Know which services are covered outside Québec

Trip or temporary stay in Canada

Professional services

The professional services covered are those rendered by doctors, dentists and optometrists, if they are covered in Québec. We issue reimbursements for professional services at amounts not exceeding Québec rates, even if you paid more.

Procedure to follow

When you receive healthcare from a private office or at a hospital, you must present your Québec Health Insurance Card. The doctor may accept the card or refuse it if they do not agree to be paid according to the applicable Québec rates.

If the doctor accepts the card: you do not have to pay for the healthcare, and we pay them for the services rendered.

If the doctor refuses the card: you must pay the doctor’s fee. Subsequently, you may apply for a reimbursement. Make sure you obtain and keep the following documents:

• Operative report, if you underwent major surgery
• Original of your invoices and receipts (credit card payment slips or photocopies of both sides of your cashed cheques showing the name of the hospital or health professional)

Hospital services

The hospital services covered are those insured under the Hospital Insurance Plan, specifically, services received during a hospital stay or at a hospital outpatient clinic. These services include:

• Nursing care
• Certain diagnostic procedures
• Accommodation in a ward (a room with 3 or more beds)
• Prescription drugs administered during hospitalization

You are not required to pay for hospital services you receive, because their cost is paid in full by RAMQ under an interprovincial agreement regarding these services. Don’t forget to present your Health Insurance Card!

Trip or temporary stay outside Canada

Professional services

The professional services covered are those rendered by doctors, dentists and optometrists, as long as the same services are covered in Québec. We issue reimbursements for professional services at amounts not exceeding Québec rates, even if you paid more.

Procedure to follow

If you have a private insurance and consult a doctor at a hospital or in a private office, you may ask the doctor to submit the invoice to your insurance company.

If you do not have a private insurance, you must pay the doctor’s fee. Subsequently, you may apply for a reimbursement. Make sure you obtain and keep the original of your invoices and receipts (credit card payment slips or photocopies of both sides of your cashed cheques showing the name of the hospital or health professional).

Hospital services

The hospital services covered are those insured under the Hospital Insurance Plan, specifically, services received during a hospital stay or at a hospital outpatient clinic. These services include:

• Nursing care
• Diagnostic procedures
• Accommodation in a ward (a room with 3 or more beds)
• Prescription drugs administered during hospitalization

We reimburse the cost of hospital services received as a result of a sudden illness or an accident. The preset rates are as follows:

• A maximum of CA$100 per day of hospitalization
• A maximum of CA$50 per day for healthcare received at a hospital outpatient clinic

For hemodialysis and the required medication, we reimburse up to CA$220 per treatment, whether you are hospitalized or not.

Procedure to follow

If you have a private insurance, you may ask the hospital to submit the invoice to your insurance company. They will request reimbursement on your behalf.

If you do not have a private insurance, you must pay for the services you receive. Subsequently, you may apply for a reimbursement. The amount reimbursed for hospital services will be determined according to the applicable Québec rates. Make sure you obtain and keep the following documents:

• Operative report, if you underwent major surgery
• Original of your invoices and receipts (credit card payment slips or photocopies of both sides of your cashed cheques showing the name of the hospital or health professional)

Special coverage

Certain situations allow you to benefit from a special coverage and extend it to your spouse and dependants. Under certain conditions, you remain covered by the Health Insurance Plan during a temporary stay outside Québec if you are:

• A students
• An unpaid trainee
• A Québec government employee
• A non-profit organization employee

Refer to the Inform RAMQ of a departure from Québec webpage to find out if you are eligible for special coverage in your situation.

When you benefit from a special coverage, we pay on certain conditions the full cost of hospital services received in an emergency and 75% of the cost in other circumstances. However, is you are vacationing away from your usual place of study, training or work, the regular coverage for hospital services applies, not the special coverage. In all cases, the special coverage does not apply for professional services.

Services not covered

Certain services received outside Québec are not covered by the Health Insurance Plan. If you do not take out private insurance for these services before leaving Québec, you must pay their full cost yourself. Here are a few examples:

• Any medical services not covered in Québec
• Services rendered by a health professional other than a doctor, a dentist or an optometrist
• The cost of a private or semi-private hospital room
• Emergency transportation, by ground or air
• The cost of bringing a person back to Québec
• Drugs purchased outside Québec, even if prescribed by a physician (before leaving Québec, if you regularly take prescription drugs, ask your pharmacist whether you may obtain the drugs you will need during your absence