Health Insurance

Health Insurance

 

Basic plans A, B, C, D, the supplementary plans and plans R1, R2 and R3 for retirees all offer health insurance coverage; some also provide dental insurance coverage. Plan Z covers only the purchase of medication.

The expenses described in this section are reimbursable if they are incurred as a result of a medical necessity demonstrated to the satisfaction of the Commission de la construction du Québec (CCQ). They exclude expenses incurred for preventive purposes, except in the specific cases expressly provided for in this section. No benefits are payable beyond the dollar amount usually charged for services rendered or products purchased. When a medical referral is requested, the specific diagnosis must be indicated.

Health insurance coverage varies from plan to plan. The Bulletin MÉDIC Construction for each plan provides a brief description of the coverage offered and the reimbursements that may be made. It should be noted that some plans do not offer all of the insurance coverages described below.

Specific conditions, limitations or exclusions may apply to the reimbursement of certain coverages; for example, expenses are reimbursable up to a reasonable amount based on the severity of the case and current medical practice.

Only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction (Regulation respecting supplemental social benefit plans in the construction industry) has legal value. 

The health insurance coverages include:

  • Hospital Costs
  • Medical reports
  • Authorized Medications
  • Exceptional Medications and Patient Exception
  • Eye Care
  • Paramedical Care
  • Hearing Aids
  • Laboratory Fees
  • Medical Supplies
  • Transportation by Ambulance
  • Services offered by pharmacists

Hospital costs may be reimbursed if the following conditions are satisfied:

  • The facility must be authorized to dispense medical care to injured or sick people (acute phase of sickness).
  • The facility must have an emergency room and an operating suite.
  • The costs must have been incurred in Québec. For hospitalization that occurs outside of Québec, see the section Medical Emergency Abroad.

Exclusions

  • Facilities that specialize in rehabilitation or convalescence
  • Facilities offering only short- or long-term residential care

Reimbursement of costs

The maximum reimbursable is $75 per day. The insured must pay the balance.

Hospitalization costs may be paid using the MÉDIC Construction card or by submitting a claim using the Health and professional care claim form.

Specific conditions, limits, or exclusions other than those mentioned above may apply to reimbursement of certain coverages; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal force.

The fee requested by a physician to fill out a form or medical report is reimbursed up to the maximum amount eligible, depending on the insurance plan, only if the document is required by the Commission.

Here are the only situations for which MÉDIC Construction will reimburse these costs:

  • Medical report filled out for analysis of a salary insurance file including the initial application
  • Medical report filled out for analysis of a file in order to recognize a dependent child’s temporary or permanent disability
  • Medical report filled out for initial or subsequent analysis of a file for an exceptional medication or a patient exception
  • Travel authorization filled out by the attending physician for a person waiting for hospital treatment, surgery, or a graft. This person must send MÉDIC Construction a copy of the authorization BEFORE he or she departs.

In all other cases, the cost of filling out a form or a medical report is not reimbursable.

The Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction du Québec defines reimbursable medications as those obtained by prescription by a professional duly authorized by law to prescribe, supplied by a pharmacist, appearing in the list of medications formulated by the Ministre de la Santé et des Services sociaux du Québec, and either set out in sections 8 and 60 of the Act respecting prescription drug insurance or determined by the CCQ in accordance with terms and conditions set out in the Act.

Biologic and biosimilar drugs

A major change has been made by the Régie de l’assurance maladie du Québec (RAMQ) concerning reference biologic drugs. In general, only biosimilar versions of a reference biologic drug have been reimbursable by the public plan since April 13, 2022.

Since that date, only biosimilar drugs corresponding to reference biologic drugs are reimbursable by the MÉDIC Construction plan, with some exceptions.

For more information on biosimilar drugs and patient support programs, visit quebec.ca/en/health/medications/biosimilar-drugs.

Exceptional Medications and Patient Exception

Certain medications falling under the Exceptional Medications measure or the Patient Exception measure may be reimbursable. However, MÉDIC construction must analyze the claim in order to determine whether the medication cost will be reimbursed. 

To find out more about these measures and the procedures to follow to request an analysis, click on the tab Exceptional Medications and Patient Exception.

Other reimbursable expenses

The Regulation also provides for reimbursement of the following products, if they were prescribed by a professional authorized by law:

  • Sclerosing injections for varicose veins. The eligible amount is limited to $50 per session.
  • For insureds covered under plan E, L, or T, certain medications related to in vitro fertilization treatments. The attending physician must confirm in writing that the patient is undergoing in vitro fertilization treatments. The cost of the treatment itself is not reimbursable.

