VIH Info Droits


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We are insured in many aspects of our lives: health insurance, prescription drug insurance, car insurance, liability insurance, etc. But is being insured a right? Yes, but also no, it all depends on the type of insurance. 

1. Should you disclose your HIV status to your insurer or not?

When signing up for insurance, you must disclose your HIV status if it is explicitly asked of you as you are making the insurance contract. This also includes if they ask you to disclose any medical condition that an insurer would want to know about. The disclosure is used to determine your health and the financial risk you represent for the insurer. However, there is no obligation to disclose your HIV status if the insurance company does not ask you a question pertaining to your health, as it is often the case with group insurances.

A person who fails to disclose their HIV status after explicitly being asked about their health could have their insurance contract cancelled and even be accused of fraud for making a false claim. A person who is diagnosed after they have signed their insurance contract does not need to disclose their HIV status as it is the health of the insured person at the time of signing the contract that is relevant.

2. Can an insurer who knows my HIV status refuse to give me insurance?

Officially, yes. Is this discriminatory? Even though the Charter of human rights and freedoms provides that it is forbidden to refuse to contract with a person because of a handicap, the same text also permits insurance companies to select customers based on their health status and that this does not constitute discrimination. The insurer can therefore refuse to insure a person based on a handicap or in this case, HIV status.

As such, it is not recommended to a person living with HIV to apply for an individual private insurance before learning the policies of the insurance company in terms of HIV status. Indeed, it is not only probable that the insurer will refuse the person insurance, but also that they will transmit the information to all other Canadian insurers.

2.1 What about group insurances?
There is an exception to the right to refuse to contract with a person based on their handicap or HIV status: group insurances. In fact, in the case of group insurances, insurers have the obligation to offer the same coverage to all members of the insured group, regardless of health condition.

Therefore, a seropositive person who is part of an insured group (for example a group of employees, a union, or a student covered by a group insurance) must have access to the same coverage as everyone else in the group. Optional complimentary insurance, often covering dental or vision fees, is considered to be an individual insurance and could therefore be refused. 

3. The different types of insurance

3.1 Health Insurance 

Health insurance, that covers medical fees, medical consultations, and hospitalisation is offered to all residents of Quebec by the Régie de l’assurance maladie du Québec (RAMQ) and is paid by public funds. Every resident of Quebec and those who are staying in Quebec must sign up for this insurance. 

Those who are staying in Quebec temporarily must verify which coverage is available to them depending on their type of visa and the agreements between their country or province and the RAMQ. Foreign students, temporary workers, and their spouses and children are all included in the definition of those who are temporarily residing in Quebec. Visitors and tourist are excluded from this definition. 

In fact, those who are staying in Quebec but are still benefiting from an insurance plan in their home country or province are not eligible for RAMQ. It is therefore important that these people contact their insurer when they plan to stay in Quebec in order to ensure coverage and not be stranded without any insurance coverage. 

Residents of Quebec who are going abroad must tell the RAMQ if their stay will be 183 days or more. With few exceptions, you will not be covered by RAMQ if you are absent from Quebec for 183 days or more in the same calendar year. For trips that are under 183 days, you will still be covered for certain services. It is recommended to consult the RAMQ to find out which services are covered and how to obtain supplementary private insurance. 

For more information, visit the RAMQ website

3.2 Prescription drug Insurance

Universal prescription drug insurance is compulsory and is guaranteed by the Act respecting prescription drug insurance. Therefore, each Quebec resident has the right to be covered by prescription drug insurance, meaning there is a limit to the maximum amount a resident would need to pay for prescription drugs each year.

There are two different plans: the private plan, offered by certain groups to their members (e.g. employers, unions, professional associations, etc.) or the Public Prescription Drug Insurance Plan. Each person who is eligible for a private plan must register themselves onto this plan, as well as their spouses and children. Only those who do not have access to a private plan are eligible for the public plan. 

