3. The cost of the following services rendered by a professional in the field of health are assumed by the Board on behalf of every beneficiary, in accordance with this Act and the regulations:(a) all services rendered by physicians that are medically required;
(b) the services of oral surgery determined by regulation and required by dentistry and rendered by a dentist in a centre operated by a university establishment or in a facility maintained by an institution operating a hospital centre, provided, however, that if rendered in Québec they are rendered in a centre operated by a university establishment determined by regulation or in a facility maintained by an institution operating a hospital centre by a dentist authorized to practise in that centre;
(c) the services determined by regulation and required by optometry and rendered by optometrists in the practice of optometry within the meaning of the Optometry Act (chapter O-7); however, the cost of such services shall be assumed by the Board only on behalf of a beneficiary whose age is that fixed for that purpose by regulation or who holds a valid claim booklet issued pursuant to section 71 or 71.1;
(d) family planning services determined by regulation and furnished by a physician.
The cost of services determined by regulation and required by dentistry and rendered by dentists are also assumed by the Board in accordance with this Act and the regulations on behalf of every beneficiary according to his age and according as to whether or not he holds a valid claim booklet issued pursuant to section 71.1.
The Board also assumes, in accordance with the provisions of this Act and the regulations and subject to the Act respecting prescription drug insurance (chapter A-29.01), the cost of the services determined by regulation that are required for pharmaceutical reasons and furnished by pharmacists, the cost of medications furnished by pharmacists on the prescription of a physician, a resident in medicine or a dentist and, where applicable, the cost of medications provided as part of the services provided by an institution in accordance with the third paragraph of section 8 of the Act respecting prescription drug insurance, on behalf of every beneficiary who is an eligible person within the meaning of that Act and who(a) is 65 years of age or over and is not a member of a group insurance contract or employee benefit plan applicable to a group of persons determined on the basis of current or former employment status, profession or habitual occupation and that includes basic plan coverage, and is not a beneficiary under such a plan, or
(b) holds a valid claim booklet issued under section 70, or
(c) is not required to become a member of a group insurance contract or employee benefit plan referred to in paragraph a and in whose respect no person is required, in accordance with section 18 of the said Act, to ensure coverage as a beneficiary under such a contract or plan.
The Board also assumes, in accordance with the provisions of this Act and the regulations and subject to the Act respecting prescription drug insurance, the cost of the services determined by regulation that are required by pharmacy and furnished by pharmacists, the cost of medications furnished by pharmacists on the prescription of a physician, a resident in medicine or a dentist and, where applicable, the cost of medications provided as part of the services provided by an institution in accordance with the third paragraph of section 8 of the Act respecting prescription drug insurance, to every beneficiary who is an eligible person within the meaning of that Act and who holds a valid claim booklet issued under section 71.
The Board also assumes, on behalf of every beneficiary whose age is that fixed for such purposes by regulation, the amount determined for services and for prostheses, orthopedic devices, locomotor or posture assists, medical supplies or other equipment compensating for a physical deficiency. The cases, circumstances and conditions in and on which the Board assumes the amount of those insured services, the cases, circumstances and conditions in and on which such services are furnished, the amount assumed by the Board as well as the physical deficiencies and insured services contemplated shall be determined by regulation.
The Board reimburses to an institution recognized for that purpose by the Minister the cost of purchase, fitting, replacement or repair of visual aids, determined by regulation, lent by the institution to a beneficiary who is a visually handicapped person whose age is that fixed for such purpose by regulation. The cases, circumstances and conditions in and on which the Board reimburses the cost of those insured services and the cases, circumstances and conditions in and on which such services are furnished shall be determined by regulation. The visual aids lent to a visually handicapped person are unassignable and unseizable.
The Board also assumes on behalf of every beneficiary who is a person with a hearing handicap whose age is that fixed for such purpose by regulation, the cost of purchase, fitting, replacement or repair of hearing aids determined by regulation. The cases, circumstances and conditions in and on which the Board assumes the cost of those insured services and the cases, circumstances and conditions in and on which such services are furnished shall be determined by regulation.
Not in force
The Board shall reimburse to an institution recognized for that purpose by the Minister the cost of purchase, fitting, replacement or repair of communication devices determined by regulation, lent by the institution to a beneficiary with a communication-related physical deficiency and whose age is that fixed for such purpose by regulation. The cases, circumstances and conditions in and on which the Board reimburses the cost of those insured services and the cases, circumstances and conditions in and on which they are furnished shall be determined by regulation. The communication devices lent to a beneficiary with a communication-related physical deficiency are untransferable and unseizable.Not in force
The Board shall publish the list of institutions recognized by the Minister for the purposes of the sixth and eighth paragraphs and each update thereof in the Gazette officielle du Québec, which will come into force on the date they are published or on any date fixed therein.However, such services, medications, prostheses and orthopedic devices, locomotor or posture assists, medical supplies or other equipment, visual or hearing aids or communication devices do not include those which a person may obtain and is entitled to under another statute of Québec, an Act of the Parliament of Canada other than the Canada Health Act (Revised Statutes of Canada, 1985, chapter C-6) or a statute of another province of Canada or another country.
However, the services contemplated in the first paragraph to which a person is entitled under the Act respecting health services and social services (chapter S-4.2), the Act respecting health services and social services for Cree Native persons (chapter S-5), the Hospital Insurance Act (chapter A-28) and the Act respecting prescription drug insurance (chapter A-29.01) or which are rendered pursuant to the Act respecting occupational health and safety (chapter S-2.1) remain insured services under this Act.
The Board also assumes the cost of the services rendered by a professional in the field of health pursuant to the Workmen’s Compensation Act (chapter A-3) or to the Act respecting industrial accidents and occupational diseases (chapter A-3.001), including those rendered by a member of the Bureau d’évaluation médicale or a member of an occupational lung diseases committee or a special committee acting under Chapter VI of the latter Act, except the services rendered by a professional in the field of health at the employer’s request.
The Board also assumes, in accordance with the provisions of the Act and the regulations, the cost of services rendered by a health professional in the discharge of activities or administrative tasks determined by a regulation made under section 69.
The Board also assumes the cost of services and goods provided under the programs it administers by virtue of the first paragraph of section 2 of the Act respecting the Régie de l’assurance-maladie du Québec (chapter R-5) according to the conditions and methods provided for under those programs.
Any service furnished by a physician who is in a period of training to obtain his first specialist’s certificate is not an insured service unless it is furnished in a centre operated by an institution other than that where he is in a period of training or for the Corporation d’urgences-santé de la région de Montréal Métropolitain. Where he furnishes a service that is not an insured service within the meaning of this section to a person residing in Québec, he must inform that person, in the cases and form prescribed, that the service is not an insured service.
1970, c. 37, s. 3; 1970, c. 38, s. 2; 1971, c. 47, s. 2; 1971, c. 48, s. 160, s. 161; 1973, c. 30, s. 2; 1973, c. 49, s. 45; 1973, c. 52, s. 31; 1974, c. 40, s. 2; 1975, c. 60, s. 1; 1977, c. 44, s. 2; 1979, c. 1, s. 2; 1979, c. 63, s. 273; 1981, c. 22, s. 1; 1985, c. 6, s. 488; 1986, c. 79, s. 2; 1989, c. 50, s. 2; 1991, c. 42, s. 558; 1992, c. 19, s. 1; 1992, c. 21, s. 101; 1985, c. 23, s. 1; 1992, c. 21, s. 101, s. 375; 1992, c. 11, s. 77; 1994, c. 8, s. 2; 1994, c. 23, s. 23; 1996, c. 32, s. 89.