Quebecers: consider this your public service announcement. You do not want to get sick away from home — unless you don’t mind puzzling out your province’s healthcare system and plunging further into debt whilst doing so.
Apart from emergency care Quebecers traveling or living temporarily outside of Quebec have to pay for all medical services on the spot and then must wait for reimbursement, which some students say rarely comes back in full.
Meanwhile, most other out-of-province students only need to pay out of pocket for prescriptions and specialty services, such as optometry and dental care, during their time at King’s.
The difference stems from Quebec’s decision not to participate in the Reciprocal Medical Billing Agreement. This program, organized in the late eighties, allows physicians to bill their own provincial or territorial medical care plans for services provided to patients from other parts of Canada. The doctor is paid for the treatment through their province’s medical care plan and then this group recovers the payment amount from the plan of the patient’s home province or territory. Quebec is the only province that opted out.
Melissa Nacke is a Montreal student who has had a hard time with health during her time at Dalhousie. She faced a nasty surprise the first time she went for a doctor’s appointment in Halifax. She paid around $40 up front for the appointment. The clinic gave her a form to fill out for reimbursement by the Régie de l’assurance maladie Québec (RAMQ), the province’s health care provider, and assured her she would get her money back, but she says she was only reimbursed around half the cost.
“I’m running on a very minimal budget being a student,” said Nacke. “Like, most of the time groceries are even an issue, so trying to pay for a doctor’s appointment that you don’t even want to pay for upfront is hard, and then when you don’t even get all of [the money] back, it’s frustrating.”
These reimbursement differences are attributed to the structure of the Quebec health insurance plan. Under the plan, students studying out of province are reimbursed in full for all emergency hospital costs and at a rate of 75 per cent for other situations, as long as the same services are covered in Quebec. This plan excludes prescription costs, transportation, requests for medical records and visits to a psychologist or podiatrist.
“Most of the time groceries are even an issue, so trying to pay for a doctor’s appointment that you don’t even want to pay for upfront is hard”
– Melissa Nacke, Dalhousie student
A complicated process
However, in many cases Quebec students studying out of province who receive services that meet these requirements still are not reimbursed the full 75 per cent. RAMQ only will reimburse 75 per cent of what the procedure would cost in Quebec, where rates are usually lower.
For example, a general appointment with a family doctor (excluding costs for certain tests or prescriptions) will cost $32 in Nova Scotia, $40 in Ontario and $60 dollars in Alberta. The same service costs $40 in Quebec, meaning a Quebec student studying anywhere in Canada would be reimbursed $30, no matter what he or she paid out of pocket.
The Canada Health Act (CHA) states its purpose is to provide reasonable access to health services “…without financial or other barriers.” However, since the CHA is a piece of federal legislation and health care is constitutionally a provincial responsibility, provinces such as Quebec have the authority to regulate basic structures including insurance.
Quebec students need to notify RAMQ each year that they are studying out of the province by submitting proof of enrollment papers from their university.
Upon receiving medical services, they must have the nurse-doctor-practitioner fill out a special form indicating the details of the visit and its cost. Some students say clinics have been confused when they ask to fill out the forms.
The students then submit the form along with the original receipts to RAMQ and sit on their hands for the reimbursement cheque.
Green Shield support
Students aren’t totally alone in handling these costs, says King’s Student Union (KSU) internal coordinator John Adams. The KSU’s Green Shield Canada health plan covers 20 per cent of prescriptions up to $1,000 per year, per student. Students are automatically placed on the plan, costing them $126.60 for the health fee and $58.80 for the dental fee, annually.
The Green Shield program covers students for dental and optometry cost, and also helps lower prescription prices. But the plan is meant to complement provincial health insurance coverage, meaning Nacke and other Quebecers still are on their own for appointment costs.
To make up for reimbursement differences, RAMQ suggests students studying out of province apply for travel insurance. Through a program such as Blue Cross this coverage could end up costing around $290.00 per semester.
Get your daily dose of vitamins, Quebecers.