Your Group Insurance Plan

Your Group Insurance Plan Policy No. F001 Your Group Insurance Plan FÉDÉRATION INTERPROFESSIONNELLE DE LA SANTÉ DU QUÉBEC Policy No. F001 This document is an integral part of the Insurance Certificate. It is a summary of your Group Insurance Policy. Only the Group Insurance Policy may be used to settle legal matters. This electronic version of the booklet has been updated on April 1, 2017. Please be advised that this electronic version is updated more frequently than the printed copy of your booklet. Therefore, there may be discrepancies between the paper and electronic copies. TABLE OF CONTENTS SUMMARY SCHEDULE OF HEALTH CARE AND DENTAL CARE REIMBURSEMENTS ..............................................3 DESCRIPTION OF BENEFITS............................................................7 BASIC PLAN ..........................................................................................7 BASIC DRUG PLAN..............................................................................7 BASIC EXTENDED HEALTH PLAN III ..............................................10 A) Expenses reimbursed at 100%................................................... 10 B) Expenses reimbursed at 80% ..................................................... 11 C) Travel insurance expenses ......................................................... 15 EXTENDED PLAN I............................................................................21 DENTAL CARE INSURANCE ..............................................................21 EXTENDED PLAN II ..........................................................................29 1) PARTICIPANT BASIC LIFE INSURANCE.......................................29 2) PARTICIPANT ADDITIONAL LIFE INSURANCE ............................30 3) PARTICIPANT BASIC AD&D AND ADDITIONAL AD&D.............31 4) DEPENDENT LIFE INSURANCE.....................................................32 5) LONG TERM DISABILITY INSURANCE........................................33 GENERAL PROVISIONS...................................................................37 DEFINITIONS .....................................................................................37 ELIGIBILITY ......................................................................................41 PARTICIPATION ................................................................................42 EVIDENCE OF INSURABILITY..................................................47 EXEMPTION PRIVILEGE ...................................................................47 TERMINATION OF THE EXEMPTION PRIVILEGE.............................48 APPLICATION ....................................................................................49 ABSENCE OF APPLICATION..............................................................49 EFFECTIVE DATE OF COVERAGE ....................................................50 WAIVER OF PREMIUMS ....................................................................55 CONTINUITY OF COVERAGE IN THE EVENT OF WORK STOPPAGE .........................................................................................56 GENERAL LIMITATIONS...................................................................60 TERMINATION OF COVERAGE .........................................................61 INSURANCE PROGRAM FOR RETIREES............................................62 CONVERSION PRIVILEGE .................................................................63 HOW TO SUBMIT A CLAIM? ..........................................................64 TO ALL MEMBERS OF THE FIQ This booklet explains the main provisions and conditions of your group insurance plan. This plan is designed to meet your principal needs, while taking into account the benefits payable under various government plans. So please read this booklet carefully, to familiarize yourself with all of the insurance coverage to which you are entitled. Please note that the feminine gender used throughout this text designates men as well as women. PLANNING AHEAD REDUCES COSTS To take out insurance is to pool the contributions made by each participant and use them for those who need the benefits provided for under the contract, either to maintain an acceptable standard of living or to help them pay the cost, usually high, of medical and paramedical services that they need. On the whole, group insurance is an act of solidarity among members of the Federation. 