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Gouvernement du Québec
Régie de l’assurance maladie

Medical services

The Medical Services Program is a universal program, which means that anyone insured by the Health Insurance Plan is eligible. To benefit from this program, just present your valid Health Insurance Card.

Covered services

The medical services covered by the Health Insurance Plan are those that are medically necessary and rendered by a general practitioner (also called a "family doctor") or a medical specialist. These services include:

  • consultations
  • examinations
  • diagnostic and therapeutic procedures
  • psychiatric treatments

Barring rare exceptions, the above services are covered regardless of where they are rendered, for instance in:

  • medical clinics
  • hospitals
  • local community service centres (CLSCs)
  • residential and longterm care centres (CHSLDs)
  • rehabilitation centres
  • the patient’s home

Other covered services

Professional and hospital services

Health care received in Québec is covered for the following persons:

  • Those eligible for the Québec Health Insurance Plan, even if their Health Insurance Card is expired
  • Those not eligible for the Québec Health Insurance Plan and without any coverage provided by their country of origin, a federal government program or a private insurance contract

Health care received outside Québec is covered for persons eligible for the Québec Health Insurance Plan, in accordance with the usual plan requirements. For more information, go to the webpage Know which services are covered outside Québec.

Services rendered only for cosmetic reasons are not covered by the Health Insurance Plan. However, doctors may ask RAMQ to cover a plastic surgery service if it is medically necessary. They must practise within the scope of the public plan and have the skills required to perform the surgery. RAMQ will then determine whether the service can be covered.

Here are examples of services that require authorization:

  • blepharoplasty (excision of any excess eyelid tissue)
  • correction of a scar elsewhere than on the face or neck
  • gynecomastia treatments (removal of excess glandular tissue in men)
  • lipectomy (surgery to remove fatty tissue and surplus skin)
  • funnel chest treatment (pectus excavatum)

Consult your doctor to find out more.

The Health Insurance Plan covers a wide range of essential medical services. However, in exceptional cases, some services may not be offered in Québec. In such cases, your doctor can request RAMQ’s authorization to receive healthcare outside Québec.

How to proceed

Your doctor must provide RAMQ with the following:

  • a brief description of the medical care required
  • a written request signed by 2 Québec medical specialists having recognized expertise in the disease from which you suffer and attesting that the services required are not available in Québec
  • the name of the doctor whose services are required and the address of the hospital where he/she practices (the hospital being recommended)
  • a summary of your medical record
RAMQ's decision

RAMQ will evaluate the request and inform you and your medical specialists of its decision. If RAMQ grants an authorization, it will pay the full cost of:

  • hospital services (services related to a hospital stay, such as nursing care and accommodation)
  • professional services rendered in a hospital setting (such as the services of a doctor)

Generally speaking, if you arrive in Québec from outside Canada to settle in Québec, even if you are a Canadian citizen, you will be eligible for the Québec Health Insurance Plan after a waiting period of up to 3 months following your registration. This period does not apply to children under age 18.

RAMQ does not reimburse you for healthcare you receive during the waiting period. To save you from having to pay for any healthcare services that your family members may need, RAMQ strongly recommends that you take out private insurance within 5 days following your arrival in Québec. Thereafter, coverage is more difficult to obtain. For information about private insurance, contact the Ombud Service for Life & Health Insurance (OLHI).

Pending receipt of your Health Insurance Card, be sure to keep the letter indicating that you are subject to a waiting period, because some healthcare services are available free of charge to persons waiting for their coverage to take effect, such as services:

  • needed by victims of conjugal or domestic violence or of sexual assault
  • related to pregnancy, child birth or termination of pregnancy
  • needed by people suffering from infectious diseases that have an impact on public health

About the fees that are billed to you

You can no longer be billed for a covered service, nor for anything relating to that service. For details, refer to the page entitled Obtain information on covered services​.

