My Insurance Plan: I’m Taking Care of It!

My Insurance Plan: I’m Taking Care of It!

Like most private insurance plans in Québec, MÉDIC Construction is facing heavy financial pressure related to increases in the price of medications (almost 40% in five years for MÉDIC).

In 2017, reimbursements paid out to insureds totalled $430 million, mainly in prescription drugs and dental care:

  • Prescription drugs: 53%
  • Dental care: 18%
  • General medical care: 18%
  • Salary and life insurance: 11%

Following recommendations made by external actuaries, the Construction Industry Social Benefits Committee (CISBC), composed of the industry’s employer and union associations, adopted modifications that will affect all plans offered by MÉDIC Construction starting January 1, 2019.

The CISBC will propose other measures in coming years to help correct the situation.

Right now, you can take some simple actions that, when added up, may make a difference to the plan’s financial health.

How you can help reduce the costs of the plan

  • Check your invoices at the pharmacy, the dentist, or the supplier of complementary services, to validate that all the medications or services were actually received, for the right amount, on the right date, and for the correct insureds. This way, if there are errors, you will be able to correct them right away.
  • Report any situation that seems suspect to the CCQ, at 1 888 842-8282.
  • Use only the medications and services that are medically required, judiciously and not abusively.
  • Quickly inform the CCQ of any change in your dependents by calling 1 888 842-8282, so that reimbursements are not made for a person who no longer has the right to your insurance coverage.
  • Ask your doctor if generic or biosimilar medications are available.
  • Send your claims for an accident or illness caused by your work to the CNESST and for vehicular accidents to the SAAQ, rather than using MÉDIC as first payer.
  • Call your Construire en santé program, at 1 800 807-2433, to find out about services offered and to receive advice and assistance.
  • Register for direct deposit for your reimbursement.

Video capsule - simple actions

Did you know that even though your employer pays for your insurance plan, the higher the amounts reimbursed by MÉDIC, the more income tax you will have to pay on your salary, as it is a taxable benefit? In addition, retirees will pay more for their insurance premiums.

Take care of your plan!

Report any situation that seems suspect to the CCQ’s Customer Services, at 1 888 842-8282.

  • Examples of errors, fraud, and abuse

    Errors, fraud, and abuse may represent up to 10% of benefits paid out

    Certain healthcare professionals sometimes abuse private plans, without the insureds even knowing. Here are some examples of real situations in which you can make a difference:

    Error in medications

    A claim for contraceptive pills amounting to more than $900 was claimed in the pharmacy. After questioning by the CCQ, the pharmacist admitted that this was a data-entry error, as he had claimed 28 containers of 28 pills, rather than a single container containing 28 pills.

    If the insured had reviewed his invoice at the cash, he would have found the error immediately in the pharmacy and thus have avoided recovery procedures.

    If you have questions about your invoice, don’t hesitate to ask the pharmacist. After all, it’s your plan!

    Fraud in dental care

    An insured with a right to a dental exam every nine months decided to have her teeth cleaned after only six months, which made her ineligible for reimbursement from MÉDIC. The dental clinic offered the insured to invoice her for another treatment – a service not rendered – so that she could obtain a reimbursement equivalent to the cost of the cleaning. This is a fraudulent act.

    After refusing this collusion, the insured contacted the CCQ to make a report. The insured’s call enabled the CCQ to intervene and identify other fraudulent situations. Blowing the whistle on this type of situation enables MÉDIC to recover money. Every action counts.

    Abuse in complementary health services

    All members of an insured’s family were receiving maximum reimbursement per insurance period for paramedical care. When the CCQ investigated, it found that the massage therapy provider was the spouse of the insured and that she was providing services and issuing receipts to all members of her family, including herself.

    Uses of complementary health services that are abusive and not medically required lead to higher expenditures by the MÉDIC plan. Make sure you claim only the services that are medically required. Abuses will be uncovered sooner or later, and verifications are underway to money that was overpaid. If you witness such activity, try to stop the abuse or report it to the CCQ.

    Take care of your plan!

    Report any situation that seems suspect to the CCQ’s Customer Services, at 1 888 842-8282.

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