Where can I find information on my group insurance?

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

My prescription drugs were reimbursed by RAMQ, do I need to inform them that I now have group insurance?

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.

Do I have to take family coverage so that my partner and our children are insured?

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.

How can I change personal information?

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.

What is my coverage while travelling?

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.

I will celebrate my 65th anniversary next month, what should I do?

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.

How to benefit from payment coordination?

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.

How to fill a medical or dental fee claim?

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:

UL Mutual Headquarters
142, rue Heriot, Postal Code 696
Drummondville (Quebec) J2B 6W9

How to fill a claim for prescription drugs?

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).

How to fill a claim for dental care?

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

How to fill a Disability claim?

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

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.)

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

I lost my insurance card, what to do?

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

How to calculate refund when a deductible must be paid?

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:

 Service

 Date of fees

 Cost of Service

 Non admissible

 Deductible 75$*

 80%

 Total Insurance Refund

 Chiropractor

 2014-01-05

 50$

 – $

 50$

 – $

 – $

 Prescription Drugs

 2014-02-07

 22$

 – $

 22$

 – $

 – $

 Chiropractor

 2014-02-18

 50$

 – $

 3$

 9,40$

 37,60$

 Chiropractor

 2014-03-05

 50$

 – $

 – $

 10$

 40$

 Prescription Drugs

 2014-06-01

 52$

 – $

 – $

 9,20$

 36,80$

 TOTAL

 224$

 6$

 75$

 28,60$

 114,40$

*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).

What is copayment?

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.

How many prescription drugs can I purchase each time I go to the pharmacist?

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?

What are single source, innovator, generic or biosimilar drugs and what use is this distinction in determining my reimbursement?

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.

My employer subscribed to a new insurance company. To whom should I fill my claim with?

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.

What happens when my employment ends?

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.

What happens if my employer ends the insurance scheme?

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.

What is a health management account?

If your group insurance policy includes a health management account, you dispose of annual extra coverage to spend on care, included or not in basic benefits. You have the freedom to make your own health care choices.

Exemple: If your group insurance policy does not cover dental care, you can ask for a refund for dental treatment through UL Mutual’s health management account.

The health management account is easy to use. It offers you the opportunity to change or adapt your health policy to your needs.

Consult your group insurance certificate to determinate if it is included in your health insurance coverage. In such case, ask your scheme manager or your human resource department for more information.

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