Keep your records up-to-date regarding plan members and their eligible dependents

#391

PDF Version

Prescription drug coverage in Quebec

In Quebec, all residents must have insurance coverage for prescription drugs. If an individual does not have access to this coverage through a private plan, he or she must enroll in the public insurance plan administered by the Régie de l’Assurance Maladie du Québec (RAMQ).

When individuals, either plan members or their dependents, are covered by a group benefits plan like yours, they will be considered to have the appropriate insurance coverage for prescriptions drugs as required by the law.  If there comes a time that the individuals are no longer eligible for coverage under the private plan, you must notify the individual that they must enroll in the public insurance plan administered by RAMQ, unless the individual is covered under another private plan. 

Eligible dependents

The purpose of this communication is to remind you of your role and responsibilities as a plan sponsor to confirm eligibility for coverage under your group benefits plan, in particular for dependents like spouses or dependent children who are automatically accepted for group benefits health coverage. Sun Life relies on you and/or your plan members to inform us of eligible dependents covered under your plan, including any changes in their eligibility. Prompt notification for changes in the status of covered dependents is very important to avoid continued payment of dependent claims. Retroactive termination is not permitted by RAMQ.

Spouse

In the case of a spouse, whether married, civil union or common law, Sun Life will terminate the coverage upon being advised by you or your plan member that the relationship has ended. RAMQ requires that Sun Life honour the last claim incurred up to the date of being informed by you or your plan member of the change in eligibility before terminating coverage. Your plan member will be asked to notify this person to register with the public plan where applicable.

Dependent child

In the case of dependent children, Sun Life relies on you or your plan members to verify eligible dependents covered under the plan and to inform us of any changes in their status. This includes verifying attendance at an educational institution for those dependents over age 21. Sun Life will terminate the coverage of the dependent child upon being informed by you or your plan member that the person is no longer in school or considered a dependent. RAMQ requires that Sun Life honour the last claim incurred up to the date of being informed by you or your plan member of the change in eligibility before terminating coverage. Your plan member will be asked to notify this person to register with the public plan where applicable.

What we need from you

Keep your records accurate and up-to-date

To ensure that drug coverage is extended to dependents who meet the eligibility criteria under your private plan, plan sponsors with members who reside in Quebec will receive a communication on an annual basis starting this August as a reminder to review the eligibility of dependents covered as students. If the eligibility of a dependent student has changed, plan members should inform their plan sponsor as soon as possible so that records and premiums, if applicable, can be updated by Sun Life accordingly. The Administration Guide will be updated to reflect this practice.

Keep proof of coverage on file

Except if participation in your private plan is a condition of employment, your plan members must submit proof of coverage at least equivalent to the basic plan coverage under another private plan to be exempt from the deduction of the premium under your plan. You must keep this proof on file. Should the plan member’s coverage change, he or she is responsible for informing you in order for the individual and any dependents to be enrolled in your private plan.

Let your plan members know

Be sure to remind all of your plan members to keep their records with you up-to-date regarding any changes to personal information or dependent status.  We have prepared a communication for you to share with your members to give them these reminders.


Questions?

Please contact your Client Service Administrator at 1-877-786-7227.