Pharmacist fees may be covered for professional activities authorized by the relevant legislation and for which the RAMQ reimburses insureds under the public plan. 

Important

When a brand-name drug is purchased for which a generic equivalent is available, the reimbursement amount is calculated using the price of the lowest-priced generic drug.

In addition, the price difference between the brand-name drug and the generic drug will be excluded from the annual family ceiling of $850 and the cost will be borne entirely by the insured.

For example*: 
Impact on the insured of purchasing a brand-name drug versus a generic drug

Drug Price paid  Percentage of reimbursement*  Amount reimbursed by MÉDIC  Amount paid by the insured  Amount added to the annual family cap 
Generic   $60  90%  $54  $6   $6 
Brand-name $150 90% $54 (90% of $60) $96 $6

* Example for a zero-deductible plan with 90% reimbursement.

In this example, the insured pays an additional $90 per month if purchasing the original drug. If the insured were to take this drug every month for a full year, it would amount to an additional annual expense of $1,080. 

An insured who cannot use a generic drug for a medical reason must send MÉDIC Construction a copy of the prescription on which the treating physician has noted “Do not substitute” and the RAMQ code. Subject to the authorization of MÉDIC Construction, the reimbursement will then be reviewed and based on the price of the brand-name drug.  

Exclusions

  • Certain injectables to relieve osteoarthritis pain (e.g. Synvisc or Monovisc), as well as lancets for capillary blood sampling in cases of diabetes, are not treated like drugs that can be reimbursed directly at the pharmacy with the MÉDIC Construction card. However, under certain conditions, they may be considered reimbursable medical supplies. In the case of injectables to relieve osteoarthritis pain, both a medical recommendation and prior authorization from the CCQ are required. For this purpose, the Claim form for medical expenses and professional care must be attached to the cost estimate so that the CCQ can analyze the file. 
  • No over-the-counter product or medication that is not reimbursable by the RAMQ will be reimbursed by MÉDIC Construction, even if prescribed by a health professional.
  • No products or drugs administered or sold for procedures carried out in private clinics are reimbursable (ophthalmology, dermatology, any "-scopy" type procedure, etc.).
  • No expenses associated with services covered by the RAMQ, also known as "incidentals", are reimbursable.
  • No physicians’ fees for cosmetic treatments or the cost of equipment used in injections or applications are reimbursable.
  • No treatments for hormone implants, anorexiants (weight management), or products related to hair loss or nicotine dependence are eligible for reimbursement. 

Section 94 of the Regulation respecting supplemental social benefit plans in the construction industry establishes the various exclusions.

Reimbursement of expenses 

The deductible and co-payment to be paid by insureds vary according to the plan under which they are subscribed. This information is given on the MÉDIC Construction card. The Bulletin MÉDIC Construction for each plan also sets out the percentages and amounts that may be reimbursed. The terms and conditions applicable to reimbursement of these expenses are those in effect at the time the drug is required to be taken according to the prescribed dosage.

Authorized drugs purchased in Quebec can be paid for with the MÉDIC Construction card. Otherwise, the insured must pay the full purchase price and submit a claim through the MÉDIC Construction app, via MÉDIC Online, or by mail by filling out the Claim form for medical expenses and professional care. This form must also be used to submit claims for the reimbursement of drugs purchased outside Quebec.

It is important to note that specific conditions, limitations, or exclusions in addition to those mentioned above may apply to the reimbursement of certain coverages; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal force.

To obtain a payment authorization request for an exceptional medication or in the case of a patient exception, the healthcare professional must fill out the required form. The list of available forms is categorized by medication and medical diagnosis. Visit the section "How to submit a claim" for more information.

An exceptional medication, whether or not it is codified on the RAMQ list, may be reimbursable if it is prescribed under the conditions and for the therapeutic indications determined by regulation by the Ministre de la Santé et des Services sociaux.

The patient exception measure allows for a medication to be reimbursable if it meets certain criteria, even if it does not figure on the RAMQ list of medications or, when it is an exceptional medication, if it is prescribed for a different therapeutic indication than those given in the RAMQ’s list.

In every case, MÉDIC Construction must conduct an analysis of the file based on the information provided on the patient’s medical condition. Note that the processing time for a claim may be up to 45 days.

Important

Depending on your medical condition and the therapeutic indications described by your physician, your claim may be accepted or rejected. MÉDIC Construction will inform you of the result by letter.

