Mr. Daniel Dubé, ACR's Retiree Spokesperson, has taken numerous actions in the travel agent customer compensation fund (FICAV) file.
For several months, FICAV has been slow to repay the sums of money, approximately $2 million, that the SSQ insurer advanced to the insured under the enriched plan. SSQ subrogated to the rights of the policyholders because of FICAV’s unjustified inaction to reimburse and process the policyholders’ claims as first payer.
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As you know, the Advisory Committee for Retirees (ACR) was formed to give its retirees a say in the administration of their group insurance plan and in determining the preferred policies of the members.
The ACR reports to the Comité paritaire intersectoriel (CPI), under which it has the power to make recommendations. The CPI reports to the Secrétariat du Conseil du trésor (SCT), which acts on behalf of the Gouvernement du Québec as the lessee of the contract for the collective insurance of retired managerial staff. It is therefore the SCT that decides and responds favourably or not to a request from representatives of retirees.
Why go back to the role of both? Because it's important for you to know that despite the efforts of the retiree representatives to improve the plan or to try to reduce premiums for those under 65, they must first get approval from SCT.
Work on the sustainability of the plan began in 2016 because your pensioners’ representatives were concerned about the rising costs of the sickness insurance scheme for pensioners under 65.
Although it is very expensive for the 5,200 members under the age of 65, who cannot cover their medications at RAMQ, the group plan becomes very advantageous for the 18,855 members aged 65 and over, which complicates the situation. Your representatives from the pensioners have put forward a number of options in order to arrive at a solution acceptable to all. But we have to wait for the SCT decision.
We believe that it would be appropriate in 2024 to improve the reimbursement guidelines for health professionals’ claims. According to our actuary, it is strongly recommended to probe the interest of all members under the enriched regime. The consultation process takes several months to develop. The annual contract negotiation starts in September. We are awaiting SCT approval to begin work.
Many of you write and wonder about the slow pace of decision-making. Thank you for your comments and suggestions. We will forward your communication to SCT, if you request it.
Mr. Réjean Gauvin of the Association québécoise du personnel retraité de direction des écoles (AQPRDE) announced last fall that he would be leaving the Advisory Committee for Retirees (ACR), and we would like to thank Mr. Gauvin for his contribution and involvement in various issues during his term of office.
Ms. Lucie Jutras, President of AQPRDE, was appointed to replace Mr. Gauvin. We welcome her to the ACR and thank her in advance for her contribution.
In the case of hospital expenses in Quebec, present your SSQ insurance card to the hospital. Your plan provides a refund for a semi-private room up to a maximum of 90 days/calendar year/insured for the basic plan and no limit of days for the enriched plan.
If the choice of a semi-private room is not available, the hospital cannot charge for the occupancy of a private room.
There are two ways to send your drug benefit application to SSQ:
Through the SSQ insurance card:
Please note that only medication costs can be passed on to SSQ by means of the system for the electronic transmission of claims for benefits.
On presentation of your SSQ insurance card, your pharmacist will check immediately if the drug purchased is eligible for reimbursement.
If you are unable to use your SSQ insurance card (loss, non-participating pharmacist, etc.), submit your claim using the claim form.
This form can be printed from the Costumer Centre.
SSQ Internet services / Customer Centre:
This electronic tool allows you to access your insurance file at any time. It offers several operations that you can perform quickly, confidentially and securely.
To be eligible for reimbursement, all invoices must be submitted within 12 months of the date they were incurred.
For more information, please consult the table of contents at the beginning of the Leaflet for retirees / January 2022, which will guide you to the full text of How to submit a claim?
Line St-Cyr, Coordinator, ACR