UPDATE ON THE SOCIAL BENEFITS SITUATION
In the current context of the COVID-19 pandemic, we are responding to a large quantity of questions from insureds of the MÉDIC Construction insurance plan.
In order to assist the industry’s insureds, click here to for a general summary of information on medical emergencies abroad and salary insurance.
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The medical emergency abroad program reimburses certain medical costs, hospital costs, and other related costs incurred during a stay abroad. This coverage applies only to people insured under a public insurance plan in Canada, such as the Régie de l'assurance maladie du Québec (RAMQ). Costs eligible for reimbursement are those that exceed the costs reimbursed by public plans (e.g., RAMQ, SAAQ).
The Medical Emergency Abroad program is not offered by all insurance plans; consult your plan’s Bulletin MÉDIC Construction.
If you are a retiree aged 65 years or older who has chosen prescription drug insurance coverage from RAMQ, you can get information from that agency (1 800 561-9749) about how costs for your prescription drugs are reimbursed.
If you take out other insurance
When you leave on a trip, you may purchase additional coverage from an insurance company. We suggest, however, that you check carefully whether this coverage is already included in the medical emergency abroad program in order to avoid unnecessary costs, as MÉDIC construction does not coordinate its insurance with other insurers with regard to costs related to a medical emergency abroad.
When a medical emergency arises, you must contact the Commission de la construction du Québec (CCQ) before incurring costs (at the time of each incident or if the state of health deteriorates). We will then inform you of the expenses that we agree to reimburse. If you decide to incur costs that we have not authorized (such as examination or laboratory costs), these will not be reimbursed.
Here are the numbers to call:
- In Canada (outside of Québec) and the United States 1 800 461-8686
- Elsewhere in the world (collect call) (514) 341-7155.
These numbers also appear on the back of your MÉDIC Construction card.
If there is hospitalization, as soon as you contact us, we will communicate with the hospital’s administration to confirm the insurance coverage of the person hospitalized.
All hospital and medical costs authorized by the MÉDIC Construction insurance plan that are incurred following an accident or emergency and necessitate a hospital stay are 100% reimbursed.
Medical consultation and other costs following an accident
The costs authorized and incurred for medical consultations following an accident are 100%
reimbursed. The first consultation must take place within 30 days following the date of the accident.
All other medical costs (e.g., medications, examination or laboratory fees) are reimbursed if they are authorized ahead of time.
Medical consultation and other costs following an emergency or illness
Costs authorized and incurred for a medical consultation due to an illness (e.g., flu, otitis.) or an emergency other than an accident and the costs related to the first three follow-up visits for this event are 80%
reimbursable. Ensuing visits are not covered by the medical emergency abroad program.
Example: Jane, vacationing in Mexico, consults a doctor for dizziness on February 5. The doctor gives her follow-up appointments on February 8, 12, 19, and 26. The CCQ reimburses 80% of the costs of the visits on February 5, 8, 12, and 19; the cost of the February 26 visit is not reimbursed.
All other medical expenses (for example, medications, examination or laboratory fees) are reimbursed according to the insured’s plan as if they had been incurred in Québec.
For reimbursement of costs related to a medical consultation following an emergency or due to an illness:
- Fill out the form Application for Reimbursement - Healthcare Covered Outside Québec issued by the RAMQ.
- Send this form and your original receipts to the RAMQ (keep a photocopy of your receipts).
- Read the notice of payment or rejection that the RAMQ will send you following its analysis of your application. If the RAMQ has not reimbursed you 100%, fill out the form Health and Professional Care Claim Form and send it to the CCQ at the address indicated, accompanied by the notice from the RAMQ and a photocopy of your receipts.
Note: The exchange rate used to make the reimbursement corresponds to the rate set by the Bank of Canada on the day when the expenditures were made.
Transport from one hospital to another
If the person is hospitalized in a facility that does not have the medical resources needed to care for him or her, we organize transport to another hospital. We choose the hospital considering the jurisdiction of the facility and its capacity to offer the required care, while incurring the lowest costs for the program.