In addition, because MÉDIC Construction follows the RAMQ protocols, if your claim is accepted, the acceptance period will be given in the letter. This means that before the expiry date given, you must have the form filled out again by your physician, if applicable. Note that in compliance with RAMQ protocol, for your first claim, the maximum acceptance period is usually 6 months. 

Exclusions to the Patient Exception measure

All claims for any of the following medical conditions will be rejected:

  • Infertility treatments
  • Aesthetic or cosmetic treatments
  • Hair-loss and baldness treatments 
  • Treatments for erectile dysfunction
  • Obesity treatments
  • Treatment for emaciation (cachexia) or to stimulate the appetite
  • Oxygen
  • Diabetes sensors (Dexcom, Freestyle Libre)

The attending physician must therefore fill out the form required according to the payment authorization claim. Consult the list of forms available categorized by medication and medical diagnosis. The principal insured must add his or her client number to the claim before submitting it to MÉDIC Construction. 

If it is a claim for a codified medication, a prescription on which the code is identified may suffice.

How to send a claim

  1. Find the appropriate form (list of forms).
  2. Have the form filled out, making sure that your CCQ client number is given on it. You have 3 options:
     
    • Send your CCQ client number to your physician, who will then be able to fill out the form completely online.
    • If you can send an email to your physician, download the form, fill out the identification section, and send the form to your physician, who will be able to fill out and sign the form. 
    • You can also print out the form and fill it out by hand.
  3. Send the form, filled out and signed by your physician, to MÉDIC Construction. You have 3 options:

    • You can upload your form to MÉDIC Online under "medications" or submit it via your CCQ online services.
    • Your physician can send it by fax to 514 341-4451 or upload it to the CCQ’s website.
    • The form may be sent by mail to MÉDIC Construction, C. P. 2212, succursale Chabanel, Montréal (Québec) H2N 0B8. Delays are likely.

An Eye exam, including supplies and procedures required for this exam, and the following products prescribed by an optometrist or an ophthalmologist, may be reimbursed:

  • Corrective glasses
  • Prescription contact lenses
  • Prescription disposable lenses
  • Frames
  • Prescription sunglasses (corrective glasses)
  • Intraocular lenses (for cataracts) excluding costs of surgery (see paragraph Surgical Vision Correction)
  • Prescription half-frame eyeglasses
  • Prescription reading glasses
  • Fresnel lenses
  • Prescription safety eyeglasses

Among the non-refundable items are:

  • All glasses not prescribed or adjusted to the vision (sunglasses, reading glasses, safety glasses, etc.)
  • Products or solutions related to the use of lenses
  • Clip-on sunglass lenses
  • Magnifying lamp
  • Photophobia glasses

Limitations to reimbursement

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts. It is important to check the plan under which the insured is covered, as some insurance plans do not offer eye-care coverage.

Important:

Since April 1, 2023, a new RAMQ program has offered a $300 reimbursement every 24 months for purchases of corrective glasses and contact lenses for children under 18 years of age. Therefore, MÉDIC Construction reimburses the amount in excess of $300 up to the eligible reimbursement limit under the insured’s insurance plan. The insured must first claim these costs from RAMQ and then submit to MÉDIC Construction the excess costs with the RAMQ payment statement. The RAMQ statement and the purchase invoice must be submitted to MÉDIC Construction, even if the amount is reimbursed in full by RAMQ. Without these documents, $300 will be automatically deducted from the next refund claim. 

For an eye exam, the maximum reimbursement is calculated based on a period of 24 consecutive months for insured workers and their spouse, and on a period of 12 consecutive months for dependent children. These periods start on the date on which the exam is paid in full (see example below).

Only insured workers may be reimbursed for the purchase of safety glasses. The maximum reimbursement is calculated on a period of 12 consecutive months from the date of purchase. The date of purchase is the date of the invoice indicating that final payment was made – that is, that the balance to pay is $0.

For the reimbursement of other eligible costs (glasses, contact lenses, prisms, etc.), the maximum reimbursement is calculated on a fixed period of 24 months. This period starts from the date of first purchase. The date of purchase is the date of the invoice indicating that the final payment has been made – that is, that the balance to pay is $0.

The example below illustrates how the calculation is done.

Mr. Jones purchases glasses and pays the $300 bill in full on February 15, 2024. During the January to June 2024 insurance period, his insurance plan covers $400 per 24-month period for the purchase of glasses and $70 per 24-month period for eye exams. The table below shows the costs claimed by Mr. Jones and the reimbursements that he obtained.

