Understanding Health Insurance in Quebec: RAMQ, Group Plans, and Individual Coverage

In Quebec, the Québec health insurance plan (RAMQ) provides basic coverage for essential medical care. However, for a more comprehensive plan, two main options are available: group insurance through an employer or individual health insurance. 

This practical guide will help you understand the differences between group and individual health insurance.

 

1. RAMQ: What Quebec’s Health Insurance Plan Covers 

The Quebec’s Health Insurance Plan provides basic health coverage to all Quebec residents. It includes essential medical services such as: 

• Visits to the doctor
• Basic medical exams and diagnoses 
• Hospital stays 
• Prescription medications (if you’re enrolled in the Public Prescription Drug Insurance Plan)

 

However, for many of us, essential — and sometimes necessary — care isn’t covered by the RAMQ, including: 

• Dental care 
• Mental health services 
• Vision care (optometry) 
• Physiotherapy

 

To access these services, individuals without group coverage through an employer may choose to supplement RAMQ with individual health insurance tailored to their specific needs. 

For more information about the limits of RAMQ coverage, see this article. 

 

2. Group Health Insurance: What’s Covered by Your Employer 

In Quebec, if your employer offers a group insurance plan, you are required to join it, unless you’re already covered under another group plan, such as your spouse’s. 

While coverage can vary depending on the employer, most group plans include: 

• Prescription drugs 
• Dental and vision care 
• Services from a range of health professionals (e.g., physiotherapists, psychologists)

 

Many plans also allow you to add coverage for your spouse and children. 

Important: A group plan offered by your employer cannot be replaced by individual insurance. However, if the coverage doesn’t meet all your needs, you can supplement it with additional individual insurance tailored to your situation. 

 

3. Individual Health Insurance: What’s Covered 

If you don’t have access to a group insurance plan, individual health insurance can be a valuable solution to cover care not included under RAMQ. It’s especially useful for self-employed workers, retirees, or anyone in transition between jobs.

With a plan like Blue Cross Health®, you can customize your coverage based on your needs and budget. Choose the coverage that matters most to you, adjust reimbursement levels, and create a plan that reflects your priorities. 

To be eligible, you must be enrolled in the Québec Health Insurance Plan (RAMQ) and, if you want drug coverage, in the Public Prescription Drug Insurance Plan (RPAM).

Individual insurance can either supplement the basic coverage provided by RAMQ or add to your existing group plan to better match your situation.

 

How Do I Know Which Health Insurance Is Right for Me? 

Choosing the right health insurance starts with understanding what coverage you already have and what you actually need.

Here are a few key questions to help determine whether individual health insurance could be a good fit: 

• Do you have access to group insurance? 
  If yes, you’re required to join it.
• What type of health care services do you regularly use? 
  Consider specific needs like prescription medications, dental care, eye exams and glasses, physiotherapy, or mental health services. 
• Does your current coverage meet your needs?
  If so, you might be well insured. However, if your existing plan falls short, individual health insurance can help fill the gaps and offer more comprehensive support for your everyday health. 

 

Tailored Coverage with Blue Cross Health^® 

At Blue Cross, we understand that every situation is unique and valuable when it comes to health. That’s why we offer health insurance products that are flexible and tailored to grow with you. Whether you are looking for basic coverage or more extensive coverage for your family, we have a solution that suits you.

And because caring for your health goes beyond medical coverage, our health insurance includes wellness programs at no extra cost to support your physical and emotional well-being.