We organize the repatriation of the ill or injured person to his or her home or to a hospital as soon as the state of health permits. These costs are paid only if it is impossible for this person to return by the means of transportation originally planned (medical recommendation required). If the attending physician determines that a medical escort is required for the repatriation, we organize the escort’s round trip in economy class. The medical escort may not be a family member or a travelling companion of the ill or injured person.
Necessary arrangements are also made for the repatriation to Québec of all insured persons accompanying the ill or injured person if they cannot return by the means of transportation originally planned. If the attending physician determines that the ill or injured person is medically incapable of returning the automobile and if none of his or her travelling companions is able to do so, we will arrange for the automobile to be returned.
Transport of a family member to the bedside of the hospitalized person
If needed and upon recommendation by the attending physician, the program assumes the transportation costs of a close relative who goes to visit the hospitalized person. Certain conditions apply; notably:
- The CCQ’s authorization must be obtained before departure.
- The person must be hospitalized for at least seven days.
- The hospitalized person must not already be accompanied by a family member aged 18 years or over.
- The visitor must travel economy class by the most direct route.
In case of death
In case of death, the program may cover certain expenses:
- Costs for the preparation of the body for repatriation in order to respect certain international or local standards
- Costs for repatriation of the body or cremated remains (the cost of a traditional coffin or an urn is excluded)
- Costs of the round trip transportation, if necessary, of a person close to the family to identify the body if the deceased person was not already accompanied by a family member or a travelling companion aged 18 years or over
- Repatriation of the deceased person’s dependents if they are unable to return by the means of transportation originally planned
Other services provided by the program
- Transmission of urgent messages related to medical assistance
- Allowance for daily living expenses up to $100 per day, per insured person, for a maximum of seven days (expenses directly attributable to medical emergency abroad; invoices must be supplied)
Medical emergency abroad covers you whatever your medical condition. However, the costs listed in the following categories are not reimbursable:
Costs related to a medical condition for which a patient is waiting, before his or her departure, for a treatment that must be administered in a hospital, an operation, a surgery, or a graft, unless the patient was authorized by his or her attending physician to take this trip abroad. A copy of this authorization must be sent to the CCQ before your departure.
Costs following an accident that occurred:
- While participating in one of the following sports: hang gliding (gliding using an apparatus without a motor such as a glider), paragliding (gliding using an apparatus with a single sail such as a hang-glider), mountaineering (activity performed on a mountain with climbing equipment), parachuting (jumping from an airplane or from a platform such as a building using a parachute), bungee jumping, or rodeo
- While participating in a competition in motorized vehicles or training for such a competition; “motorized vehicle” is defined as any means of locomotion propelled by one or several motors (for example, powerboat, motocross bike)
- While participating as a professional in sports or underwater activities; a “professional” is defined as a person who performs an activity (e.g., scuba diving, hockey) for remuneration for his or her principal income
All costs for medical or paramedical treatments or hospital services when the trip outside of Québec has been taken order to receive such treatments (e.g., pregnant woman who wants to give birth in another country or a person who has surgery outside of Québec when he or she is on a waiting list in Québec)
Country that is at war or politically unstable
MÉDIC Construction does not reimburse medical costs incurred in a country for which the government of Canada has posted an “Avoid all travel” advisory, due to civil unrest, war, uprising, or political instability, on its website www.canada.ca
under the “Travel and tourism” tab, unless the repatriation or medical costs to be incurred are reasonable given the gravity of the case and the geopolitical situation in the country, and given that they were approved beforehand by MÉDIC Construction.
Depends on the stage of pregnancy of the insured at the time that she travels abroad, MÉDIC Construction will not reimburse costs related t this condition.
- If the insured is between 1 and 28 weeks pregnant, she may travel without supplying a document.
- If the insured is between 29 and 34 weeks pregnant, she may travel, but she must provide MÉDIC Construction with written permission from her physician giving the destination, the duration of the trip, and the mode of transportation.
- If the insured is 35 or more weeks pregnant, she will not be covered by the MÉDIC Construction medical emergency abroad program for any treatments related to her condition.
Note: No costs related to a childbirth or a planned abortion outside of Québec are covered by the medical emergency abroad program.
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 force.