Your “Savvy Retiree” Newsletter for March 2024

Understand how my group insurance plan works

It is essential to understand the functioning of its group insurance. The new tab on the ACR website covers most of the guarantees, repayment guidelines, benefits to which you are entitled, or actions to take during life situations.

By selecting the keyword most relevant to your request, you will be redirected to the corresponding information.

We strive to simplify the search for answers to your questions.

Click here to discover the Understanding my group insurance tab

Understanding reimbursement limitations: Common and reasonable costs

Reimbursement limitations are limits set by insurance plans for the costs of certain medical services or health products. They represent the maximum amount that an insurer is willing to reimburse for these services or products. This is a common practice in the insurance industry. These guidelines are based on what the insurer considers to be "usual and reasonable" costs, i.e. typical rates for similar services in a given region.

Why are they important?

- To prevent the insurance scheme from incurring excessive costs.

- To maintain the financial health of the group insurance scheme.

- To ensure that reimbursements reflect realistic and customary costs of medical services or products.

If you have questions about reimbursement limitations or about the usual and reasonable costs for a specific service or product, it is a good idea to ask Beneva before incurring an expense.

Understanding the annual group insurance deductible

The annual deductible is of paramount importance in accessing health care and the overall cost of your insurance. The amount varies according to the guarantees and repayment guidelines stipulated in your group insurance contract.

In effect, the annual deductible is the amount you have to pay out of your pocket before the insurer begins to reimburse the medical expenses covered. This approach aims to share costs between the insured and the insurer, while encouraging responsible use of health services.

It should be noted that the annual deductible applies on an annual basis, which means that it must be paid once a year, usually at the beginning of the coverage period.

It is therefore essential for members to fully understand the terms of their annual group insurance deductible. This understanding will allow them to best assess their health care needs and make informed decisions on how to use their coverage effectively and cost-effectively.

Are you paying a drug premium without knowing?

The cost of the premium surcharge is added to the cost of the monthly premium. In 2023, 122 insured persons aged 65 or older are not covered by the RAMQ and are paying a surcharge.

If the member applies for coverage under the Group Plan Medicines Guarantee rather than the RAMQ, he or she will have to pay the additional premium indicated in the table below. (ref. Your leaflet At a glance).

Our consulting actuary informed us that people insured with the premium premium have not made any claims in recent years. So is it necessary to pay a surcharge?



Line St-Cyr, Coordinator, ACR