Date of purchase  Eye care  Cost claimed  Reimbursement obtained 
February 22, 2022 Purchase of glasses  $250  $250 
January 29, 2023 Eye exam  $70  $70 
February 3, 2024 Eye exam  $70 No reimbursement
February 15, 2024 Purchase of glasses  $300 $150

Why is the claim for the eye exam performed on February 3, 2024, not reimbursable, and why is the purchase of eyeglasses made on February 15, 2024, not reimbursable in full? 

Reimbursement for the cost of Mr. Jones’s eye exams and eyeglass purchases is now based on a 24-month period. For the February 3, 2024, eye exam, no reimbursement is possible because 24 months have not passed since the last exam. As for the eyeglasses purchases, because Mr. Jones already received a $250 reimbursement (for the purchase he made on February 22, 2022), only $150 is available to him to reach the $400 maximum allowed for this period ($400 – $250 = $150).

To obtain a better reimbursement, Mr. Jones should have waited until February 23, 2024 to purchase his glasses. In this case, the 24-month period would have gone from February 23, 2022, to February 23, 2024. Because Mr. Jones had not made any claim for reimbursement of glasses during this period, $400 would have been available to reimburse his purchase. Mr. Jones would therefore have received full reimbursement for his $300 purchase, instead of only $150.

On the other hand, Mr. Jones would have had to wait until January 30, 2025, to receive a reimbursement for an eye exam.

Vision correction surgery

Some plans provide specific lifetime reimbursements of the cost of vision correction surgery, whether performed by laser or by incision. However, these amounts exclude the cost of intraocular lenses, which is reimbursable under your plan’s eyeglasses and contact lenses coverage. This information can be found in the Bulletin MÉDIC Construction.

Reimbursement of costs

There are four ways to make a claim for eye care:

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will have to pay only the balance exceeding the reimbursable amount. 
  • Insureds may submit their claims through the MÉDIC Construction app.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires 
d’avantages sociaux dans l’industrie de la construction
has legal value.

Paramedical care involves the treatments received from certain health and alternative-medicine professionals.

It is important to note that some insurance plans do not offer this coverage; others offer coverage to the insured only (not to dependents).

Health professionals

The health professional must be a member of a professional order recognized by the government of Québec. Treatments by the following health professionals may be reimbursed:

  • Acupuncturists
  • Audiologists
  • Chiropractors (including x-rays)
  • Speech therapists
  • Physiotherapists 
  • Podiatrists
  • Psychologists
  • Psychotherapists holding a permit from the l’Ordre des psychologues du Québec (starting July 1st, 2023)
  • Social workers

It should be noted that remedial education and occupational therapy treatments for dependent children younger than 18 years are covered by assistance to workers services in the CONSTRUIRE en santé program of MÉDIC Construction.

The supplementary plan for electricians  and the supplementary plan for pipefitters cover treatments received from an occupational therapist.

Fees paid to a health professional are reimbursable only if the health professional is a member in good standing of the appropriate professional order or, if no order exists, of a professional association recognized by the Commission.

Furthermore, the services rendered by the professional must fall within the scope of his or her professional competence, and the professional must comply with all standards provided for by his or her association, its code of ethics and any relevant legislation.

No reimbursement will be made for expenses incurred with a health professional who the Commission is able to demonstrate is in violation of the law or acting fraudulently, in particular by issuing documents or invoices containing false information or that do not accurately represent the items, care or services obtained.

The Bulletin MÉDIC Construction for each plan indicates the amounts that may be reimbursed.

Limitations to reimbursement for professional care

  • Only one treatment per day per category of professional may be reimbursed. For example, an insured who receives two physiotherapy treatments in a single day will be reimbursed for only one.
  • Psychologist, social worker: Only one treatment is reimbursable for all treatments received in the same day from these professionals.
  • Costs incurred for any sort of assessment (neuropsychological, cognitive, learning or intellectual capacities, educational assessment or exemption test) are not reimbursable by the Construire en santé program or by MÉDIC Construction. When the assessment is performed by a psychologist or a neuropsychologist who is a member of the Ordre des psychologues, it is reimbursable. However, the reimbursement is limited to the amount allocated by the worker’s plan for one session with a psychologist. Exclusion: A psychosocial assessment made to obtain a report for adoption of a child is not reimbursable, regardless of the practitioner who performs the assessment.

