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Trip Cancellation or Interruption Benefit Claim Form

To access your group insurance file, open a secured session by clicking on the icon related to the topic of your interest.

Yes, it is essential that you contact RAMQ as soon as possible to inform them that you and your family members have group insurance that reimburses prescription drugs.
If you fail to unsubscribe from RAMQ, you could eventually have to reimburse amounts paid by RAMQ while you were also insured with your group insurer. As per the terms of your contract and based on the date of expenses, these prescription drugs could no longer be eligible for reimbursement by the group insurance.
Below is a list of your family members who, under the Quebec Act respecting prescription drug insurance, must be registered with your private group scheme if they are eligible:

• Your spouse or common-law partner if they do not personally have access to group insurance.
• Your children under 18*, and your partner’s, who do not have their own group insurance or who are not covered by another parent’s private group scheme.
• Your children under 26, and your partner’s, considered to be full-time students for whom you would exercise parental authority if they were minors, who do not have their own group insurance or who are not covered by another parent’s private group scheme.

Your scheme probably provides for a more advantageous clause regarding the age limit for insuring your dependent children. Please refer to your booklet as needed.

Yes, as per the Quebec Act respecting prescription drug insurance, you are responsible for subscribing on your certificate the eligible members of your family as well as unsubscribing them from RAMQ.
Please not that if you fail to insure your family members who are eligible to your group insurance and to unsubscribe them from RAMQ, you could eventually have to reimburse amounts paid by RAMQ while you were also insured with your group insurer. As per the terms of your contract and based on the date of expenses, these prescription drugs could no longer be eligible for reimbursement by the group insurance.
Below is a list of your family members who must be registered with your private group scheme if they are eligible:

• Your spouse or common-law partner if they do not personally have access to group insurance.
• Your children under 18*, and your partner’s, who do not have their own group insurance or who are not covered by another parent’s private group scheme.
• Your children under 26, and your partner’s, considered to be full-time students for whom you would exercise parental authority if they were minors, who do not have their own group insurance or who are not covered by another parent’s private group scheme.

*Your scheme probably provides for a more advantageous clause regarding the age limit for insuring your dependent children. Please refer to your booklet as needed.

To change personal information, click on the icon to open a secured session.

If you face difficulties, talk to your scheme administrator or human resources department.

Click on the icon to open the form to change beneficiary.

* Ensure a witness signs documents to reduce treatment delays.

• Beneficiary
  Person designated to receive benefits from your life insurance policy. If no beneficiary has been selected, benefits will be paid to your estate.
• Subrogated Beneficiary
  If more than one person is entitled to benefits, you can designate primary beneficiaries or subrogated beneficiaries (also called contingent beneficiaries). Subrogated beneficiaries will receive payments only if primary beneficiaries are not eligible for payment.
• Irrevocable Beneficiary
  Beneficiary that must provide a written consent to change beneficiary or to modify insurance Policy.
• Revocable Beneficiary
  Beneficiary that can be changed at all time.

Travel Assistance and Trip Cancellation option covers medical needs due to an accident or a sudden illness while traveling abroad or in another Canadian province.

Look at your insurance certificate to see if this service applies to your Policy.

You can consult your personalized group insurance certificate to know all services and restrictions applicable.

You can also get more information from your scheme administrator.

• Travel Insurance
  An insurance allowing to cover certain unexpected fees while traveling abroad or in another Canadian province, including hospital, emergency medical care or trip cancellation.

If you are a Quebec resident, you will receive a letter from UL Mutual a month ahead of your 65th anniversary concerning your choice for insurance medication coverage.

For more information, consult the RAMQ fact sheet for the persons older than 65 years old, by clicking here.

Both your partner and you are covered with a group insurance? You can possibly benefit from payment coordination. In this case, if current scheme does not cover the entire fees that you have paid for, you can submit parts of the non-covered fees to your partner’s scheme. This way, fees, yours or your children’s one, can be refunded up to 100%.

Consult our group insurance certificate to learn about services and restrictions applicable.

You can also contact your scheme administrator for more information.

