MÉDIC Construction Card

In general, MÉDIC Construction covers part of the eligible costs of medical care (medications, hospitalization fees, dental care, paramedical treatments, vision care, etc.). The insured must pay the balance.

The eligible costs and the amounts that may be reimbursed are described briefly in the Bulletin MÉDIC Construction. There are bulletins for the basic insurance plans and for each of the supplementary insurance plans.

When insureds use their card, MÉDIC Construction pays the portion of eligible costs that are reimbursable directly to the pharmacist, dentist, healthcare professional, or hospital, depending on the insurance coverage that they and their dependents have. This way, insureds do not have to pay all of their costs and wait for reimbursement, they pay only the portion that is not covered. The amount paid by insureds is the same, whether they use their MÉDIC Construction card, submit their claim with the MÉDIC Construction application, with MÉDIC online, or make a claim by mail.

Purchasing Medications

The use of the MÉDIC Construction card results in the substitution of certain prescription medications with lower-cost generic versions of equivalent quality, if available. 

If the insured refuses to accept the suggested generic version of the drug, the reimbursement amount will be calculated using the price of the lowest-cost generic (or biosimilar) drug.

Insureds who do not use their MÉDIC Construction card to purchase medications must pay the total purchase cost and submit a claim either with the MÉDIC Construction application, through MÉDIC online or by mail using the form Claim form for medical expenses and professional care.

When insureds use their MÉDIC Construction card to purchase medications, they pay only a part of the total cost, depending on the deductible and the co-insurance set out in their insurance plan. The pharmacist bills MÉDIC Construction directly for payment of the balance. 

Payment of Hospital Costs

To pay hospital costs in Québec

During a hospital stay in Québec, insureds may present their MÉDIC Construction card to pay their or their dependents’ hospital costs (room for acute care). The hospital then bills MÉDIC Construction directly up to the maximum amount provided in the insurance plan and claims the rest from the insured.

To pay hospital costs outside of Québec

MÉDIC Construction sets out special provisions in this case. The section medical emergency abroad provides more information.

Medical emergency abroad coverage is not offered under all insurance plans. For insureds who have this coverage, it is indicated on their MÉDIC Construction card.

Payment of Dental Costs

Insured may use their MÉDIC Construction card to pay for dental care when they have this coverage. The card may also be used to pay dental costs for a dependent if this person is not covered for dental care by a plan other than MÉDIC Construction.

For the payment of basic dental care (diagnosis, prevention, minor treatments, endodontics and parodontics), the MÉDIC Construction card may be presented to a dentist participating in the direct payment program. The dentist then contacts MÉDIC Construction to determine the portion of the dental costs that will be reimbursed by MÉDIC Construction; the insured only pays the difference.  

Major dental care is also covered by the direct payment plan; it must, however, be authorized by MÉDIC Construction before being received. The procedure is as follows:

• The insured must obtain a treatment plan (cost estimate) accompanied by relevant x-rays from a dentist participating in the direct payment program.
• The insured must send this treatment plan and the x-rays to MÉDIC Construction for authorization through MÉDIC online or by mail.
• MÉDIC Construction sends the insured a letter to inform them of its decision to accept or reject reimbursement of the procedure described in the treatment plan. The worker may also consult the decision in their MÉDIC online file.
• If the treatment plan is accepted, the insured must show their MÉDIC Construction card to the dentist along with the letter authorizing reimbursement when the procedure described in the treatment plan is received. The dentist then contacts MÉDIC Construction to find out the amount that the insured must pay (the dentist must supply the registration number on the authorization letter). 

It should be noted that the services billed by the dentist must be identical to those in the treatment plan authorized by MÉDIC Construction.

When dental care (basic or major) cannot be paid with the MÉDIC Construction card, the insured may submit a claim with the MÉDIC Construction application, by using MÉDIC online at sel.ccq.org or by sending the form the Claim for dental expenses, by mail. A claim form approved by the Association des chirurgiens dentistes du Québec may also be used. In this case, the insured (worker or retiree) must write their client number on the form.

It is important to note that certain insurance plans do not cover dental care. For insureds who have dental coverage, this is indicated on their MÉDIC Construction card.

Payment for professional treatments

Insureds must present their MÉDIC Construction card when they have an appointment with a healthcare professional (chiropractor, physiotherapist, massage therapist, etc.) participating in the providerConnectTM direct payment program, The professional will immediately know the portion of the cost reimbursed by MÉDIC Construction; insureds will have to pay only the balance. 

When the costs cannot be paid with the MÉDIC Construction card, insureds may submit their claim with the MÉDIC Contruction application, with MÉDIC online or by mail. 

The MÉDIC construction card is available only in French 

1. Plan

• Indicates the insurance plan held by the worker or retiree.
• Plan A offers the most complete insurance coverage.
• Plan D offers minimal insurance coverage.
• Plans B and C provide insurance coverage of differing levels between A and D.
• Plan Z covers medications only.
• The insurance plan for retirees is identified as R1, R2, or R3.

If the letter indicating the plan (A, B, C, D or R) is followed by the name of a trade, occupation, or specialty, this means that the worker or retiree is covered by the supplementary insurance plan for this group of workers.

2. Insurance period

Indicates the period during which the worker or retiree is insured. The period indicated is either from January 1 to June 30 of a specific year, or from July 1 to December 31 of a specific year.

3. Hour reserve

The number of hours accumulated in the worker’s or retiree’s reserve on the last day of the reference period is given on his or her card. It is important to note that this number may change after the date on the card, as there may be upward or downward modifications to the hour reserve.

4. Coverage

The main coverage provided for insureds and their dependents is written on the MÉDIC Construction cards.
Some coverage is provided only to insureds, and other coverage is offered to insureds and their dependents. 

The Bulletin MÉDIC Construction gives more information on the coverage offered by each of the insurance plans.

The deductible and the percentage of co-insurance applying to the purchase of medications are indicated in this section; it should be noted that the percentage of co-insurance is the portion of the cost of medication paid by the insured.

This section also indicates whether the insured and his or her dependents are covered if there is a medical emergency abroad.