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Health & Dental Insurance

Health Dental InsuranceHealth care funding is continually being reassessed. As governments reduce coverage for some health care services, and cease to provide others, more responsibility is placed on Canadians to pay out-of-pocket for their own routine health-related services. Government health insurance plans generally do not cover expenses such as dental care, vision care, preferred hospital accommodations or registered specialists and therapists.



Québec Provincial Health Insurance Plan: Fact Sheet

Services covered by the Québec Health Insurance Plan:

Prescription Drugs - All residents not covered by a private group plan must enroll in the government drug insurance plan (RAMQ). Those with individual health policies must still be enrolled in the government plan.

- When purchasing prescription drugs listed on the List of Medications, residents pay a deductible of $16.00. Once that is paid, the resident pays a co-insurance of 32%. The maximum monthly contribution for persons age 18 to 64, and for those over age 65 not receiving a Guaranteed Income Supplement, is $80.25. For those aged 65 and over receiving a GIS, the maximum is $49.97 a month. The maximum annual contribution is $963. For those aged 65 and over receiving a GIS, the annual maximum is $600.
Ambulance - Full coverage for those aged 65 and over and those on social assistance.
Dental Benefits - Coverage for certain oral surgeries when performed in a hospital.

- Basic routine services covered for children age 10 and under.
Eye Care Services

- Coverage for one eye exam every 12 months for those aged 17 and under and seniors aged 65 and over.

- Coverage for those aged 18 to 64 who are hospitalized to receive long-term care or persons in a long-term care facility.

- Coverage for visually impaired persons of any age who are registered with an accredited centre.

Hospitals - Coverage for standard ward rooms only
Paramedicals - No coverage for paramedicals, except for physiotherapy when performed by a physician in an accredited facility.
Hearing Aids - Coverage for eligible residents who meet program requirements.

- The purchase and replacement cost of a hearing aid.

- The purchase and replacement cost of an assistive listening device: decoder, teletypewriter, a telephone amplifier, an adapted alarm clock, or a ring detector
Nursing and Home Care Benefits - Coverage for home care services – nurses, doctors, social workers, occupational therapists – provided through the CLSC
(Centres locaux de services communautaires) free of charge.
Medical Supplies - The purchase, adjustment, replacement and repair of orthotics, prosthetics, and other assistive devices are covered after meeting eligibility requirements.
Out of Country - The Régie reimburses at pre-set rates the cost of hospital services required as a result of sudden illness or an accident to a maximum $100 per day for hospitalization, and up to $50 per day for healthcare received at a hospital out-patient clinic.

- For hemodialysis and the required medication, the Régie reimburses up to $220 per treatment, regardless of whether the person is hospitalized.

We can provide you with the right solutions to meet your health and dentals needs. With many types of programs on the market from the various companies, we will guide you and help you determine the best options for your situation and your budget. Here are some of the services that an Extended Health Care and Dental Plan can offer:

Extended HEALTH BENEFIT
This benefit, available with or without drugs, covers costs of medical and hospital expenses incurred by you or a member of your family in case of illness, pregnancy or injury.

ELIGIBLE EXPENSES COVERED AT 100% WITHOUT DEDUCTIBLE

Hospitalization

  • Semi-private room
  • $25/day starting the fourth day of hospitalization if you must stay in a ward because no semi-private rooms are available

Convalescence and physical rehabilitation

  • Semi-private room

ELIGIBLE EXPENSES COVERED AT 100% WITH DEDUCTIBLE

Hearing aids

  • $500 every 36 months (cost of purchase and repair)

Prostheses and accessories

  • Breast implant following mastectomy, up to $200 (initial purchase cost)
  • Initial cost of a wig required due to chemotherapy, up to $300
  • Support hose, up to $100 per calendar year
  • Orthopaedic shoes or foot orthoses, up to $200 per calendar year

ELIGIBLE EXPENSES COVERED AT 80% WITH DEDUCTIBLE
A written recommendation from a physician is not required for the following services:

Professional services
$25 per visit and an overall maximum of $500 per calendar year for each of the following specialists:

  • Acupuncturist
  • Audiologist or audioprosthetist
  • Chiropractor
  • Dietician
  • Kinesiologist
  • Naturopath
  • Occupational therapist
  • Osteopath
  • Physiotherapist
  • Podiatrist
  • Psychologist
  • Speech therapist

Ambulance, unlimited reimbursement
Ultrasound scans, up to $50 per calendar year
X-rays by a chiropractor, up to $25 per calendar year
Ophthalmologist or optometrist, overall maximum of $50 every 24 months
Medical questionnaire, up to $75 per calendar year
Intrauterine device, up to $75 every 24 months
Tens machine, up to $500 per calendar year

A written recommendation from a physician is required for the following services:

Purchase or rental of equipment, unlimited reimbursement
Laboratory tests, unlimited reimbursement
Magnetic resonance imaging, up to $675 per calendar year
Polysomnography, up to $400 every 24 months
Varicose-vein injections (sclerotherapy), $20 per visit and 15 visits per calendar year
Massage therapist, up to $25 per vist and $500 per calendar year
Nursing services, 160 hours of care and up to $5 000 per calendar year
Dental care following an accident, up to $1 000 per accident
CT scan, up to $250 per calendar year

PREVENTIVE DENTAL CARE

  • Examinations and diagnostic services
  • X-rays
  • Laboratory tests and examinations
  • Preventive services
  • Space maintainers

BASIC DENTAL CARE

  • Removal or erupted teeth (uncomplicated surgery)
  • Restorative services
  • Endodontics
  • Periodontics
  • Removable prosthesis (adjustment, rebasing)
  • Oral surgery
  • Anesthesia
  • Temporary dressing for emergency pain relief
  • Finishing restorations

In today’s uncertain health care climate, more and more Canadians are turning to private health insurance plans to provide the complete protection and security they need. Whether you are self employed or a salaried employee, a customized private health insurance plan can meet your unique needs and provide the valuable coverage you deserve at a reasonable cost.Contact Quattro Insurance Solutions today at 514-258-2171

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