If you are on the public plan yet are eligible for the private plan, you could find yourself having to reimburse some costs to the RAMQ. Visit the RAMQ website to learn more.

The same guarantees are applicable to both plans:

The maximum amount that an insured person will have to pay for prescription drugs is fixed by the Act. This contribution is only applicable to the amount the insured person needs to pay for the prescription drugs, it is not applicable to premiums, which are the price of the insurance itself. The maximum amount to be payed is currently fixed at $1161 per year*.  The cost of the premium varies yearly: for those insured by the public plan it depends on income (the premiums will be $0 to $710*) and for those insured by the private plan, it depends on the negotiations with the group providing the insurance (the union, the employer, etc). 

There is one exception: employees of the federal Crown, and therefore eligible for a federal plan, do not have the same maximum amount. For them it is higher. They can still be registered with RAMQ in addition to their federal plan but RAMQ will only cover up to $1161 in prescription drugs. Employees of the federal Crown who would like to benefit from RAMQ’s insurance will have to pay the premium on both their federal and provincial plans.

*valid as of November 1, 2019

The prescription drugs covered by each plan are the same. These drugs are listed in regulations. 

Certain prescription drugs are not covered by RAMQ and do not have to be covered by private insurance either: these are exceptional prescription drugs, often considered too expensive or ineffective in comparison to other drugs with the same pharmacotherapeutic properties. However, it is possible to request that these drugs be covered if the patient cannot take the approved medication, if the patient has developed a tolerance to the approved medication, or if this medication is contraindicated to the patient. The doctor must fill out a form and make a special request for reimbursement with the RAMQ or seek prior authorization from the private insurer, depending on the circumstances. 

3.3 Disability Insurance 
Disability insurance guarantees a revenue for a person who is no longer able to work. It is also offered within group insurance plans. The insurer must first establish the disability, be it permanent or temporary, and then offer a certain indemnity. 

The insurer must establish in advance the physical conditions for which they will not provide an indemnity. These conditions must be explicitly mentioned in the insurance policy. Except in cases of fraud, the insurer cannot exclude from the insurance’s general coverage physical conditions not mentioned by the insured, except if the disability results from the condition in the 2 years following the signing of the insurance contract. 

This means that an insurer can reduce the coverage for a disability resulting from a preexisting condition, unmentioned in the policy, if the disability occurs within two years of signing the contract. Generally, these exclusion clauses foresee conditions for which the recipient was treated within a specified time period. 

Those who do not have disability insurance can benefit from a public pension plan or social solidarity for those who have severe work constraints. 

3.4 Life Insurance 
Life insurance allows beneficiaries to receive an indemnity following the death of the title holder. It is often made to cover the costs of a funeral and to leave some money to the deceased’s descendants. It can be required in certain circumstances, such as to become a shareholder in a company or to obtain a mortgage. For people living with HIV, it can be very difficult, even impossible, to obtain individual life insurance. Until this day, insurance companies (HumaniaSunlife and Manulife) have extended their insurancecoverage to people living with HIV under certain conditions. Hopefully, other insurance companies will follow suit in light of the medical and scientific advances of the past years. 

Group insurances must provide the same insurance for HIV positive people as all other group members. This is therefore a good way to acquire life insurance. It is also possible for people under 65 years-old to transform their group insurance into individual insurance within 31 days of leaving the insured group. However, you must pay the full premiums, which were until then absorbed in part by the group. It is best to speak to your insurer if you are planning to leave your work.

It is also worth asking if other guarantees are possible or accepted when a bank or company requires life insurance. Sometimes a bond of indemnity (a security) or a change of beneficiary from an existinginsurance plan can be an effective solution and would allow you to participate in a variety of contractual relations regardless of your HIV status.

VIH INFO DROITS does not provide legal advice or counsel.

The information in this document is not intended to council the public, and does not replace the services of a lawyer. 

Although we monitor legal developments, we cannot guarantee that the information presented here is up to date. COCQ-SIDA cannot be held responsible for any damages resulting from the use of the information contained in this document.