Health Plus - 59 years and under

Hospitalization and Extended Health Care without prescription drug coverage

Medical and hospital expenses incurred in Quebec and relating to an illness, pregnancy, or injury are covered. Coverage also applies elsewhere in Canada if expenses are incurred due to an emergency. All of these expenses are covered, up to the limits indicated.

With the exception of hospitalization expenses, an annual deductible is applied to eligible expenses before issuing a reimbursement.

For individual coverage, the deductible is $50; for single-parent and family coverage, the deductible is $100.

Hospitalization expenses

Reimbursement at 100%, no deductible, of expenses for semi-private room accommodation:

• in a hospital for short-term medical care, unlimited number of days
• In a public or private convalescent home, or in a rehabilitation centre, combined maximum of 90 days per year
• Compensation of $25 per day of hospitalization, from the 4th day , if you have to stay in a ward due to the unavailability of a private or semi-private room.

The 3-day waiting period applies to any new admission in a hospital.

Medical and paramedical expenses

Reimbursement at 100%, with deductible, of the following expenses:

• $500 per 36-month period for purchase and repair of hearing aids
• $300 for initial purchase of a capillary prosthesis after chemotherapy
• $200 per 36-month period for glasses, contact lenses or soft intraocular lenses following a cataract operation
• $200 per year for orthopedic shoes or podiatric ortheses
• $150 for initial purchase of an internal mammary prosthesis after a mastectomy
• $100 per year for purchase of elastic stockings

Services of health professionals

Reimbursement at 80%, with deductible, of the following expenses, with a maximum of:

• $1,000 for dental care after an accident
• $500 per year for each of the following professionals: acupuncturist, audiologist, audioprosthetist, chiropractor, dietitian, occupational therapist, kinotherapist, massage therapist (with medical recommendation), speech therapist, osteopath, physiotherapist or physical rehabilitation therapist,podiatrist and psychologist; plus $25 per year for X-rays needed for chiropractic treatment
• $50 per 24-month period for eye examination by an optometrist or ophthalmologist
• 20 8-hour shifts per year for home care by a registered nurse
• Ambulance transportation

Purchase and rental expenses

Reimbursement at 80%, with deductible, of the following expenses, with a maximum of:

• $500 per year for purchase or rental of a TENS therapeutic device
• $75 per 24-month period for purchase of an intrauterine device (IUD)
• Purchase cost of syringes, hypodermic needles, and reagent strips needed by diabetics, as well as devices and accessories for ostomy patients
• Rental or purchase of crutches, walkers, canes, casts, trusses, orthopedic braces, and oxygen
• Rental of a respirator, non-motorized wheelchair, and manual hospital bed

Analysis and examination expenses

Reimbursement at 80%, with deductible, of the following expenses, with a maximum of:

• $540 per year of eligible expenses for magnetic resonance imaging
• $300 per year for varicose vein injections
• $200 per year of eligible expenses for CAT scans
• $400 per period of 24 months for polysomnography
• $60 per year for a medical examination to obtain Blue Cross travel insurance
• $50 per year for ultrasound scans performed in a private office
• During pregnancy, medical visits beyond the 10 visits covered by Québec Medicare
• Laboratory tests due to an accident or for the diagnosis or treatment of an illness, like blood test, urine test, throat culture.

Travel coverage

When you travel outside of Quebec, this coverage reimburses expenses and services arising from an emergency due to an accident or a sudden illness.

The maximum reimbursement is $5 million per insured per trip of 14 days or less.

Hospital, medical and paramedical expenses

• Cost of hospitalization
• Physicians' fees
• Nurse's services
• Professional services by a physiotherapist, chiropractor, osteopath or podiatrist, prescribed as part of an emergency treatment, up to a maximum of $300 per profession
• $2,000 per accident for dental care after an accident
• $500 for a dental surgeon's fees for any other emergency treatment
• $100 per hospitalization for hospital-related expenses
• Laboratory tests and X-rays
• Drugs prescribed by a physician, in case of an emergency
• Purchase or rental of crutches, canes, and splints
• Rental of wheelchairs, orthopedic devices, and other medical devices

Subsistence allowance

$3,000 (maximum $300 per day) for accommodation and meals when return must be delayed.

