A-29, r. 7.2 - Regulation respecting the terms and conditions for the issuance of health insurance cards and the transmittal of statements of fees and claims

Section 11 Disposition versions

2018-06-28

11. (Revoked).

R.R.Q., 1981, c. A-29, r. 2, s. 11; O.C. 1471-92, s. 5; O.C. 1756-92, s. 3; O.C. 1522-96, s. 2; O.C. 1089-2011, s. 1; O.C. 659-2018, s. 7.

2012-09-01

11. Request for payment or reimbursement by an insured person

(1)  For services received outside Québec: Every insured person who exacts reimbursement by the Board of the cost of insured services furnished to him outside Québec from a professional in the field of health or who requests the Board to assume on his behalf the payment of the cost of services, must transmit to the Board:

(a)  in the case of an application for reimbursement, the originals of the receipts of the fees paid by him and provide the information required by the Board to justify the reimbursement claimed; or

(b)  in the case of a claim, the originals of the statements of account and provide the information required by the Board to justify the payment claimed.

The originals of receipts of fees and of statements of account must be duly signed by every health professional who rendered the insured services.

(2)   For services obtained from a professional who has withdrawn: Every insured person who exacts from the Board payment of the cost of the insured services furnished to him in Québec by a professional who has withdrawn, must send to the Board a request for payment form duly signed and completed by the professional according to the form and tenor of Forms 3 (physicians), 4 (dentists) or 5 (optometrists).

(3)  (paragraph revoked);

(4)  For services obtained in Québec from a professional subject to the application of an agreement, by an insured person who has not presented his health insurance card or his claim booklet, as the case may be: Every insured person who has not presented his health insurance card or his claim booklet, as the case may be, and who exacts from the Board payment or reimbursement of the cost of the insured services furnished to him in Québec by a professional subject to the application of an agreement, must send to the Board a request for payment or reimbursement form duly completed and signed by the professional according to the form and tenor of Forms 26 (physicians), 27 (dentists) or 28 (optometrists).

(4.1)  Every insured person who has not presented his health insurance card or claim booklet, as the case may be, every person who resides in Québec, as well as a person who is referred to in paragraph 4 of section 15 of the Act respecting prescription drug insurance (chapter A-29.01), who is not registered with the Board under section 19 of that Act and who requires that the Board reimburse him for the cost of insured services provided to him in Québec by a pharmacist covered by the agreement must send the Board an application for reimbursement containing the following information:

(a)  the elements provided for in section 9.1 in a section of the application reserved for the pharmacist;

(b)  in a section of the application reserved for the insured person, the address of the insured person’s domicile and, if different, the address at which he wishes to receive the reimbursement;

(c)  an indication by the insured person to the effect that his health insurance card has expired, where such is the case;

(d)  an indication by the insured person to the effect that he has never applied for a health insurance card, where such is the case, or no longer has one, where such is the case; in the latter case, the date on which he notified the Board to that effect;

(e)  an indication by the insured person that he holds a health insurance card or a claim booklet, but that he presented neither of them, where such is the case;

(f)  an indication by the insured person that he has not yet received, where such is the case, a health insurance card that he applied for or for which he requested a replacement; in the latter 2 cases, the date of the application;

(f.1)  an indication by the insured person to the effect that he is not registered for the prescription drug insurance plan;

(g)  the insured person’s signature and the date on which he signed.

The insured person’s application for reimbursement must also contain the following mention above the space reserved for the insured person’s signature:

“I certify that the above information is accurate and I request a reimbursement for the cost of the services received”.

(5)  (paragraph revoked).

R.R.Q., 1981, c. A-29, r. 2, s. 11; O.C. 1471-92, s. 5; O.C. 1756-92, s. 3; O.C. 1522-96, s. 2; O.C. 1089-2011, s. 1.