To fill an online claim:

Click on the icon to open an online session.

To make a postal claim:

Click on the icon to open the Medical and Paramedical Fee Form

To make an online claim:

To accelerate treatment, consult your insurance policy certificate to know if your claim demand is eligible

If your policy states that a prescription is necessary to be eligible for medical service, do not forget to attach it to your claim. Do not forget to ensure that your paramedical service receipts mention the professional license number. Without a license, the claim will not be eligible for refund.

Once completed, make sure that original receipts are included.

Mail all documents to:

P.O. Box 696, Drummondville, Quebec J2B 6W9

Your group insurance scheme provides for the reimbursement of prescription drugs directly at the pharmacy when you make your purchase. Simply show your pharmacist your insurance card where your group and certificate numbers are indicated. He will then transfer us the details of your request.

In the event that you forget to show your card to your pharmacist or if a prescription drug can’t be reimbursed directly at the pharmacy because it requires prior authorization, you must fill a claim the same way you would for a medical claim (see previous question).

If your group insurance scheme includes a direct card or deferred card for in your policy, you do not have to fill a claim.

If your group insurance does not include a direct card or a deferred card, you must fill the Dental Fee Claim Form.

Click on the icon to open the Dental Fee Claim Form

If your group insurance scheme includes disability coverage, you must fill the following forms:

Click on the icon to open the Disability form – Employer

• Inform your employer of your leave

Click on the icon to open the Disability form – Employees

Physician’s Disability Form / Initial Demand

• Ensure that your physician write a clear diagnosis (pain or tiredness are symptoms and are not a diagnosis). The physician must explain how your current medical condition prevents you from working. Your physician must also list necessary treatments (surgery, drugs, physiotherapy, etc.)

To submit your application:

• Applications for disability benefits can now be submitted online through our secure portal by clicking here.

A new button: Application for Disability Benefits is now available in the main menu. Once on the secure site, disability information booklets will be available to guide you through the process. You can also request these booklets from your employer.

• By fax: 819 474-1990
• By mail: P.O. Box 696, Drummondville, Quebec J2B 6W9

We will contact you if information misses or if more details need to be provided about your condition.

Consult our explanatory document to obtain your access to the secured website.

You can preview and print your card at any time by clicking on the following icon:

Example: A policy states that a deductible must paid on prescription drugs only.

No deductible will be paid on other medical or paramedical fees. The opposite case could apply. Your policy might indicate that a combined deductible might be payable for all medical and paramedical fees, as well as prescription drugs.

If there is a 75$ combined deductible:

*In this example, the combined deductible on other medical and paramedical fees, as well as on prescription drugs, applies.

• Partial Deductible
  Fees that are paid annually and entirely before claims are acceptable. Civil year is used as reference (from January to December).

Contrarily to a deductible, copayment (also called deterrent fee) must be paid before each purchase of prescription drug. In some cases, your physician might recommend you more than one drug on the same prescription or prescribe a renewable medication for a long period of time (ex: 12 times). In spite of that, you will pay a deterrent fee (copayment) at each transaction at the pharmacy, and for every prescribed drug.

However, since most prescription drugs can be renewed for a 90-day period, you can ask your pharmacist to give you the equivalent of three months when possible. This will save you the cost of two copayments out of three.

You can renew most of your prescription drugs for up to 90 days. Depending on your situation, this could be beneficial for you. Indeed, if your medical condition doesn’t require frequent visits to your pharmacist, you could go only once every three (3) months instead of every month. In addition, if your purchase of prescription drugs requires a copayment, you could save the cost of two (2) copayments over a three (3) month period. Talk to your pharmacist! time I go to the pharmacist?

Your contract provides for the reimbursement of a percentage of the prescription drugs depending on their nature. Many contracts also provide for the reimbursement of prescription drugs based on the cost of the least expensive generic or biosimilar drug.  Here is what these terms mean:

When any new therapeutic molecule is marketed by a pharmaceutical company, it is a “single source drug”. It is the only drug available in this format and this formula on the market. This drug is usually patented to allow some time for the pharmaceutical company to recover development costs.