Transportation expenses

• Transportation costs to the nearest medical facility
• Repatriation to Quebec
• Round-trip for a family member or a friend to visit the insured hospitalized outside Quebec
• Baggage return when the insured is repatriated for medical reasons, up to a maximum of $300
• Return of a pet when the insured is repatriated for medical reasons, up to a maximum of $500
• $5,000 for returning a personal or rental vehicle
• $10,000 for preparation and repatriation of the deceased or for cremation or burial at place of death

Medical Follow-up in Canada

When the insured is repatriated in Canada for medical reasons, the following expenses are covered:

• Cost of a semi-private room in a hospital or a rehabilitation centre or a convalescent home up to a maximum of $1,000
• Fees for home nursing care, up to a maximum of $50 per day, maximum 10 days
  Cost for the rental of medical devices such as crutches, standard walkers, canes, up to a maximum of $150
• Cost for transportation by an ambulance or taxi in order to receive medical care up to a maximum of $250

Travel cancellation or interruption

You are covered when an unforeseeable event keeps you from making your trip as planned. The expenses are reimbursed, up to $2,500 per trip and per insured, if:

• A trip is cancelled before departure
• A trip is cancelled after departure
• A trip is interrupted
• Return is delayed

Travel assistance

Telephone service available 24 hours a day, 7 days a week, offering the following services:

• Referral to a physician, hospital or to a lawyer in case of accident
• Follow-up on medical file and settlement of certain formalities
• Coordination for repatriation or transportation of a family member
• Assistance in the event of loss or theft of identity papers and services of an interpreter for emergency calls
• Information on embassies and consulates

With prescription drug coverage (optional)

Extended prescription drug coverage

Reimbursement at 100%, no deductible

This protection covers the part not insured by Quebec Medicare under the Act Respecting Prescription Drug Insurance:

• Maximum monthly deductible established by RAMQ
• Maximum monthly co-insurance percentage established by RAMQ

It also covers reimbursement for certain prescription drugs not on the Quebec Medicare list.

Dental care Insurance (optional)

Dental benefits are subject to a $50 deductible per year, per contract.

For the first complete year, the maximum total reimbursement per insured person is $500. If your contract comes into force during the current year, the maximum will be calculated in proportion to the number of complete months between the effective date of the contract and December 31 of the current year.

For the subsequent years, the maximum reimbursement per insured person is $1000 per year.

This coverage offers you top-quality care without hurting your budget.

Preventive care

These treatments are covered 80%, after deductible:

• Tooth positioners
• Examinations and diagnoses
• X-rays
• Preventive services
• Laboratory tests and examinations

Basic care

These treatments are covered 50%, after deductible

• Extraction of erupted teeth
• Anesthesia
• Oral surgery
• Endodontics (root canal)
• Polishing of fillings
• Temporary dressings
• Periodontics (scaling)
• Removable prosthodontics (adjustments, cleaning)
• Restoration of crowns

Home health care (optional)

This coverage reimburses all costs incurred in Canada after hospitalization when you are unable to perform without assistance at least 2 out of 5 activities of daily living. Activities of daily living are defined as: feeding oneself, getting dressed, using the washroom, moving around, as well as personal care and hygiene.

In the case of a fracture or cancer, prior hospitalization is not required to be covered.

Home care

You may choose our Regular Option or our Extended Option

*The number of days covered is determined according to the duration of hospital stay and expenses must be incurred within a maximum period following discharge from the hospital.

Number of days covered

The number of days covered is based on the duration of the hospital stay. Expenses must be incurred within a maximum benefit period after being discharged from the hospital.