Eligibility & enrolment

Before retirement

Québec law requires that you, your spouse and your dependent children be covered under a group health insurance plan such as Concordia’s if:

• you are a Québec resident under age 65; and
• you are eligible for coverage under that plan.

You may opt out of the Concordia Health Plan only if you are covered under another group health insurance plan elsewhere, such as your spouse’s plan where he or she works. The same rule applies to your eligible dependents. You will need to provide proof of such coverage to Benefits Services.

If you live in Québec and coverage under your spouse’s plan ends, you and your eligible dependents must join the Concordia Health Plan.

During retirement

If you retire from active service with Concordia and you are under age 65, the following will apply depending on whether or not you remain in Québec.

If you remain a Québec resident ...
Québec law requires that you continue your coverage under the Concordia Health Plan, unless: you are covered under another group health insurance plan, such as your spouse’s plan where he or she works; or you are NOT considered an eligible pensioner.

If you reside outside Québec ...
If you are an eligible pensioner, you may make a one-time choice to continue to participate in the Concordia Health Plan or to opt out.
If you opt out, your decision will be irrevocable, that is, you will not be eligible to participate in the Concordia Health Plan at any future date. The only exception to this is if: you opted out because you were covered under another group health insurance plan elsewhere, such as your spouse’s plan where he or she works (and proof of that coverage was provided to Benefits Services at the time you opted out); and you subsequently lose that coverage. In this case, you may join the Concordia Health Plan anytime within 31 days of the date your coverage ceases under the other plan. You will need to provide proof of the loss of coverage to establish your eligibility under the Concordia Health Plan.

Before and during retirement, if you are age 65 or over, and live in Québec, you can choose to have the drugs that appear on the formulary of the Régie de l’assurance-maladie du Québec (RAMQ), covered under:

• the provincial government’s universal drug plan; or
• under a group insurance plan such as Concordia’s (the University will require that you pay an additional premium).

Certain provisions apply.

Note: This age requirement applies only to you, not to your spouse. As a result, if you are age 65 or over, the above rules will apply regardless of your spouse’s age. Also, if you are under age 65 but your spouse is age 65 or over, the Concordia Plan will continue to cover RAMQ drugs.

For coverage of other eligible expenses, we recommend that you remain with the Concordia Health Plan. Your choice of plan for drug coverage does not affect your coverage of other eligible expenses under the Concordia Health Plan.

If you are not a Québec resident and you and your eligible dependents do not enrol in the Concordia Health Plan when you are first eligible to enrol, any subsequent application for coverage will require that you and your dependents submit proof of good health (at your expense) that is acceptable to the insurer.

If you are a pensioner residing outside Québec and you opt out of the Concordia Health Plan, you cannot rejoin at a later date.

The categories depend on whether you are under age 65 or over, as shown below.

Categories of coverage if you are under age 65
You have 4 categories of coverage to choose from:

1. Single (you alone)
2. Couple (you and your spouse)
3. Single parent (you and your dependent children)
4. Couple with children (you, your spouse and dependent children)

Categories of coverage if you are age 65 or over
You have 2 categories of coverage to choose from:

1. Single (you alone)
2. Family (you, your spouse and dependent children)

Remember, regardless of whether you are an active employee or a pensioner, the category you choose must reflect your actual family situation, unless you provide written proof of duplicate coverage elsewhere.

The cost of coverage varies by category of coverage. If you reside in Québec, you may want to consider the tax implications of your choice of coverage.

The cost sharing arrangements vary based on your category of employment:

You must enroll when you first become eligible. Typically, this is when you are hired.

If you have any eligible dependents, they must be enrolled at the same time you become eligible for coverage.

If you do not have any eligible dependents when you are hired but later acquire an eligible spouse or a dependent child, Québec law requires that you enroll them immediately, unless they are covered under another group health insurance plan.

Special rules apply if you are under age 65 or if you are age 65 or over.

Benefits Services will provide you with an enrolment kit.

• For you:
  On the date you complete the enrolment kit, unless you have opted out of the plan:
  • because you are covered under the plan where your spouse works; or
  • as a pensioner from a prior employer.

If you are not actively at work on that date, your coverage will begin on the day you actively begin work.

• For your eligible dependents:
  On the date you complete the enrolment kit showing your dependent information.

Dependents (other than a newborn) who are confined to a hospital will be covered upon their release from the hospital. This does not apply to an insured person domiciled in Québec

Once enroled in the Concordia Health Plan, you and your eligible dependents will not be allowed to opt out at a later date, unless you obtain duplicate coverage elsewhere or unless you are age 65 or over.

Also note that, by law, your spouse and dependent children must enroll in the provincial drug plan if:

• you are 65 or over; and
• you are covered under the provincial drug plan.

If you already have coverage under a health plan where your spouse works or as a pensioner from a prior employer, you may choose not to participate in the Concordia Health Plan. If so, you must provide satisfactory proof of duplicate coverage.

