A-28 - Hospital Insurance Act

Section 11 Disposition versions

2019-06-13

11. No insurer may enter into or maintain an insurance contract that includes coverage for the cost of an insured service furnished to a resident.

No person may establish or maintain an employee benefit plan that includes coverage for the cost of an insured service furnished to a resident.

An insurance contract or employee benefit plan inconsistent with the first or the second paragraph, as the case may be, that also covers other goods and services remains valid as regards those other goods and services, and the consideration provided for the contract must be adjusted accordingly unless the beneficiary of the goods and services agrees to receive equivalent benefits in exchange.

Nothing in this section prevents an insurance contract or an employee benefit plan that covers the excess cost of insured services rendered outside Québec from being entered into or established.

“Insurer” means a legal person authorized by the Autorité des marchés financiers to carry on insurance of persons activities.

“Employee benefit plan” means a funded or unfunded uninsured employee benefit plan that provides coverage which may otherwise be obtained under a contract of insurance of persons.

An insurer or a person administering an employee benefit plan that contravenes the first or second paragraph is guilty of an offence and is liable to a fine of $50,000 to $100,000 and, for a subsequent offence, to a fine of $100,000 to $200,000.

R. S. 1964, c. 163, s. 10; 1971, c. 48, s. 161; 1992, c. 21, s. 98; 2006, c. 43, s. 41; 2018, c. 23, s. 720.

2008-01-01

11. No insurer may enter into or maintain an insurance contract that includes coverage for the cost of an insured service furnished to a resident.

No person may establish or maintain an employee benefit plan that includes coverage for the cost of an insured service furnished to a resident.

An insurance contract or employee benefit plan inconsistent with the first or the second paragraph, as the case may be, that also covers other goods and services remains valid as regards those other goods and services, and the consideration provided for the contract must be adjusted accordingly unless the beneficiary of the goods and services agrees to receive equivalent benefits in exchange.

Nothing in this section prevents an insurance contract or an employee benefit plan that covers the excess cost of insured services rendered outside Québec from being entered into or established.

“Insurer” means a legal person holding a licence issued by the Autorité des marchés financiers that authorizes it to transact insurance of persons in Québec.

“Employee benefit plan” means a funded or unfunded uninsured employee benefit plan that provides coverage which may otherwise be obtained under a contract of insurance of persons.

An insurer or a person administering an employee benefit plan that contravenes the first or second paragraph is guilty of an offence and is liable to a fine of $50,000 to $100,000 and, for a subsequent offence, to a fine of $100,000 to $200,000.

R. S. 1964, c. 163, s. 10; 1971, c. 48, s. 161; 1992, c. 21, s. 98; 2006, c. 43, s. 41.

1992-10-01

11. (1)  No one shall make or renew, or make a payment under a contract under which

(a)  a resident is to be provided with or to be reimbursed for the cost of any hospital service that is one of the insured services;

(b)  payment is conditional upon the hospitalization of a resident; or

(c)  payment is dependent upon the length of time the resident is a patient in a facility maintained by an institution contemplated in section 2.

(2)  This section does not apply for such time after a person arrives in Québec as a resident as he is not an insured person.

(3)  This section does not prohibit a contract or a payment under a contract under which a resident is to be reimbursed or indemnified for

(a)  the cost of any hospital service other than the insured services; or

(b)  (subparagraph repealed);

(c)  loss of time because of disability, whether or not the date of the commencement of the benefit is determined by reference to the date of admission to the institution contemplated in section 2, if the rate of payment is not increased by the hospitalization of the resident.

(4)  No resident shall receive, under one or more contracts to which the next preceding subsection applies, a total sum, in respect of the cost of any hospital service that is not an insured service, that is in excess of the actual charges made for the service by the institution contemplated in section 2.

(5)  This section applies

(a)  to the making or renewing, since 1 January 1961, of a contract that provides for a benefit described in subsection 1; and

(b)  to a payment in respect of hospital services rendered on or since 1 January 1961, except a payment under a contract that is not a group contract for hospital services rendered before 1 April 1961, or before the anniversary in 1961 of the making or renewing thereof, if it occurs before that date.

(6)  In this section, “group contract” means a contract of insurance whereby two or more persons other than members of the same family are insured severally under a single contract of insurance.

R. S. 1964, c. 163, s. 10; 1971, c. 48, s. 161; 1992, c. 21, s. 98.

1977-12-31

11. (1)  No one shall make or renew, or make a payment under a contract under which

(a)  a resident is to be provided with or to be reimbursed for the cost of any hospital service that is one of the insured services;

(b)  payment is conditional upon the hospitalization of a resident; or

(c)  payment is dependent upon the length of time the resident is a patient in a hospital centre.

(2)  This section does not apply for such time after a person arrives in Québec as a resident as he is not an insured person.

(3)  This section does not prohibit a contract or a payment under a contract under which a resident is to be reimbursed or indemnified for

(a)  the cost of any hospital service other than the insured services;

(b)  the cost of fees for professional services whether or not the services are rendered in a hospital centre; or

(c)  loss of time because of disability, whether or not the date of the commencement of the benefit is determined by reference to the date of admission to hospital centre, if the rate of payment is not increased by the hospitalization of the resident.

(4)  No resident shall receive, under one or more contracts to which the next preceding subsection applies, a total sum, in respect of the cost of any hospital service that is not an insured service, that is in excess of the actual charges made for the service by the hospital centre.

(5)  This section applies

(a)  to the making or renewing, since 1 January 1961, of a contract that provides for a benefit described in subsection 1; and

(b)  to a payment in respect of hospital services rendered on or since 1 January 1961, except a payment under a contract that is not a group contract for hospital services rendered before 1 April 1961, or before the anniversary in 1961 of the making or renewing thereof, if it occurs before that date.

(6)  In this section, “group contract” means a contract of insurance whereby two or more persons other than members of the same family are insured severally under a single contract of insurance.

R. S. 1964, c. 163, s. 10; 1971, c. 48, s. 161.