Healthcare Insurance (Perspective 3992)
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Healthcare Insurance Application
Are you opting out of your Group Insurance plan?
Healthcare Insurance (Policy No. 3992) allows you to maintain insurance that's similar to the coverage you have under your Group Insurance plan. It's also the perfect complement to the public health insurance plan.
Hurry! You have a period of 60 days following the termination of your Group Insurance plan in which to update your Healthcare Insurance coverage without having to answer a medical questionnaire.
5 reasons why you should get Healthcare Insurance (Policy No. 3992)
- 3 plan options and an optional coverage supplement to better meet your needs
- Use a service card to get direct reimbursement of prescription drug expenses1
- Take advantage of the Enriched plan, travel insurance that covers you for a 180-day stay
- Choose a prescription drug insurance formula that will allow you to complement your coverage under the provincial public plan
- Get access to the VIVA Workplace Health and Wellness Program
Leaflet - Healthcare Insurance (policy3992) (PDF - 5 pages)
Questions and Answers
Premium increase on January 1, 2017
Why do my premiums increase every year?
There are two main reasons for the increase:
- The average increase in healthcare costs is significantly higher than the average inflation rate in Canada.
- Population aging leads to increased use of prescription drugs and healthcare covered by the plan (e.g. massage therapy).
Even though I make few claims, my premiums are increasing. Why is that?
Premiums are established based on an analysis of consumption by all the participants in your plan. That is the principle of insurance. The risk is shared among all insureds, so that you can be covered if the need arises.
How can I reduce the cost of my plan? Could I, for example, switch from the Enriched plan to the Basic plan?
A plan change or an addition or termination from the optional coverage supplement is possible on the renewal date, i.e. January 1 of each year, if the participation requirements have been met. The plan purchased can be increased or decreased, one level at a time, as follows:
- From the Basic plan to the Intermediate plan
- From the Intermediate plan to the Basic plan or Enriched plan
- From the Enriched plan to the Intermediate plan.
However, if the minimum participation requirements have not been met, the policyholder must wait until January 1 of the following year to modify its plan selection or to make an addition or termination from the optional coverage supplement.
Please note that a plan change or an addition or termination from the optional coverage supplement is always possible within 30 days following one of the life events described below:
- Birth or adoption of a child
- Separation or divorce
- Death of a spouse or a dependent
- Termination of eligibility of the last dependent child.
Contract changes effective January 1, 2017
Will I receive a new leaflet summarizing the coverages offered?
Why did you rename policy No. 3992?
We renamed policy No. 3992 to facilitate communications with clients. PERSPECTIVE is a more meaningful name for this insurance plan, since new perspectives become available to participants who leave their group insurance plan.
The change of name has no bearing on the product.
Does No. 3992 still apply?
PERSPECTIVE still bears policy No. 3992, and that number is indicated on your service card.
Am I obliged to maintain spousal coverage in the event of separation or divorce (addition of Section 2.21: Maintaining the spouse’s coverage in the event of separation or divorce)?
The addition of this section does not oblige you to maintain your spouse's coverage in the event of separation or divorce. It simply allows the person who was your dependent spouse to apply for coverage under the product, without evidence of insurability, within 60 days following the date of separation or divorce.
Why did you modify the second paragraph of Section 2.2: Conditions of insurance? Does the change have any repercussions for me?
We only clarified an administrative rule that was already included in our practices. The PERSPECTIVE individual insurance policy complements the Health insurance plan of the province of residence.
How can I know if my province of residence offers a public prescription drug insurance plan?
The admission rules for the public prescription drug insurance plan differ based on your province of residence and your age. To find out whether or not you are eligible, please go to the website of the prescription drug insurance plan of your province of residence.
With the name change to PERSPECTIVE, does the direct payment service still work at the pharmacy?
Yes, there is no change to the direct payment service. Payment will continue to be made directly at the pharmacy with the service card you already have in your possession.
Why was the 100% coverage level revoked for prescription drug coinsurance?
Because of the increase in the cost of prescription drugs, particularly with the introduction of new biologic drugs, 100% coverage has been revoked to obtain better cost control and ensure the longevity of your plan.
The Substitution section has been added. Will the addition have any impact on reimbursement of my prescription drug expenses?
The repercussions will be different if you are eligible for the public prescription drug insurance plan of your province of residence and if you have the optional coverage supplement. The table below summarizes the repercussions based on various possibilities.
|Without the optional coverage supplement||With the optional coverage supplement|
|Eligible for the public health insurance plan of your province of residence||No repercussion||For prescription drugs covered under the provincial prescription drug insurance plan, reimbursement (coinsurance and deductible) will be limited to the cost of the least costly generic drug, when a generic drug exists.|
|Not eligible for the public health insurance plan of your province of residence||For prescription drugs covered under the provincial prescription drug insurance plan, reimbursement will be limited to the cost of the least costly generic drug, when a generic drug exists. There is no repercussion for prescription drugs that are not covered under the public health insurance plan of your province of residence.|
What are the repercussions of the change in the maximum amount for Travel Insurance?
The amount of your Travel Insurance has not changed. The eligible amount applied for the term of the contract and now applies on a per-trip basis. It's even better for you.
Why have you added details regarding the departure and return dates in Section 4.3 Scope of coverage?
The purpose of the elements added is to specify what constitutes a travel period.
Why have you added details in the fourth paragraph of Section 4.3 Scope of coverage?
Certain people have more than one insurance contract for reimbursement of medical expenses incurred outside their province of residence. In the event of an incident that occurs while outside the province of residence, insurance plans are coordinated to determine which insurer is the first payor. In this way, La Capitale complies with the recommendations of the Canadian Life and Health Insurance Association (CLHIA).
Why did you add Important ‒ Exclusion and reduction to the Travel Insurance benefit? I will be leaving soon to go on a trip. Are there any repercussions that apply to me?
The change applies only before you leave to go on a trip. Going forward, you will have to contact us prior to departure if your medical condition is not stable or under control. That way, we can verify your eligibility prior to departure, and you can travel with full peace of mind.
Should I call you and consult a physician before I leave to go on my trip?
If there is no change in your medical condition, there is no need for you to call us.
If you have a known illness or condition and you are unsure about your health condition, you must contact the Assistor at least 15 days before departure to obtain confirmation of insurance coverage under this benefit.
However, the Public Health Agency of Canada advises those travelling abroad to contact a physician “preferably six weeks before departure.”2
1 The portion of expenses not covered under the prescription drug insurance plan of the province of residence will be reimbursed based on the percentage indicated in your plan when you enrol in the optional coverage supplement.
2 Bon voyage, but... Essential Information for Canadian Travellers. Government of Canada. https://travel.gc.ca/travelling/publications/bon-voyage-but?
This page is provided for information purposes only. It merely provides an overview as to the nature of the coverage available. At all times, the terms and conditions pertaining to the coverage provided under each benefit are governed solely by the insurance contract. Some conditions and exclusions apply.