Frequently Asked Questions—Group Insurance

No, only a life event allows this modification. The employee can therefore change their coverage only when one of the following events occurs:

• Change in marital status;
• Birth or adoption of a child;
• Cessation or significant change in spouse’s coverage.

No, the plan is mandatory, which means that all eligible employees must enroll. Furthermore, Quebec residents cannot be enrolled in the public drug plan if they are eligible for private coverage.

Confirmation of the amount of their contribution to the group insurance premium can be requested from their employer, as this amount is deducted directly from their pay. They can also call their group insurance advisor for more information.

Their group insurance plan allows for direct reimbursement of prescription drugs at the pharmacy when a purchase is made. To do so, employees simply need to present their insurance card, including the group and certificate numbers, to the pharmacist, who will then forward the claim information.

If the employee forgets to present their card at the pharmacy or if a drug requires prior authorization for reimbursement, they will need to submit a claim for drug expenses, following the same procedure as for medical expenses.

If a Quebec resident’s prescription drug insurance coverage is in question, you must send them correspondence to inform them of the amounts owed, specifying that a 30-day period is granted to receive the reimbursement, after which the coverage will be cancelled. If the situation is not resolved after the deadline expires, the coverage may be suspended.
Otherwise, the person must be notified that their coverage will be terminated due to non-payment. In the event of certificate termination due to non-payment, upon their return to work, the employee will need to complete a health declaration for UV to assess their eligibility for life insurance and salary insurance coverage.

The premium for a given month is payable on the first day of that month.

However, a grace period of thirty (30) days is allowed for payment of any premium due. After this period, the benefits payable by UV Insurance to your employees may be suspended, and the contract may even be cancelled.

Plan administrators can submit documents securely online through the My Universe portal.

Here are the steps to follow:

1. Access the My Universe portal and log in with your username and password.
2. Click on the Upload Documents button.
3. Digitize your administrative documents and keep the originals.
4. Select the recipient department, either administration or disability.
5. Complete the certificate.
6.  Upload your documents:
   1. Click on the Browse button and select one document at a time;
   3. Repeat this step for each digitized document.
7. Add additional information as required.
8. Click the Submit button.

When you submit a document that includes an electronic signature, it is essential that the validation or audit history of the signature process is accompanied by the electronically signed document.

See the procedure

Under Quebec’s Act respecting prescription drug insurance, any person who has access to a group insurance plan must withdraw from RAMQ and be covered by the group insurance plan.

Therefore, you must purchase coverage for the dependents listed on your certificate. However, an exemption may apply if these dependents have access to another group insurance plan. For more details, please reach out to your plan administrator.

Please note that in the absence of coverage for family members eligible for your group insurance, and in the event of non-registration with RAMQ, you may be required to reimburse the amounts paid by RAMQ, even though you were also covered by your group carrier. Depending on the terms of your contract and the date of the fees, these drugs may no longer be reimbursed by group insurance.

The following family members must be enrolled in your private group plan if they are eligible:

•  Your spouse or common-law partner, if not covered by another group insurance plan;
• Your children under age 18*, as well as those of your spouse, who do not have their own group insurance or who are not insured under another parent’s private group plan;
• Your children under age 26, and those of your spouse, who are full-time students and for whom you would exercise parental authority if they were minors, and who do not have their own group insurance or are not insured under another parent’s private group plan.

*Your plan may have a different age limit for your dependent children.

Please refer to your brochure if necessary.

Are you and your spouse both enrolled in a group insurance plan? You may be eligible for coordination of benefits. If your plan does not cover all your expenses, you can submit the remaining amount to your spouse’s plan. This could allow you to be reimbursed for up to 100% of your expenses, as well as those of your children.

For more information, please reach out to your plan administrator or reach out to our customer service department.

If you are a Quebec resident, you will receive a letter from UV Insurance one month before your 65^th birthday to inform you of the choices you need to make regarding your prescription drug coverage.

We recommend that you consult your brochure, as coverage changes may occur when you reach age 65.