Alternative-medicine professionals

Alternative-medicine professionals must be members of an organization recognized by MÉDIC Construction. Treatments by the following health professionals may be reimbursed:

  • Naturopaths 
  • Osteopaths 
  • Massage therapists 
  • Kinesiologists 
  • Kinotherapists 
  • Orthotherapists

The Bulletins MÉDIC Construction indicate the amounts that may be reimbursed for each plan. 

Limitations on reimbursement for alternative-medicine treatments

  • Massage therapist, kinesiologist, kinotherapist, orthotherapist, osteopath, naturopath:
    • One treatment per day per category of professional is reimbursable. For example, if an insured person receives two osteopathy treatments in one day, only one may be reimbursed.
    • A limit of 10 treatments per person per insurance period is applied for all treatments given by these 6 types of professionals. For example, during a single insurance period an insured person may have 4 treatments with a massage therapist, 2 with a naturopath, and 4 with an osteopath; the maximum number of 10 reimbursable treatments has now been reached. The other limitations and conditions regarding reimbursement of these treatments continue to apply.
  • Massage therapist, kinesiologist, kinotherapist, and orthotherapist:
    • A medical referral with specific diagnosis from the attending physician must be provided for treatments received from each of these professionals. This referral is valid for 12 months starting from the date of the physician’s signature. If treatments continue beyond these twelve months, a new referral must be provided.

Exclusions

Treatments received from the following professionals are not reimbursable: dermatologist, dietician, homeopath, respiratory therapist, general practitioner, medical specialist, pediatrician, physiatrist, posturologist, psychoanalyst, psychotherapist, somatotherapist, sports therapist. Other exclusions may apply

Reimbursement of costs

There are four ways to make a claim for paramedical care:

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will only have to pay the balance exceeding the reimbursable amount.
  • Insureds may submit their claims with the MÉDIC Construction application.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care.

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

In addition to hearing aids, all accessories and repair costs involved are reimbursable (earpiece, tube, mould, etc.). The batteries are also reimbursable up to a maximum of $50 per person per period of 12 consecutive months; a proof of purchase of the hearing aid must be supplied.

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Limitation to reimbursement

For hearing aids, the maximum amount reimbursable is calculated over a period of 36 consecutive months. The period considered corresponds to the 36 months preceding the date of purchase. The date of purchase is the date of the invoice indicating that the final payment has been made – that is, that the balance to pay is $0. The example given for the limitation of reimbursement for eye care illustrates, adjusting the period to 36 months and the maximum reimbursable, how the reimbursement is calculated. 

Reimbursement of costs

A claim for hearing aids must be made using the Health and Professional Care Claim Form.

Specific conditions, limitations, and exclusions other than those mentioned above may apply; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal standing.

Diagnostic imaging tests (X-ray, scan, ultrasound) are included among the reimbursable laboratory fees. Reimbursable laboratory and medical imaging costs are those incurred for tests carried out by laboratory or radiology professionals on medical recommendation and used for the purpose of diagnosis. 

Exclusions

The following items are among those not reimbursed by MÉDIC Construction:

  • Medical check-ups, membership fees, and consultations in private clinics
  • “Scope”-type tests or treatments (gastroscopy, colonoscopy, arthroscopy, etc.)
  • Cost of materials used for biopsies
  • Professional fees charged for blood sample collection are not reimbursable.
  • Ovulation or pregnancy tests purchased in a pharmacy
  • Test requested by a third party (an employer, SAAQ, CNESST, another insurance company)
  • Holo-energetic test
  • Test done in sexo-physiological analysis laboratories (DNA test, LAPS, etc.)
  • Infertility and impotence treatments

    The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Limitations on reimbursement

The insured must provide a receipt mentioning the lab tests done and the reason for these tests. 

For laboratory fees, the maximum reimbursement is calculated based on a period of 12 consecutive months. The period considered corresponds to the 12 months preceding the date of purchase. The date of purchase is the date of the invoice indicating that the final payment has been made – that is, that the balance to pay is $0. The example given for the limitation of reimbursement for eye care illustrates, adjusting for the maximum reimbursable, how the reimbursement is calculated per 12-month period.

Reimbursement of costs

There are four ways to make a claim for laboratory fees.

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will have to pay only the balance exceeding the reimbursable amount. 
  • Insureds may submit their claims through the MÉDIC Construction app.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care

Specific conditions, limitations and exclusions other than those mentioned above may apply to the reimbursement of certain expenses; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

**IMPORTANT**

For the purchase or rental of any therapeutic apparatus, supplies, or equipment, the insured must send a medical referral with a specific diagnosis. In the case of a rental, the prescription must also specify the duration of the rental.

