If you are a full-time employee, part-time faculty or a continuing education instructor covered under the Comprehensive Health Plan, the following provisions apply. However, if you are part-time faculty or a continuing education instructor covered under the RAMQ Drug Plan Equivalent, you are covered for the drugs listed on the RAMQ formulary: for more details, go to the government plan site.
The deductible is essentially the amount that you pay each benefit year before the plan starts to reimburse eligible health expenses up to certain limits.
The Concordia Health Plan offers a deductible that is equitable for all members. The current deductible per benefit year is $60 per adult, to a maximum of $120 per family.
This deductible does not apply to:
- non-RAMQ drugs for participants under 65 who have a deferred payment card;
- semiprivate hospital room and board charges in a public general hospital;
- a licensed convalescent hospital; or
- emergency hospital and medical treatment incurred while you were travelling outside your province of residence.
By paying the deductible, you share in the cost of claims, and you help yourself reduce the premius for yourself and all other participants.
The Health Plan reimburses eligible expenses incurred for the following types of services:
Amounts reimbursed subject to the deductible and certain limits:
Amounts reimbursed not subject to the deductible but subject to certain limits:
Note: For each calendar year, the Plan provides that once the combined expenses for RAMQ drugs an major medical services reach $2,000, such expenses will be reimbursed at 100% for the rest of the calendar year.
This out-of-pocket limit does not apply to:
- non-RAMQ drugs;
- vision care (which is available depending on your eligible employee group);
- the services of psychologists and psychiatrists;
- emergency care and travel assistance outside your province of residence; or
- hospital care;
- all other expenses.
Please refer to the Eligible expenses section for a list of various covered expenses under each type of service as well as the Exclusions and limitations section.
The current maximum lifetime reimbursement for emergency care and travel assistance is $1 million per insured person.
All other eligible expenses are reimbursed up to a lifetime maximum of $1 million per insured person.
However by law, since January 1, 1997, if you live in Québec and reach the maximum lifetime reimbursement, the plan will continue to reimburse prescription drugs on the formulary of the Régie de l’assurance-maladie du Québec (RAMQ), without limit.
