Common use of Health Insurance Plan Clause in Contracts

Health Insurance Plan. Participation in the health insurance plan is mandatory for all eligible employees and their eligible dependents, subject to the exceptions stipulated in the Quebec Act respecting prescription drug insurance and the exemption privilege provided under this contract. Provisions applicable to insured persons aged 65 or older: There are no changes to the health insurance plan of a participant once she reaches the age of 65. That participant retains all of the coverage offered by the health insurance plan, including the reimbursement of prescription drug expenses, and this, without altering the premium. The same terms and conditions apply to the spouse of an insured participant under this contract’s health insurance plan, who has reached the age of 65. However, according to the rules of the Régie de l’assurance maladie du Québec (RAMQ), a person turning 65 is automatically covered under the Basic Prescription Drug Insurance Plan (RGAM) for the reimbursement of prescription drugs covered by that plan. Any insured person who reaches the age of 65 must therefore withdraw from the RAMQ to avoid paying the premium for the RGAM. If, however, an insured person decides to remain enrolled in the RGAM, that decision is irrevocable. In addition, no dependent may remain insured for prescription drug reimbursement under this contract, customarily covered by the RGAM, if the participant herself does not remain enrolled.