平特五不中

平特五不中.CA / Human Resources / Benefits / Insurance & plan details / Supplemental health & dental plans

Provincial plan replacement coverage

Employees arriving in Quebec from outside Canada, or returning to Quebec after a long absence, only become eligible for Quebec Medicare after聽a waiting period of up to three (3) months. Consult the for further information on the eligibility criteria.听

Since all staff are required to have basic health care coverage, from the date of hire and聽for up to the duration of the 3-month waiting period, Manulife offers Provincial Plan Replacement coverage to employees, who are under age 65 and their eligible dependents who are also under age 65.

What is Provincial Plan Replacement (PPR) coverage?

  • PPR duplicates provincial health care by providing聽health care benefits similar to those provided to residents of Quebec through the Quebec Health Insurance Plan.
  • PPR satisfies the requirement that all 平特五不中 employees have basic health care coverage,聽allowing you and your dependents to participate in 平特五不中's Supplemental Health plan.
  • Coverage is subject to a lifetime maximum of $1,000,000 for each person insured.
  • Coverage extends to聽active聽employees under age 65, and to their under-65 dependents only.

Plan details

The plan contract is 37822 and the division number is 258.听

Questions concerning PPR coverage can be addressed directly to Manulife at 1-800-268-6195.

Applying for coverage

Eligibility

To be eligible for Provincial Plan Replacement (PPR) coverage, the employee and their dependents must be:

  1. Applying聽for the Quebec Health Insurance Plan聽managed by RAMQ.
  2. Registered for coverage under the 平特五不中 Supplemental Health Plan.

For information on how to register with RAMQ, please refer to the聽or Quebec Health Insurance聽pamphlet.听The R茅gie can be contacted by phone at: (514) 864-3411.

How to apply

  1. Complete the聽Application for Provincial Plan Replacement Coverage聽(Section 2- Family Information), providing all required information for all covered individuals.
  2. If you are expecting a child while enrolled for PPR coverage: Select family coverage and indicate "unborn child' as the child's name and the expected delivery date as the date of birth.
  3. Sign and date the form (Section 3 - Authorization).
  4. Include a copy of the confirmation of registration for Quebec provincial health care letter(s) from the RAMQ.
  5. Forward the completed and signed application & the RAMQ letters to the Human Resources Service Centre without delay.

If you are applying for coverage for dependents who have arrived after your initial 3-month waiting period and are responsible for the cost of coverage, include a personal cheque made payable to 平特五不中 for the cost of the coverage you need.

Pending approval

  • Human Resources will send the application to Manulife for consideration.
  • PPR coverage can only be confirmed once Human Resources receives Manulife's approval.
  • The employee will receive from Human Resources notification of Manulife's review (letter from Manulife).

Please note that any medical expenses incurred before coverage has been approved may not be covered.

Cost of coverage

The University covers the cost of premiums for new employees聽who are not covered by a Provincial Health Insurance Plan. The employee incurs no expense for coverage during the initial three (3) month waiting period.

If the employee has any dependents arriving other than during this initial 3-month waiting period, or if the employee requires and is eligible for this coverage other than during the initial 3-month period, the employee will be responsible for the entire cost of their coverage.听Refer to the聽application for provincial plan replacement coverage for information on costs.

PPR coverage for an unborn child

If you are expecting a child during the 3 month waiting period for Quebec Provincial Health Care, you must:聽

  • Apply for听蹿补尘颈濒测聽Provincial Plan Replacement Coverage
  • Indicate "unborn child" in the name of the dependent section
  • Indicate the expected delivery date as the date of birth

Claiming expenses

The plan contract is 37822 and the division number is 258.听

All claims must be received by our insurer within 90 days of the end of the benefit year, March 31st and no later than 90 days following the last day of coverage (termination of the PPR contract). Claims received after this date will not be paid.

Plan members may be required to pay their health care practitioner directly for services rendered and then submit a claim to Manulife Financial for reimbursement.