If you reside in Québec and coverage under your spouse’s plan or your prior employer’s plan ends, provincial law requires that you and your eligible dependents join the Concordia Health Plan.

The health plan that you and your eligible dependents may participate in depends on the following criteria:

If you permanently reside in Quebec AND ...

You are a member of...	With less than...	With at least...
CUPFA	50 credits	50 credits
CUCEPTFU (ESL Dept.)	720 hours	720 hours
CUCEPTFU (Non-ESL Dept.)	30 points	30 points
	Then you and your family are eligible to participate in the ...
	RAMQ Drug Plan equivalent This plan provides the same coverage as the Régie de l’assurance-maladie du Québec (RAMQ).	Comprehensive Health Plan

If you are under age 65 and live in Quebec

The law requires that you, your spouse and your dependent children be covered under a group health insurance plan such as Concordia’s if you are eligible for coverage under that plan. The procedure for joining the plan depends on your answer to the following question:

Do you currently participate in the plan?

Yes

No

If you have no dependents, you have nothing to do. If you have dependents, you must complete a Dependent’s Statement and return it to Benefits Services. The same category of coverage will automatically be extended for the duration of the benefit year. Also, you will continue to pay the cost of coverage through payroll deductions. Please check your pay stubs for the exact amount.

Benefits Services will provide you with the appopriate enrolment information Benefits Services must receive your completed forms by the deadline indicated in the enrolment kit. Since you are required by law to cover your spouse and dependent children if they do not have coverage elsewhere, you must apply for their coverage. You will pay the cost of coverage through payroll deductions. Please check your pay stubs for the exact amount. Your coverage will start in September or in January, whichever follows the date of your teaching contract. Coverage lasts for the duration of the benefit year.

Please return all applicable forms, duly completed and signed, to: Benefits Services, FB 1130, Concordia University, 1455 de Maisonneuve Blvd. West, Montreal, Quebec H3G 1M8.

If you are age 65 or over and live in Quebec

You can choose to have the drugs that appear on the formulary of the Régie de l’assurance-maladie du Québec (RAMQ), covered:

• under the provincial government’s universal drug plan; or
• under a group insurance plan such as Concordia’s (the University will require that you pay an additional premium).

Please see Benefits Services for details.

You and your family may opt out of the plan depending on your answer to the following question:

Are you and your family covered elsewhere, such as your spouse’s plan where he or she works?

Yes

No

You may opt out of the Concordia plan. If you opt out of the plan, so must your dependents. If you prefer, you may choose Single coverage and have your dependents opt out of the plan. If you have already submitted proof of coverage elsewhere, you have nothing to do. Your exempt status will be extended the duration of the benefit year. No premiums or coverage will apply during this period. If you never had coverage at Concordia, here’s what you need to do to opt out of the Concordia plan: Complete the Enrolment form provided by Benefits Services and attach proof of coverage elsewhere.* Return the form, duly completed and signed, to: Benefits Services FB 1130, Concordia University 1455 de Maisonneuve Blvd. West Montreal, Quebec H3G 1M8 As a result, no premiums will be deducted from your pay and no coverage will be provided. Benefits Services must receive your form by the date indicated in the enrolment information provided. Otherwise, premiums will automatically be deducted from your pay accordingly until receipt of the required documenation. * Example: photocopy of a wallet card or of a recent claim payment, a pay stub confirming coverage, or a letter of confirmation from the other plan sponsor as prescribed by the Régie de l'assurance maladie du Québec.

You may not opt out of the Concordia Health Plan since you are not covered under another group health insurance plan elsewhere. The same rule applies to your eligible dependents.

No claims processed during the first two months of each benefit year. Since the insurer receives your eligibility information after the enrolment period has ended for each benefit year, it can only reimburse claims once it has processed this information. You may still submit claims during the first two months, but they will only be handled afterward. The drug card will not work during this period.

To make sure the insurer has the right information on file and can continue covering you and your dependents, please keep Benefit Services informed of any changes in personal data on you and your family.

When an eligible life event occurs, you can modify your benefit choices within 60 days following the event.

Eligible life events include a new spouse, having a baby, divorce or legal separation, and the loss of your spouse’s coverage where he or she works. Please be aware that changes presented within 60 days of the event will become effective on the exact date of the event. Evidence of insurability may be requested when changes are presented more than 60 days after the event.

If you wish to cover any dependent children who are full-time students age 21 or over and who depend on you for support, you must complete the section on Dependent Information on the enrolment form

This confirmation of full-time school attendance is required once a year and is valid for a full school year from September until August 31 of the following year.

If proof of full-time school attendance is provided for any session other than the fall session starting in September, that proof will be valid only until the en of the benefit year; new proof of full-time school attendance will be required again in the following year.

More information, contact:
Tel.: 1- 866-526-7566
E-mail: groupservice@dfs.ca

Forms:
Forms section