In all cases, an estimate of costs is required so that the CCQ can determine whether the costs are reimbursable.

To obtain a reimbursement, you must send a receipt indicating that the payment has been made in full (balance to be paid $0) to MÉDIC Construction. The percentage of reimbursement allocated to you depends on the insurance plan under which you are covered at the time when the purchase is completed.

The following items may be reimbursable when the required supporting documents are supplied to MÉDIC Construction.

  • Shoe adjustment (correction made to a shoe to modify a foot anomaly) 
    MÉDIC Construction reimburses a maximum of six adjustments per insurance period; the maximum allowable per adjustment is $30.
  • Traction device (to stretch the neck) and rigid or semi-rigid cervical collar 
    If these items are required following an automobile accident or a work-related accident, the reimbursement must be claimed from the Société de l'assurance automobile du Québec (SAAQ) or the Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST) and not from MÉDIC Construction.
  • Blood-pressure device (sphygmomanometer) 
    The maximum eligible for reimbursement is $100 per family per 60 month period. The example given for the limitation on reimbursement for eye care illustrates, adjusting the period to 60 months, how the reimbursement is calculated.
  • Anti-enuresis apparatus (Ledoux Réflexe or Méthode Urino-arrêt incontinence warning device)
  • Orthopedic apparatus: orthosis for forearm (“tennis elbow”), ankle (anklet, ankle-foot), elbow, corset (black belt, white belt), finger (Murphy ring), shoulder (brachial harness), knee (patellar orthotic, OrthopreneTM, knee pad, LP support), wrist (epicondylar bracelet), back (lumbar support, lumbar belt, abdominal belt), body (immobilizer, splints) 
    Document to provide: the receipt must indicate the type of orthotic (rigid, semi-rigid, flexible). Exclusions: sport orthotics, accessories for workplace comfort.
  • Respiratory apparatus for the treatment of certain diseases (examples for an adult: asthma, emphysema, cystic fibrosis, COPD; for a child, sleep apnea) 
    The insured must provide a complete medical file (including a medical referral with precise diagnosis and duration of treatment) to MÉDIC Construction to obtain authorization to rent or purchase the apparatus.
  • TENS apparatus 
    The maximum eligible is $65 per month for the rental and $500 for the purchase of a TENS apparatus. Certain accessories related to the use of the TENS apparatus may be reimbursed (e.g., electrode gel, electrodes).
  • Hernial band (inguinal belt, inguinal support) 
  • Support or bath bar 
    Maximum eligible is $200 per 12-month period for purchase and installation. The example given for the limitation on reimbursement for eye care illustrates, adjusting the period to 12 months, how the reimbursement is calculated. 
  • Compression stockings (Airway, Delilah, Futuro, Jobst, Parke Davis, Profore, Segretta, Sigvaris, Valcofit, Varisma, Venosan) 
    A maximum of four pairs per 12-month period are reimbursable. The period considered corresponds to the 12 months preceding the date of purchase (counting the days).
  • Crutches, cane (purchase or rental as applicable) 
    Document to provide: the medical referral must indicate the duration of need for the crutches or cane and a description of the circumstances requiring their use. The maximum reimbursement varies depending on the insurance plan but does not exceed $30 per event. Ice studs, rubber tips, and underarm pads are reimbursable.
  • Medical alert bracelet for allergies, diabetes, epilepsy, hypoglycemia, and cardiovascular diseases 
    The maximum eligible is $30 per person per 24-month period. The period considered corresponds to the 24 months preceding the date of purchase (counting the days).
  • Cane – see “Crutches
  • Orthopedic shoes 
    The purchase of custom-made orthopedic shoes, upon presentation of all documentation required by the CCQ and under the following conditions:
    • Prior authorization by the CCQ
    • Shoes made by a legally authorized professional and obtained from a laboratory recognized by the CCQ
    • Shoes made from a foot mould of the person concerned, following a medical diagnosis and taking into account a structural malformation that cannot be corrected by another type of orthopedic shoes.
    Document to provide: medical referral (renewable each year) by a physician or a podiatrist must indicate the reason for wearing this type of shoe exclusively. A $150 deductible for insureds and their spouse and a $100 deductible for dependent children is applicable to the purchase of each pair of orthopedic shoes. In addition, a maximum of two pairs per 12-month period may be reimbursable. The period considered corresponds to 12 months preceding the date of purchase (counting the days).
  • Wheelchair 
