The APTS group insurance plan is designed to meet our members’ specific needs. Regular surveys conducted with a significant sample of our membership allow members to specify their expectations so that coverage can be adjusted accordingly.
WHAT TYPES OF COVERAGE ARE AVAILABLE TO ME?
The APTS health insurance plan allows you to choose between three levels of coverage: basic, intermediate, and superior. The main differences involve the range of services that are covered and the maximum amounts for reimbursement claims.
The APTS also provides life insurance and long-term disability insurance plans. Both are mandatory, ensuring that all APTS members benefit from financial security regardless of the state of their health. You can increase your life insurance coverage by requesting additional insurance.
How much does my insurance cost me?
Rates are set every year with the insurer, on the basis of claims filed by our group. The group’s claims experience – meaning the total cost of claims filed by all insured persons – is a key factor when the time comes to determine yearly rates.
CALCULATE your insurance premium for the current year
New rates for 2023
What kind of disability coverage will I have if I get sick?
First, there is a waiting period. If you have a full-time position, this will be covered by your sick leave days; if you have a part-time position or do not have a position, the waiting period will not be compensated. The subsequent 104 weeks will be compensated by your employer. After that, compensation will be provided by the insurer (Beneva) in the form of long-term disability insurance benefits.
Long-term disability insurance benefits are payable until you reach the age of 65. To be eligible for benefits during the first 48 months of disability, you must be unable to work. To keep on receiving benefits after that, you must be unable to perform any kind of gainful employment.
For more information, see the booklet on Disability insurance and medical arbitration.
Do I have to participate in the APTS health insurance plan when I have an employment relationship with an institution that is part of the health and social services system?
Yes, unless you belong to another group insurance plan that covers prescription drugs. Under the Act respecting prescription drug insurance, if you are part of a group insurance plan, you must obtain prescription drug coverage for yourself and your dependents. However, once you turn 65, you may choose either to register for the public RAMQ plan or to keep the coverage provided by your group plan.
If you are eligible for another group insurance plan (such as your spouse’s plan, for instance), you can ask your employer to exempt you from the APTS health insurance plan.
Why is it that some forms of coverage are not included in the APTS insurance plan, and yet are available under other plans?
Forms of coverage and maximum claims amounts vary from one plan to another. A number of factors are involved, including the needs of the people who are insured and the premiums associated with each type of coverage. With group insurance, the cost of premiums is based on the number and amount of claims filed by those covered by the plan. The more generous the reimbursements, the higher the premiums.
If there are frequent requests to improve a given form of coverage, the social security sector calculates the impact on premiums. When a higher premium is involved, members are consulted to find out if a majority wants to make the change. These surveys are carried out approximately every two years.
Why don’t we shop around more often for an insurer? That’s what I do when I need to insure my car or my home.
An individual policy for car insurance, for instance, doesn’t work in the same way as a group insurance plan. With individual insurance policies, all of the risk is borne by the insurer, who receives a premium in exchange. With group insurance, much of the risk is borne by the insured group. This means that almost the entire cost of the group insurance premiums goes to cover the amount the plan needs to reimburse all the claims. Less than 10% of the value of the premiums is used to compensate the insurance company for managing the plan, i.e., paying out benefits, managing changes applying to participants, developing and providing access to online tools to facilitate claims reimbursement, sending out information, and preparing booklets.
For this reason, despite what many of us might expect, changing insurance companies would not lead to any substantial reduction in premiums.
Can I make a claim online?
Yes, you can make a claim online through the Beneva Customer Centre.
When can I add dental care coverage if I didn’t ask for it when I was hired?
The dental care insurance plan is optional. You can request it at any time; coverage will begin with the pay period following the date on which your employer receives your application. If you are on disability leave when you apply, the coverage will begin with the pay period following your full return to work.
To apply for dental care coverage, contact your employer.
Once you request this coverage, you will have to keep it for at least 48 months before you will be allowed to terminate it.
When can I ask for increased health care insurance coverage if I want to move up to the intermediate or superior level?
You can ask for increased coverage at any time. Your request must be sent to your employer, and once your application has been received by Beneva, your new coverage will take effect on January 1 or July 1 (whichever comes first).
Once you choose the intermediate or superior level, you have to keep it for at least 24 months before you can ask for reduced coverage.
What can I do to reduce the cost of insurance premiums?
To reduce premiums, you can shop around to find the least expensive pharmacy, buy medication only when you need it, and file claims with any organization that is providing you with compensation (such as the CNESST for a workplace injury, or the SAAQ for an injury resulting from a car accident). You can also ask your pharmacist to renew your prescriptions every three months rather than once a month if your dosage is not likely to change.
Of course, what would really give us significantly lower premiums would be a public, universal pharmacare plan.
How can I get more information?
Our team can answer your questions on insurance topics, including long-term disability insurance and how to interpret the insurance contract or the national provisions of the collective agreement. We also work closely with the employer to settle disputed claims. You can write to us at firstname.lastname@example.org or use the box below to SEND US A MESSAGE