Non-covered services

Medical services not necessary or required are not covered by the Health Insurance Plan. You cannot present your Health Insurance Card to receive them. You must pay for these services on your own. Non-covered services include:

  • acupuncture
  • corrective laser surgery or other eye surgery aimed at doing away with eyeglasses or contact lenses
    Exception: The surgery is covered if the following 2 conditions are met:
    • documented failure regarding the wearing of corrective eyeglasses or corneal lenses
    • anisometropia of more than 5 diopters or astigmatism of more than 3 diopters
  • psycho-analysis (except when rendered in a facility authorized for this purpose by the Ministère de la Santé et des Services sociaux)
  • services rendered for cosmetic reasons
  • treatment of varicose veins by injection and the examination made at that time, in a private medical office

Non-covered medical visits and examinations

If you see a doctor and undergo examinations for the sole purpose of obtaining a certificate attesting to your state of health, you are required to pay for these services. They are not covered because they are not related to preventing or curing an illness. They include medical visits and examinations for the following reasons:

  • obtaining or renewing an insurance policy
  • starting or holding a job (unless the examination is required under a Québec law other than the Act respecting collective agreement decrees)
  • being admitted to an educational institution, an association, an organization, a summer camp, a health centre, a sports club, a daycare centre or a recreational service
  • being assessed for the ends of justice

Professionals who participate in the public plan and those who do not

Some professionals practise their profession outside the scope of the public plan. This determines how they are remunerated. For more information, consult the webpage Professionals offering covered services.

Frequently asked questions

The following products and services are free of charge if they are provided by a participating physician as part of a covered service:

  • Eye drops
  • Retinophotography
  • Cataract extraction
  • Optical coherence tomography to treat certain pathologies (age-related macular degeneration, macular edema, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma, neovascular diabetic retinopathy, for example)

  • Soft contact lenses (single-piece, foldable, monofocal aspheric intraocular lenses) used to treat cataracts

The following costs may be billed to you, as they are carried out as part of a non-covered service:

  • Echography of the eye performed in a clinic by a physician other than a radiologist participating in the public plan
  • Toric contact lenses or speciality lenses

 

 

Examples of diagnostic tests covered when carried out by a participating physician:

  • Simple tests (strep test, screening tests for sexually transmitted or blood-borne infections, urine test strip, pregnancy test, blood glucose test, for example)
    Exception: a laboratory may bill you for this service if the test is not analyzed by a participating physician.
  • Electrocardiogram
    Exception: a laboratory may bill you for a resting electrocardiogram if the findings are interpreted by the professional who prescribed the test.
  • Mammogram
    A diagnostic mammogram is a covered service and cannot be billed to you when carried out by a participating physician.
    A screening mammogram cannot be billed by a participating physician when:
    • it is conducted on a woman age 35 or older
    • it has been 1 year since one was last conducted
    • it is conducted at one of the screening centres designated by the Québec Breast Cancer Screening Program
  • Test for sleep apnea
    Exception: a laboratory may bill you for the recording of a sleep apnea test if the result is not analyzed by a participating physician.
  • Radiography
  • Echography (ultrasound)
    Exception: echography may be billed to you if it is interpreted by a physician other than a radiologist.
  • Vasectomy

Hormonal intrauterine devices (IUDs) cannot be billed to you by a physician participating in the public plan. However, the physician may ask you to procure the hormonal IUD at your expense at a pharmacy.

Copper intrauterine devices are supplied by the health care network when their placement is made immediately after a voluntary interruption of pregnancy (VIP), carried out in certain private clinics and certain women’s health centres. If the copper intrauterine device is not related to a VIP, you must procure it at your expense at a pharmacy.

 

Supplies and medications needed for treatment are covered only if they are used during a covered service, since they are included in the service. This includes the plaster of Paris, the basic splint, liquid nitrogen and viscosupplements.

If a physician participating in the public plan plans to render a service (such as an injection) to you is entitled to ask you to obtain from a pharmacy the medications necessary for the injection. However, the physician cannot ask you to procure the products needed for the service (such as an injection kit), since it is included in the service. If you wish to have a fibreglass cast or a premium splint, you will need to pay the difference between its cost and that of their basic model.

Medications used during a non-covered service, such as an aesthetic service, may be billed to you.

 

We are unable to dedicate sums to persons who have paid for non-covered services and therefore cannot reimburse you the costs associated with the service.

See also

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