construction is required.
  • Breast prosthesis (women only)
    Document to provide: the medical recommendation must indicate whether it is a total or partial prosthesis and date of surgery. The amount reimbursed by MÉDIC Construction depends on the reimbursement paid by the RAMQ. In the case of a total prosthesis, the reimbursement is limited to one prosthesis per breast per 24-month period; the period considered corresponds to the 24 months preceding the date of purchase (counting the days). The Maillot breast prosthesis and bras are not reimbursable.
  • Ocular prosthesis 
    The amount reimbursed by MÉDIC Construction depends on the reimbursement made by the RAMQ. MÉDIC Construction reimburses the cost of polishing the ocular prosthesis after the amount paid by the RAMQ is deducted.
  • IUD 
    The maximum eligible amount is $75. Contraceptive implants (e.g., Norplant) are reimbursable (but the cost of injection is not).
  • Vaccine for allergy treatment 
    Document to provide: the receipt must indicate the product injected and that it is a vaccine for treatment of allergies. MÉDIC Construction does not reimburse preventive vaccines (for newborns, for travel, booster vaccine, immunizing vaccine, HPV).

Exclusions

The following items are among those that are not reimbursed by MÉDIC Construction: 

  • Erecaid device
  • Respiratory apparatuses such hyperbaric chambers, air purifiers, or domestic humidifiers, nor maintenance contracts for respiratory apparatuses
  • Pulse oximeter
  • Hairpiece
  • Penile implant
  • Spinecor brace

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Reimbursement of costs

There are four ways to make a claim for medical supplies:

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will only have to pay the balance exceeding the reimbursable amount. 
  • Insureds may submit their claims with the MÉDIC Construction application.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care. 

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

Ambulance transportation costs are reimbursable when it is an emergency (that is, following a sudden and unpredictable event) or when recommended by a physician. The transportation must be to the closest hospital. In certain emergency situations, the cost of transportation by ambulance airplane may be reimbursed; an attestation by a physician indicating that this mode of transportation is medically necessary and that no other mode of transportation can be used is required.

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Adapted transport

The cost of adapted transport between the home and the hospital (or clinic) is reimbursable upon recommendation by a physician confirming that another means of transport cannot be used.

Exclusions

  • MÉDIC Construction does not reimburse the cost of transportation between hospitals. If the transfer is authorized by the hospital with confirmation by the attending physician, the transportation costs are paid by the hospital. If the hospital does not authorize the transportation, the cost must be paid by the insured.
  • MÉDIC Construction does not reimburse the cost of taxis.

Reimbursement of expenditures

The form Déclaration de transport des usagers must be provided to MÉDIC Construction to obtain reimbursement for expenses incurred. If the worker cannot present this form, they must provide the following information about the transport: date and time of pick-up, destination, costs, and reason for transportation.

A claim for emergency transport costs must be made with the MÉDIC Construction application, by using MÉDIC online at sel.ccq.org or by sending the form  Claim form for medical expenses and professional care by mail.

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

Since the Act to Amend the Pharmacy Act came into effect, on June 20, 2015, pharmacists have been authorized to practise new activities that had previously been reserved for doctors.

MÉDIC construction reimburses costs related to these new services that your pharmacist may offer at the same percentage as it reimburses your prescription drugs. The MÉDIC construction card may be used to pay these costs directly.

When a medical consultation is requested, the exact diagnosis must be indicate on it.

The Bulletin MÉDIC Construction contains information on different reimbursements offered by the insurance plans. It should be noted that some plans do not offer all of these insurance coverages. 

  • Application for reimbursement

    The sections of the Commission de la construction du Québec (CCQ) site dealing with different insurance coverage explain how medical expenditures incurred may be paid. Applications for reimbursement must be sent to MÉDIC Construction within one year after the date on which the medical expenditure was made. If the expenditure is high, it is suggested that you ask MÉDIC Construction for an estimate of reimbursement before making the purchase. This enables you to know the amount that you will have to pay as an insured.

    A worker who feels that he or she has the right to a reimbursement different from that granted by MÉDIC Construction may make a complaint about this decision. To do this, he or she must contact Customer Services, which will send him or her the appropriate form. If the employee has taken this step and is still dissatisfied with the CCQ’s decision, the Act Respecting Labour Relations, Vocational Training and Workforce Management in the Construction Industry allows him or her to ask for a review. The CCQ’s Customer Services can guide the employee with this process and supply the appropriate form.

  • Additional details

    Coordinated insurance

    When the spouse of a worker or retiree insured under MÉDIC Construction is covered by another group insurance plan, it is possible for the other insurer concerned and MÉDIC Construction to share the reimbursement of claims. This is called coordinated insurance. It is legal and advantageous to make a claim to the spouse’s insurer and from MÉDIC Construction for a single expenditure; the amount reimbursed, however, may not surpass the total of the costs incurred.

    For coordinated insurance, MÉDIC Construction requires that all of its insureds produce a Declaration by the Spouse form.

    Following a work-related accident or an occupational disease

    If you are recognized or indemnified by the Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST), including Indemnisation des victimes d’actes criminel (IVAC), you must claim reimbursement for medical care and medications related to your job-related injury or to the harm you have suffered as a result of a criminal act.

    MÉDIC Constrction does not reimburse these costs or coordinate insurance with the CNESST.

    Following an automobile accident

    The reimbursement of medical care and medications related to an automobile accident must be claimed from the Société de l'assurance automobile du Québec (SAAQ).

    MÉDIC Construction does not reimburse these costs or coordinate insurance with the SAAQ.

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