1 YOUR PERSONAL RESPONSIBILITIES Each of you can do your part to keep insurance costs low. Please make sure to: - send your claims to the appropriate organization (Desjardins Insurance, CSST or SAAQ), as the case may be; - only take medication that you really require; - pay attention to the cost of medication in order to pay the best possible price; - develop a healthier lifestyle that includes exercise and a balanced diet. MONEY DOESN'T GROW ON TREES! Benefits are not paid with dollars picked from the money tree, but by an insurance company that is using your premiums. In a large group such as yours, the premiums for one year depend on the benefits paid during the previous year. If, in the course of one year, there is a surplus of premiums, the surplus is returned to the plan. Likewise, if there is deficit for one year, premiums of the subsequent year must be raised in order to prevent future deficits. 2 SUMMARY SCHEDULE OF HEALTH CARE AND DENTAL CARE REIMBURSEMENTS For a complete description of each benefit as well as the details on exclusions and limitations, please refer to the relevant pages. BASIC PLAN BASIC DRUG PLAN Drug Expenses 1) Generic drugs: 80%* of the lowest priced equivalent drug available on the market 2) Brand name drugs: 80%* of the brand name drug if no equivalent drug is available on the market or if an equivalent drug is available on the market and the Physician provides the required form indicating a valid reason, in the Insurer’s opinion, for which the drug cannot be substituted Percentage of Reimbursement 80%* of the lowest priced equivalent drug available on the market and the Physician did not provide the required form indicating a valid reason, in the Insurer’s opinion, for which the drug cannot be substituted * The percentage indicated applies to the first $3,750 of Eligible Expenses incurred by the Participant and her Dependents, if any, each Calendar Year and becomes 100% for the balance of Eligible Expenses incurred during the Calendar Year. Eligible Maximum Nil Amount Sclerosing injections Percentage of 80% Reimbursement Eligible Maximum $20/visit(1) Amount 3 BASIC EXTENDED HEALTH PLAN III Eligible Percentage of List of Eligible Expenses Maximum Amount Reimbursement Hospital expenses incurred Semi-private room 100% in Quebec Ambulance Nil 100% Travel insurance $5,000,000 100% Audiologist or hearing Nil 100% therapist Speech therapist Nil 100% Varicose vein treatment $20/visit(1) 80% Artificial limbs Nil 80% Therapeutic equipment Nil 80% Wheelchair, hospital bed Nil 80% Orthopaedic appliances Nil 80% Glucometer $300/5 years 80% $300/pair, maximum Foot orthoses 80% 1 pair/calendar year(1) Elastic support stockings 3 pairs/calendar year 80% (over 20 mm/hg) Nurse, nursing assistant $200/day, maximum 80% and respiratory therapist $4,000/calendar year 4 BASIC EXTENDED HEALTH PLAN III (CONTINUED) Eligible Percentage of List of Eligible Expenses Maximum Amount Reimbursement (1) Physiotherapist, podiatrist, $35/treatment naturopath, chiropractor, Overall maximum of osteopath, acupuncturist, $500/calendar year for 80% massage therapist, all these specialists kinesiologist, orthotherapist combined X-ray examinations by a $40/calendar year(1) 80% chiropractor Psychologist and registered $1,000/calendar year 50% psychotherapist Treatment of alcoholism $75(1)/day, lifetime 80% and drug addiction maximum of $3,000 Hearing aids $500(1)/3 years 80% Dental surgeon to repair Nil 80% accidental damages (1) Eligible amount must be multiplied by 0.80 5 EXTENDED PLAN I – DENTAL CARE INSURANCE Fee Guide Year (ACDQ): Current year Frequency: For recall oral examination, polishing, light scaling and fluoride treatment every: 9 months Deductible Amount: Nil Payable Percentage of List of Eligible Expenses Maximum Amount Reimbursement Preventive services: Nil 100% Basic services, endodontics Combined maximum of 80% and periodontics: $1,000 per calendar year per insured person Major restorative services: 50% Lifetime maximum of Orthodontics: $1,000 per insured 50% person 6 DESCRIPTION OF BENEFITS BASIC PLAN BASIC DRUG PLAN (compulsory) For any calendar year, the maximum reimbursement the insurer will make for eligible drug expenses incurred by a participant or one of her insured dependents as a result of an illness, an accident, a pregnancy or complications during a pregnancy, a surgical procedure related to family planning or an organ donation or bone marrow donation for which a medical follow-up is provided, is: 1) for generic drugs: 80% of the lowest priced equivalent drug available on the market 2) for brand name drugs: 80%* of the brand name drug if no equivalent drug is available on the market or if an equivalent drug is available on the market and the Physician provides the required form indicating a valid reason, in the Insurer’s opinion, for which the drug cannot be substituted 80%* of the lowest priced equivalent drug available on the market and the Physician did not provide the required form indicating a valid reason, in the Insurer’s opinion, for which the drug cannot be substituted * The percentage indicated applies to the first $3,750 of Eligible Expenses incurred by the

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