Submit Online

  • Sign in to the Manulife聽Plan Member Secure site.听Under聽Group Benefits and Retirement聽select聽My Group Benefits.
  • If you are already registered on the聽, enter your plan contract number (85210), your member certificate number (平特五不中 ID) and your password.
  • If you are not already registered, scroll down to 'Get started' and follow the instructions.
  • You will need to keep your receipts for at least one year.听
  • For questions about the online claims submission process,聽contact Manulife directly聽at 1-800-268-6195.

Mobile App

  • Download the Manulife Mobile on the聽App Store, or on聽Google Play.
  • By downloading the app, you will be able to:
  • Submit claims from your smartphone.
  • View your most recent claims.
  • Explore claim details.
  • Visit your favourite app store to download it now and enjoy the convenience of managing your benefits on the go

Paper Claims

Paper submissions can be made by mail or in person. Download and print a聽Health Claim Form聽or聽Dental Claim Form.

Be sure to include:

  • The plan member certificate number (your 平特五不中 ID number).
  • The name and date of birth of claimant.
  • The total amount submitted.
  • Referral or prescription from the treating physician where necessary (consult the聽Supplemental Health Plan聽as to whether the service you incurred requires a referral/doctor's prescription).
  • Attach the original receipt(s) and keep a copy for your personal records, then sign, date and forward the completed form directly to Manulife.

Claims can be mailed to the following addresses:
Health claims

Group Claims Department
PO Box 2580, STN B
Montreal, Qc H3B 5C6

Dental claims

Group Claims Department
PO Box 5000, STN B
Montreal, Qc H3B 4B5

At the Pharmacy/Direct Billing

At the Pharmacy

Payment for drug expenses will be processed through the Deferred Drug Card Program.

You will be required to pay for the cost of the medication up front, at which time your pharmacist will submit an electronic claim directly to Manulife for processing.听You will automatically receive payment by direct deposit (into the bank account 平特五不中 has on file) for the total amount covered by the 平特五不中 Supplemental Health Plan. There is no need to submit a paper claim, or update your bank account with Manulife.

Direct Billing

Health care providers, such as physiotherapists and chiropractors, can submit plan member claims directly to Manulife at the point of care. In many instances, plan members will only have to pay the amount not covered by the plan for approved claims. For more information, speak to your health care provider.

Coverage termination

PPR coverage terminates when:

  • The plan member turns 65 (including their dependents)
  • The employee (and their dependents) is accepted for coverage by the Provincial Health Plan (RAMQ)
  • Employment terminates
  • The University will cease paying coverage beyond the initial three-month waiting period.

New arrivals from another Canadian province

Employees arriving from another Canadian province must apply for Quebec Provincial Health Care. However, they聽do聽not聽need to apply for Provincial Plan Replacement Coverage, as the employee's聽other provincial health care plan will cover them for the first three months they are in Quebec. Please confirm with your province.听For more information, refer to the聽.听

Extended Provincial Plan Replacement (PPR) coverage

If you and/or your spouse and dependents require Provincial Plan Replacement Coverage longer than the initial three-month period, you may apply for Extended Provincial Plan Replacement Coverage.

Coverage is similar to initial PPR coverage, however you are responsible for the entire cost of this coverage.

To apply:

1. Complete the聽application for Provincial Plan Replacement Coverage

  • On Page 3, provide information for all family members requiring coverage. Under coverage Information, select the box "Temporary Health Coverage for a Returning Canadian Employee or a New Canadian Resident.
  • On Page 4, under the Pricing聽Chart,聽select the coverage level you require. Under Authorization, sign and date the application form.

2. Attach a personal cheque made payable to 平特五不中 for the required amount.听(Payment must be made for periods of 3 months.)
3. Forward the completed & signed application form to the HR Service Centre WELL BEFORE the end of the initial 3-month period of coverage聽(this will allow time to process your request).听

If additional periods of extended coverage are required, please provide an explanation of the steps being taken to arrange eligibility for RAMQ coverage. Manulife needs to know that you are actively pursuing eligibility for RAMQ coverage. If you have any questions, please contact the HR Service Centre at (514) 398-4747 or聽hr.hr [at] mcgill.ca

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