    Document to provide: the medical referral must indicate the duration the wheelchair is needed and, in the case of an accident, the date, place and circumstances of the incident. The maximum reimbursement varies depending on the insurance plan but may not exceed $2,000 per 12 months for all rental, purchase, repair and maintenance costs. In addition, rental fees are limited to a maximum of $150 per month. The period considered corresponds to the 12 months preceding the date of the purchase.
  • Supplies for incontinence 
    Certain supplies for incontinence may be reimbursed in the case of paraplegia or quadriplegia. In the other cases, MÉDIC Construction will study the file in order to determine eligibility.
  • Supplies for ostomies (colostomy, ileostomy, urostomy) 
    Document to provide: the medical referral must indicate the date of surgery. In the case of a temporary ostomy, MÉDIC Construction must know the planned date for the next surgery. In the case of a permanent ostomy, the Régie de l'assurance maladie du Québec (RAMQ) defrays part of the expenses and MÉDIC Construction reimburses the balance. To obtain this reimbursement, the accumulated receipts that you send to MÉDIC Construction must have a value higher than the amount reimbursed by the RAMQ.
  • Supplies related to treatment of diabetes 
    Upon medical referral, MÉDIC Construction will study the file in order to determine the amount to be reimbursed to patients with diabetes or who are insulin-dependent. Certain supplies (e.g., needle, syringe, lancet, test strips) may be reimbursed. Certain types of equipment are not reimbursable (e.g., hypo alarm, data manager).
  • Hospital bed 
    Document to provide: the medical referral must indicate duration of need for the hospital bed and, in the case of an accident, the date, location and circumstances of the incident. MÉDIC Construction will study the file to determine the amount to be reimbursed for the rental or purchase. The mattress and pillows may, under certain conditions, be reimbursable. The maximum reimbursement varies depending on the insurance plan but may not exceed $2,000 per 12 month period for all costs related to rental fees, the purchase of the bed, the purchase of the mattress, repairs and maintenance. In addition, rental fees are limited to a maximum of $150 per month. The period considered corresponds to the 12 months preceding the purchase date.
  • Walker 
    Document to provide: the medical referral must indicate the duration of need for the walker and a description of the circumstances requiring its use. Certain accessories (e.g., walker skis) may be reimbursed. The cost of a walker for a handicapped child is usually reimbursed by the RAMQ; MÉDIC Construction will not pay the balance of the cost if the RAMQ reimburses only a part of the cost.
  • Orthotics: see “Orthopedic apparatus
  • Podiatric orthotic (moulded orthopedic device designed to immobilize part of the foot to correct a malformation; this device is made by an orthotist or podiatrist) 
    Document to provide: a medical referral, which must be written by a physician or podiatrist and must be renewed every 12 months. For dependent children, one pair per 12-month period is reimbursable. For the insured or his or her spouse, two pairs per 36-month period are reimbursable. The period considered corresponds to the 12 or 36 months preceding the date of purchase (counting the days), respectively. The maximum reimbursement varies depending on the insurance plan but does not exceed $350 per pair. The cost of repairing an orthotic is reimbursable.
  • Fibreglass cast
    Document to provide: the medical referral must provide a description of the accident (date, location, circumstances). MÉDIC Construction will study the file to determine whether the cost of the cast is reimbursable.
  • Injectable products for arthritis
    Certain injectable products for relieving arthritis pain (e.g., Synvisc, Monovisc) may be reimbursable with a medical referral. Prior authorization by MÉDIC Construction is required.
  • Breast prosthesis (women only)
    Document to provide: the medical referral must indicate whether it is a total or partial prosthesis and the date of surgery. The amount reimbursed by MÉDIC Construction depends on the reimbursement paid by RAMQ. In the case of a total prosthesis, the reimbursement is limited to one prosthesis per breast per 24-month period; the period considered corresponds to the 24 months preceding the date of purchase (counting the days). Maillot breast prostheses and bras are not reimbursable.
  • Ocular prosthesis 
    The amount reimbursed by MÉDIC Construction depends on the reimbursement made by RAMQ. MÉDIC Construction reimburses the cost of polishing the ocular prosthesis after the amount paid by RAMQ is deducted.
  • IUD 
    The maximum eligible amount is $75. Contraceptive implants (e.g., Norplant) are reimbursable (but the cost of injection is not).

