Quebec (PQ)
The Quebec Hospital Insurance Plan & The Quebec Health Insurance Plan:
Financing

Premiums

• employers contribute 4.26% of their payroll to the plan with no yearly maximum
• Quebec individual's contribution to the cost of the program are integrated with the income tax rates

Utilization Fees

• utilization and deterrent fee may be payable for drugs
• there is a daily fee charged for Chronic care patients:
  • the fee will vary according to the accommodation requested and the type of facilities provided in the hospital room
  • charges commence as of the date the patient's condition is classified as "chronic"

Extra Billing

• "opted-in (or participating) professionals" and "opted-out professionals (or professionals withdrawn)" are not entitled to extra-bill
• "non-participating professionals" may extra-bill because payment of their fees is assumed by the patient alone

Billing and Payment

• every registered resident is provided with a Health Insurance Card that must be produced to the provider of the service. Otherwise the patient must pay for the service and subsequently claim from the plan.
• physicians, dentists and optometrists have the right to opt into the plan, opt out, or to become non-participating professionals
• pharmacists do not have the right to opt out,
• Methods of billing:
  • opted-in professionals' bills are paid directly by the Board
  • opted-out professionals agree to charge according to the approved Schedule of Fees and patients are reimbursed by the Board
  • non-participating professionals bill's are assumed in full by the patient except when received in an emergency

Private Insurance

Same as That Provided by the Provincial Plan

• prohibited for insured services provided to a resident under the Plan
• insurance may be taken out to cover any excess costs for services received outside the province of Quebec

Over and Above That Provided by the Provincial Plan

Private insurers may provide coverage for all or any part of the following services:

• Hospital: other than ward accommodation, i.e. private and semi-private
• Physicians: no private insurance permitted (except excess outside the province of Quebec)
• Ambulance: entire coverage for persons under age 65 and not in receipt of social aid
• Laboratory: other than an authorized facility
• X-rays: other than an authorized facility
• Optometrists: if not paid by the plan
• Chiropractors: entire coverage
• Osteopath: entire coverage
• Chiropodist/Podiatrist: entire coverage
• Physiotherapists: other than for use of physiotherapy facilities in a hospital on an in-patient or out-patient basis which are covered by the Plan
• Special Nursing: entire coverage
• Nursing Homes/Homes for the Aged: if not paid by the plan
• Chronic Care: if not paid by the plan
• Home Care: entire coverage
• Out of Province/Country: the difference between the cost, and the amount paid by the Regie
• Dental: other than oral surgery in hospital and children under age 10
• Drugs: other than those administered in hospital or those covered by the Prescription Drug Program

Third Party Liability

The Board will pay any medical expenses for a person injured through negligence of a third party and may recover these expenses from the third party.

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