Your group insurance coverage ends on your last day of work. Ask your plan administrator or human resources department about your life insurance conversion rights. Please note that this right applies exclusively to life insurance.

Your group insurance coverage will end on the cancellation date set by the insured employer and UV Insurance. You can verify this date with your insurance plan administrator or your human resources department. If you want to maintain your current insurance contract, ask your plan administrator or your human resources department about conversion privilege. Please note that this right applies exclusively to life insurance.

Travel Assistance and Trip Cancellation cover medical needs due to an accident or a sudden illness while travelling abroad.

To confirm whether you have this coverage, please refer to your insurance certificate:

View your insurance certificate

You can also consult your personalized group insurance certificate to know all services and restrictions applicable.

View your brochure

Should you have additional questions, please reach out to your plan administrator.

• Travel Insurance
  Travel insurance covers certain unforeseen expenses when you travel abroad, including hospitalization, emergency medical care and trip cancellation.

If your group insurance contract includes a health management account, you dispose of extra annual coverage to spend on care, included or not in basic benefits. You have the freedom to make your own health care choices, in accordance with the Income Tax Act (R.S.C.).

For example, if your group insurance contract does not cover dental care, you can ask for a refund for dental treatment through UV Insurance’s health management account.

It offers you the opportunity to change or adapt your health contract to your needs.

Refer to your group insurance booklet to check whether this option is included in your health insurance benefits. If so, speak with your plan administrator or human resources department.

To modify your personal information, go to your secure access.

If you encounter difficulties, please refer to your plan administrator or human resources department.

• • To change your address or bank account
  • To change your email address or password

To change your family situation or your list of dependents:

• You must notify your plan administrator or human resources department.

To change your beneficiary(ies):

Consult the beneficiary change request form.

* Ensure a witness signs documents to reduce treatment delays.

• Beneficiary
  The person you designate to receive the benefit of your life insurance contract. In the case of life insurance, if you do not designate a beneficiary, your insurance benefit will be paid to your estate.
• Contingent Beneficiary
  If you decide to designate multiple individuals to receive an amount, you can assign both primary and secondary beneficiaries (also referred to as “contingent” beneficiaries). The secondary beneficiaries will only receive the amounts if no primary beneficiary is alive at the time of payment.
• Irrevocable Beneficiary
  A beneficiary whose written consent is required to change or modify the beneficiary of your life insurance contract.
• Revocable Beneficiary
  A beneficiary whose designation can be changed at any time.

Follow the procedure in the following document:

Registration for online services – for members

Yes, an app is available. You can download it from the Apple App Store or Google Play. Upon initial login, you’ll have access to your account, where you can view your certificate, brochure and submit claims.

You can preview and print your card anytime through your My Universe portal account or the UV Insurance mobile app.

If your group insurance plan includes disability coverage, you can view the information documents available in your account on the My Universe portal. They can be found under the Brochures and Guides tab in the main menu. Your employer also has access to these documents and can provide them upon request.

For all claims, you must submit the following three basic forms:

Disability Benefits Request – Employer

Disability Benefits Request – Employee

Physical illnesses – Original Request

To submit your request :

You can now submit your disability claims online through your member access on the My Universe portal, by clicking here.

• By fax: 819-474-1990
• By mail: P.O. Box 696, Drummondville, Québec J2B 6W9

Additional information may be requested if further details about your health are needed.

You can submit your claim directly in your member account on the My Universe portal or using the UV Insurance mobile app.

Online medical and dental claims

To submit a claim by mail, please complete the following form:

Medical and paramedical fee form

Dental fees form

To speed up the processing of your claim, we recommend that you consult your brochure before submitting it to check for eligibility.

• If your contract stipulates that a prescription is required for a medical service to be eligible, be sure to include this prescription with your claim.
• Also make sure that the receipt for paramedical services clearly indicates the professional’s license number. If this number is missing, the claim cannot be processed.

Once you have completed your claim, be sure to include your original receipts.
*Note: keep a copy of your receipts.