Exclusions

The following items are among those that are not reimbursed by MÉDIC Construction: 

  • ErecAid® device
  • Respiratory apparatuses such as hyperbaric chambers, air purifiers, and domestic humidifiers, as well as maintenance contracts for respiratory apparatuses
  • Pulse oximeter
  • Hairpiece
  • Penile implant
  • SpineCor® brace

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Reimbursement of costs

There are four ways to make a claim for medical supplies:

  • If the professional is registered with the providerConnectTM program, the fees may be paid directly with the MÉDIC Construction card. The insured will have to pay only the balance exceeding the reimbursable amount. 
  • Insureds may submit their claims through the MÉDIC Construction app.
  • Insureds may submit their claims through MÉDIC online at sel.ccq.org.
  • Insureds may send their claims by mail using the Claim form for medical expenses and professional care

Specific conditions, limitations and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

Ambulance transportation costs are reimbursable when it is an emergency (that is, following a sudden and unpredictable event) or when recommended by a physician. The transportation must be to the closest hospital. In certain emergency situations, the cost of transportation by air ambulance may be reimbursed; an attestation by a physician indicating that this mode of transportation is medically necessary and that no other mode of transportation can be used is required.

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts.

Adapted transport

The cost of adapted transport between home and the hospital (or clinic) is reimbursable upon referral by a physician confirming that another means of transport cannot be used.

Exclusions

  • MÉDIC Construction does not reimburse the cost of transportation between hospitals. If the transfer is authorized by the hospital with confirmation by the attending physician, the transportation costs are paid by the hospital. If the hospital does not authorize the transportation, the cost must be paid by the insured.
  • MÉDIC Construction does not reimburse the cost of taxis.

Reimbursement of expenditures

The form Déclaration de transport des usagers must be provided to MÉDIC Construction to obtain reimbursement for expenses incurred. If the worker cannot present this form, he or she must provide the following information about the transport: date and time of pick-up, destination, costs and reason for transportation.

A claim for emergency transport costs must be made through the MÉDIC Construction application, by using MÉDIC online at sel.ccq.org, or by sending the Claim form for medical expenses and professional care by mail.

Specific conditions, limitations and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d’avantages sociaux dans l’industrie de la construction has legal value.

Since the Act to Amend the Pharmacy Act came into effect, on June 20, 2015, pharmacists have been authorized to practise new activities that had previously been reserved for doctors.

MÉDIC construction reimburses costs related to these new services that your pharmacist may offer at the same percentage as it reimburses your prescription drugs. The MÉDIC construction card may be used to pay these costs directly.

  • Application for reimbursement

    The sections of the Commission de la construction du Québec (CCQ) site dealing with different insurance coverage explain how medical expenditures incurred may be paid. Applications for reimbursement must be sent to MÉDIC Construction within one year after the date on which the medical expenditure was made. If the expenditure is high, it is suggested that you ask MÉDIC Construction for an estimate of reimbursement before making the purchase. This enables you to know the amount that you will have to pay as an insured.

    A worker who feels that he or she has the right to a reimbursement different from that granted by MÉDIC Construction may make a complaint about this decision. To do this, he or she must contact Customer Services, which will send him or her the appropriate form. If the employee has taken this step and is still dissatisfied with the CCQ’s decision, the Act Respecting Labour Relations, Vocational Training and Workforce Management in the Construction Industry allows him or her to ask for a review. The CCQ’s Customer Services can guide the employee with this process and supply the appropriate form.

  • Additional details

    Coordinated insurance

    When the spouse of a worker or retiree insured under MÉDIC Construction is covered by another group insurance plan, it is possible for the other insurer concerned and MÉDIC Construction to share the reimbursement of claims. This is called coordinated insurance. It is legal and advantageous to make a claim to the spouse’s insurer and from MÉDIC Construction for a single expenditure; the amount reimbursed, however, may not surpass the total of the costs incurred.

    For coordinated insurance, MÉDIC Construction requires that all of its insureds produce a Declaration by the Spouse form.

    Following a work-related accident or an occupational disease

    If you are recognized or indemnified by the Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST), including Indemnisation des victimes d’actes criminel (IVAC), you must claim reimbursement for medical care and medications related to your job-related injury or to the harm you have suffered as a result of a criminal act.

    MÉDIC Constrction does not reimburse these costs or coordinate insurance with the CNESST.

    Following an automobile accident

    The reimbursement of medical care and medications related to an automobile accident must be claimed from the Société de l'assurance automobile du Québec (SAAQ).

    MÉDIC Construction does not reimburse these costs or coordinate insurance with the SAAQ.

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