When a drug patent has expired, other pharmaceutical companies can then produce and market that same molecule. The drugs that have the same active molecule as the original drug are called “generic drugs”.  The drug that used to be but is no longer a single source is now referred to as “innovator drug”. Competition then reduces the cost of the drug and the generic versions often become much cheaper than the innovative drug.

“Biosimilars” are considered as generics for drugs called biologics. A biologic drug is produced from living organisms or cells, using biotechnology.

To reduce the costs of a drug insurance scheme and hence the premium to be paid, several contracts are set up to encourage the insureds to get the generic or biosimilar version of a prescription drug. This incentive can take different forms, e.g. by giving a higher percentage of reimbursement for generic drugs or by reimbursing the drug based on the cost of the cheapest generic equivalent drug. The insureds can get the drug of their choice, but if they choose the innovator drug, they will have to pay a larger part of the drug. In that respect, if you choose to get the innovator drug while your contract reimburses the cost of the cheapest generic equivalent drug, you will be reimbursed for your innovator drug at the percentage provided for innovator drugs, but that percentage will be applied to the eligible amount equal to the cost of the generic drug.

If your insurance policy changes, contact your scheme administrator or your human resources department to learn when your new policy is in force. Your claim must be sent to the new insurer only if fees have been paid after the policy is in effect. If not, the former insurer must handle claims.

Your group insurance ends your last working day. Ask your scheme administrator or your human resources specialist about conversion privilege.

• Conversion privilege

Privilege for a policy subscriber to change policy without a health statement.

Your group insurance ends at the date agreed between the new scheme and UL Mutual. You can confirm that date with your insurance scheme administrator or your human resources department. If you want to retain your current insurance policy, ask your scheme administrator or your human resources department about conversion privilege.

Sources for definitions: http://www.clhia.ca

New procedure to submit your documents

It is now possible for plan administrators to submit documents online, in a totally secure manner, via our portal.

Here are the steps to follow: 

• Go to our secured site, by clicking here and logging in
• Click on Secured deposit documents icon

1. Scan your administrative documents and conserve the originals

2. Please select the appropriate departement

• Administration
• Disability

3. Please complete the following statement

4. Upload your documents

• Click on the Browse button and select one document at a time
• Click on Upload button
• Repeat this step for each scanned document

5. An acknowledgement of receipt will be sent to you by e-mail, confirming we have received the documents that you sent.

If you have any questions, do not hesitate to contact our customer service department at: 1 800 567-0988.

No. The group insurance plan is mandatory, meaning that all eligible employees have an obligation to join it. In addition, a person residing in Quebec cannot adhere to the public drug insurance plan if they have acces to a private plan.

The premium for any given month is payable on the first of the said month.

However, a 30 day grace period is granted to make payments of the premiums due. After this time, all services or benefits paid to your employees by UV Insurance could be suspended, and the contract could even be cancelled.

In order to facilitate the payment of your premiums, UV insurance offers several options :

• By way of automatic debiting of the premiums;
• By way of the internet, via your banking institution’s website;
• At any banking institution’s ATM
• At any banking institution’s counter;
• By way of check.

To ensure the payement of all premiums, the automatic debiting option is preferred. To have acces to the form, click here.

If a Québec resident’s prescription drug insurance coverage is concerned, a correspondence informing the employee of the premiums due must be sent.  The correspondence will specify that a 30 day grace period is granted to receive the reimbursement. Failing to comply within the alloted period will result in the termination of the protections.

If the employee is not a resident of Quebec, you must notify him that his protections will be terminated due to failure of making paiement of the premuims due.

No. The principle of “shopping” for insurance is not allowed, only life events allow for such modifications. The employee can therefore only make changes to his coverage when one of the following event occurs :

• A change in the martial status;
• The birth or adoption of a child;
• The cessation or significant change of a spouse’s coverage.

They can contact their employer, since the amount is deducted directly from the employee’s payroll. They may also get this information from their group’s insurance consultant.