The health insurance plan in Quebec: free and universal
Medical care and hospitalization are free for everyone who has their “health insurance card” (Carte Soleil). They are insured by the universal health insurance and hospitalization insurance plan of Quebec. However, this plan does not cover dental care for people over 10 years of age, nor certain specific treatments (alternative medicine, cosmetic surgery, etc.). Before consulting a doctor or other health specialist, make sure that he participates in the Quebec health insurance plan. If not, you will have to pay for the consultation yourself.
The drug insurance plan
When registering for the RAMQ for the first time, registration for prescription drug insurance is automatic. This insurance is compulsory, but for people with private insurance (for example through their employment or that of their spouse), it is then compulsorily covered by this private plan (you must then inform the RAMQ to unsubscribe from the public system). The drugs are not free but only a small part has to be paid (a contribution), which is capped at CAN$83.83 monthly. In the case of coverage by the public plan,
a premium must be paid (ranging from CAN$0 to CAN$611 according to the 2014-2015 rates) collected during the annual income tax return.
Dental care
Except for certain surgeries performed in hospitals or certain academic institutions, dental treatment is not free. However, children under 10 can obtain free dental care by presenting their health insurance cards. To obtain care from a dentist, go to one of the many private practices or to a university dental clinic that offers treatments at reduced prices. However, these clinics are very busy and it is usually difficult to get an appointment quickly.
Private insurance and those offered by the employer
Many employers offer their employees group insurance (complementary health insurance) which covers certain care not covered by the RAMQ, for example, dental care, the services of a psychologist, acupuncture, massage therapy, etc. Types of care covered and the amounts allocated are very different from one plan to another.
What about complementary health insurance?
The role of the mutual
The basic schemes provide a minimum level of healthcare reimbursement. But Social Security only covers part of the services and medicines. It reimburses a certain percentage of a tariff, known as the “Social Security tariff”, which does not necessarily correspond to that charged by practitioners, pharmacies, and medical establishments.
The supplement to be reimbursed is covered by the Complementary Health Insurance (AMC), more familiarly called “mutuelle”.
The role of the mutual is to cover all or part of the expenses beyond reimbursements from Social Security.
If you were an employee or civil servant when you were working, you automatically had mutual insurance, partly paid for by your employer. Once retired, you are only covered by basic health insurance. You have the right to ask to continue benefiting from it, but you will have to pay a significantly higher contribution.
If you were self-employed, on the other hand, you probably voluntarily subscribed to mutual insurance, which continues to cover you.
Each health insurance company offers different levels of cover. When you retire, your needs are probably different from those you had when you were working. When you retire, it may be a good idea to take stock of your health coverage.
