The keywords of your group insurance
This page contains keywords that allow you to quickly access a wide range of relevant content related to your group insurance coverage. Here, you will find information extracted from your brochure, carefully condensed to present the essential benefits, reimbursement guidelines, the advantages you are entitled to, and the actions to take in various life situations.
We invite you to explore the keywords that best match your needs and questions.
Accomodation contract - Trip cancellation
The private rental contract does not include any reimbursement provision in case of cancellation, and some accommodation websites may not be recognized by the insurer in the absence of a cancellation clause in their contract. Policyholders were informed of this policy through communication from the insurer in July 2021.
Annual Maximum Out-of-Pocket - Drugs
Amount you pay over the course of the year before your eligible prescription drugs are reimbursed at 100%. This principle applies to the Basic, Intermediate, and Enhanced plans, although the reimbursement percentages differ.
Simple reimbursement example
If your medication costs $30 and your basic plan reimburses 70%:
-
Plan reimbursement: $21
-
Amount you pay: $9
This $9 is added to your annual out-of-pocket total.
When the total amount you have paid reaches the annual out-of-pocket maximum, which corresponds to the maximum annual contribution set by the Régime général d'assurance médicaments (RGAM) on July 1 of the previous year, you automatically receive 100% reimbursement for eligible prescription drugs for the remainder of the year.
Curative and preventive vaccines
This benefit is included in the Basic, Intermediate, and Enhanced modules.
Only expenses for the substance used in curative or preventive vaccines are eligible, up to a maximum of $400 per insured person per calendar year. Fees related to the medical act of administering the vaccine are not eligible for reimbursement.
An annual deductible applies per certificate. This is the agreed-upon amount that the member must pay before the insurer begins to reimburse the coverages provided by the insurance policy. It is a single deductible, applicable to expenses incurred by both the member, their spouse, their dependents, and the person with a functional impairment, if applicable.
This benefit is included in the Enhanced module.
Expenses for the purchase of a hair prosthesis required as a result of chemotherapy are eligible. The maximum reimbursement per period of 48 consecutive full months is limited to one (1) prosthesis per insured, up to a maximum of $1,000 per insured.
Home accessories are not covered by the therapeutic appliance warranty. This means that items such as a toilet seat, a grab bar, a humidifier, an air conditioner, an air purifier, products from the Docteur Gibaud range, an electric cushion, a car heating cushion, a solar lamp, an electric toothbrush, a whirlpool bath, a sheepskin, etc., are not eligible for reimbursement. Please inquire before making a purchase.
Home Care / Home Support Services
This benefit is included in the Basic, Intermediate, and Enhanced modules.
Home support services for daily living activities not provided by the CLSC / CISSS / CIUSSS, up to $60 per day.
Includes: personal care, meal assistance, housekeeping, home maintenance, meal preparation, and medical accompaniment.
(Services are not covered if they are already provided by the CLSC / CISSS / CIUSSS, or if the home support provider ordinarily resides in the insured person’s home. The provider must not be a family member of the plan member or the spouse.)
This benefit is included in the Basic, Intermediate, and Enhanced modules.
Nursing care provided at home within 30 days following a hospitalization, up to $60 per day per insured.
Eligible services include: postoperative teaching, vital signs monitoring, dressings and wound care, administration of medications/IV solutions, removal of sutures, and specimen collection.
(Services are not covered if they are already provided by the CLSC / CISSS / CIUSSS, or if the nurse ordinarily resides in the insured person’s home. The nurse must not be a family member of the plan member or of the spouse.)
Unlike other professionals for whom a prescription is not required, the requirement of a medical prescription for massage therapy aims to ensure that the treatment is medically necessary and appropriate for the patient. This also helps ensure that healthcare costs are used responsibly and in accordance with medical guidelines.
According to the terms of the insurance contract, a maximum reimbursement of 6 postoperative bras is established for the lifetime of the insured. This means that expenses related to the purchase of these bras are covered up to this specified number. This ceiling ensures adequate financial support while avoiding excessive expenses.
Submitting a power of attorney to the insurer of the group insurance is an essential step to safeguard one's interests and ensure the continuity of financial protection, even in the event of incapacity. This simple yet crucial measure provides additional security and peace of mind to all members and their families, ensuring that their insurance needs will always be addressed, regardless of circumstances. The member can contact Beneva's customer service or submit a letter along with their power of attorney requesting the insurer to confirm receipt of the power of attorney.
Rental of an oxygen concentrator (portable or stationary)
The rental of an oxygen concentrator (portable or stationary) is reimbursable at 80% according to the contract. There is a maximum of 12 months of rental allowed over the lifetime. The purchase of the concentrator would also be reimbursable at 80%. Rental fees already reimbursed are deducted from the eligible amount for the purchase of the device. The expected frequency for purchase is once every 5 years. Accessories and oxygen refills are also covered at 80%. If the need is recurrent, it is more cost-effective to purchase the concentrator.
Risk Activities - Travel Insurance
This coverage does not cover losses resulting from the insured's participation in hang gliding, paragliding, parasailing, bungee jumping, mountaineering, skydiving, or any similar activity, extreme or combat sports, participation in any motorized vehicle competition, or participation in any sports activity involving remuneration.
Sclerotherapy Injections (Substance)
This benefit is included in the Basic, Intermediate, and Enhanced modules.
Eligible expenses for the substance used in sclerotherapy injections are limited to a maximum of $80 per treatment (maximum of one treatment per day per insured). The medical procedure itself is not covered.
It is crucial to keep the SSQ insurance card in your wallet while traveling, as it contains vital information, including emergency contact numbers when you are abroad. Even though the name Beneva is ubiquitous since the merger of SSQ and La Capitale, there will be no mass mailing solely to replace an SSQ card with a Beneva card.
Travel Assistance - Intermediate
Your coverage includes a maximum reimbursement of $5,000,000 per trip per insured, for a stay of up to 35 consecutive days per trip.
Short trips (for example: a 7-day stay, return to Québec, then another 7-day stay) are not combined.
The 35 days apply only to the maximum duration of a single trip.
Travel Assistance - Limitations
Neither the insurer nor the travel assistance company are responsible for the availability and quality of medical and hospital care, nor for guaranteeing access to such care. Some services may not be available in certain countries. It is strongly recommended to inquire about this matter.
Trip Cancellation - Limitations
In case of trip cancellation prior to departure due to a travel advisory issued by the Government of Canada, the insured must contact CanAssistance for instructions, and this must be done 72 hours before a deposit becomes due or 72 hours before the scheduled departure date, whichever comes first. For any other reason for trip cancellation prior to departure, the insured must always contact CanAssistance for instructions, no later than 48 hours after the occurrence of the event that may result in eligible cancellation fees.