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Posted by Louise Gagne, FICA, FSA, février 22 2017
Health Insurance
Health Insurance: Are You Familiar With Your Employee's Coverage?

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Did you know that if your employees are not covered by RAMQ, they may not be covered under your group insurance plan? Indeed, there are several details you should know about health insurance as a business manager. To learn more on the subject, read this!

WAITING PERIOD for health insurance 

Newcomers to Quebec are subject to a waiting period of up to 3 months before being covered by RAMQ, even if they hold Canadian citizenship or any other status entitling them to coverage under that plan.

As RAMQ does not generally reimburse expenses incurred during this waiting period, these individuals will have to pay out-of-pocket for everything that is usually paid by the government plan, unless they have a private insurance covering these expenses:

  • full cost of hospital stay or any hospital visit
  • doctors’ fees

Quebecers moving to another province are also subject to this waiting period before being covered by the government plan of their host province. In the meantime, they remain under the Quebec Health Insurance Plan, thus avoiding coverage interruption. Hospitalization costs will be fully covered, but RAMQ will only reimburse doctors’ fees according to the rates in effect in Quebec, which can result in unexpected expenditures.

Provinces other than Quebec also have a 3-month waiting period before a newcomer (from another Canadian province or country) is covered by their government health insurance plan. The situation is similar to what is described above, except for certain terms and conditions that may differ from those applied in Quebec. Please speak to your advisor if you have employees in this situation.

Did you know...

Did you know the Quebec government has entered into reciprocal social security agreements, which include a health component, with certain countries? With such agreements, individuals arriving from outside Canada do not have to wait for up to 3 months before becoming eligible for the Health Insurance Plan. Visit the RAMQ website for the list of countries party to these special agreements.

HOW TO PREVENT PROBLEMS?

If you have employees in this situation and you don’t want them to incur substantial expenses in case of a health problem, you should contact your insurer to obtain RAMQ-equivalent coverage for these first three months.

Also, some group insurance contracts require government coverage as a condition of eligibility. If this is your case, your newcomer employees will have no insurance coverage at all as long as they are not covered by the government health insurance plan. Remember that your employees’ spouses and children are also subject to these rules. Carefully read the eligibility conditions in your contract to find out what applies in your case or call your AGA Advisor who will help you clarify your situation.

ALSO FOR EXPATS AND STUDENTS

The 3-month waiting rule could also affect your Canadian employees working abroad for an extended period, as Quebecers leaving the province for more than 183 days in a given year lose their eligibility to RAMQ and are subject to this waiting period when they return. The same applies to a child who studies outside Canada for more than 183 days.

To extend coverage beyond 183 days and avoid this inconvenience, your employees must simply advise RAMQ that they are going to work for their employer (or their child is going to study) abroad. The coverage period will be extended (subject to a maximum number of years) and there will be continuity of coverage under the government plan upon their return.

Do not hesitate to contact your AGA Advisor if you have any questions.

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Louise started her career at Blue Cross before working as a Senior Advisor for a large actuarial firm for more than 15 years. Fellow of the Canadian Institute of Actuaries, Louise joined AGA in June 2014. She assumes responsibility for training, provides technical support, and supplies advisory activities for the large business clientele. Louise is also lecturer at l’UQAM.
Louise Gagne, FICA, FSA