Send your documents to the following address:

P.O. Box 696, Drummondville, Quebec J2B 6W9

Your group insurance plan allows you to be reimbursed directly at the pharmacy at the time of purchase. Simply present your insurance card, showing your group and certificate numbers, to your pharmacist. They will then transmit the information required to process your claim.

If you forget to present your card, or if a drug cannot be reimbursed directly at the pharmacy due to a required authorization, you will need to submit a claim for prescription drug fees, following the same procedure as for medical fees.

Medical and paramedical fee form

If your group insurance plan includes the direct card option as part of your dental coverage, you are not required to file a reimbursement claim for any fees. Simply present your insurance card, showing your group and certificate numbers, to your dentist. They will then transmit the information required to us.

Dental fees form

Most of your prescription drugs can be refilled for up to 90 days. Depending on your situation, this may be beneficial for you. If your medical condition does not require frequent visits to the pharmacy, you may only need to go once every three months instead of every month. Furthermore, if your prescription drug purchases include a copayment, you could save the cost of two copayments over three months.

Speak with your pharmacist!

Let’s take the case where your contract states that a deductible is payable on prescription drug fees only. In this case, no deductible will be applied to reduce your benefits for other medical and paramedical fees. The opposite case is also possible.

Your contract might indicate that a combined deductible might be payable for all medical and paramedical fees, as well as prescription drugs.

If there is a $75 combined deductible:

*In this example, the combined deductible on other medical and paramedical fees, as well as on prescription drugs, applies.

The deductible is the portion of the fee that must be paid in full each year before any reimbursement can be made. Depending on the contract, the calendar or membership year is used as the reference for calculating the annual deductible. Please check with your plan administrator.

In the event of a change of carrier, please confirm with your plan administrator or human resources department the coming into force date of the new group insurance contract. Your claim should be submitted to the new carrier only if the fees were incurred after that date. Otherwise, it will be handled by the previous carrier.

Unlike a deductible, copayment (also called deterrent fee) must be paid before each purchase of prescription drug. In some cases, your physician might recommend you more than one drug on the same prescription or prescribe a renewable medication for a long period of time (i.e., 12 times). However,  you will pay a deterrent fee (copayment) at each transaction at the pharmacy, and for every prescribed drug.

Furthermore, since most prescription drugs can be renewed for a 90-day period, you can ask your pharmacist to give you the equivalent of three months when possible. This will save you the cost of two copayments out of three.

Your contract provides for the reimbursement of a percentage of the prescription drugs depending on their nature. Some contracts also provide for the reimbursement of prescription drugs based on the cost of the least expensive generic or biosimilar drug. Here is what these terms mean:

When any new therapeutic molecule is marketed by a pharmaceutical company, it is a single source drug. This drug is usually patented to allow some time for the pharmaceutical company to recover development costs.

When a drug patent has expired, other pharmaceutical companies can then produce and market that same molecule. The drugs that have the same active molecule as the original drug are called generic drugs. The drug that used to be but is no longer a single source is now referred to as innovative drug. Competition then reduces the cost of the drug, and the generic versions often become much cheaper than the innovative drug.

Biosimilars drugs are considered as generics for drugs called biologics. A biologic drug is produced from living organisms or cells, using biotechnology.

Why is this distinction important in determining the reimbursement?

To reduce the costs of a drug insurance scheme and hence the premium to be paid, several contracts are set up to encourage the insureds to get the generic or biosimilar version of a prescription drug. This can be done in various ways, for example by giving a higher percentage of reimbursement for generic drugs, or by reimbursing the drug according to the cost of the cheapest generic equivalent drug available. The insured can get the drug of their choice, but if they choose the innovator drug, they will have to pay a larger part of the drug. In that respect, if the insured chooses to get the innovator drug while their contract reimburses the cost of the cheapest generic equivalent drug, they will be reimbursed for the innovator drug at the percentage provided for innovator drugs, but that percentage will be applied to the eligible amount equal to the cost of the generic drug.