The Medical Services Program is a universal program, which means that anyone covered by the Health Insurance Plan is eligible. To benefit from this program, just present your valid Health Insurance Card.
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:
- examinations Examination
Usually consists of a questionnaire and a physical examination designed to enable the doctor to evaluate a person's state of health.;
- consultations Consultation
An examination of a patient carried out at the request of another doctor.;
- diagnostic procedures Diagnostic procedures
Procedures used by a doctor to evaluate a person's state of health and to determine the health problem in question.;
- therapeutic procedures Therapeutic procedures
Procedures used by a doctor to treat a disease.;
- psychiatric treatments;
Barring rare exceptions, the above services are covered regardless of where they are rendered, for instance in:
- private medical offices;
- local community service centres ( CLSCs);
- residential and longterm care centres (CHSLDs);
- rehabilitation centres;
- the patient's home.
Please note that some types of services are covered only when rendered in a hospital. These include certain highly specialized examinations, such as ultrasound (except when performed as part of assisted procreation procedures), computer axial tomography (CAT or CT scans) and magnetic resonance imaging (MRIs).
Services covered under special authorization
Services rendered only for cosmetic reasons are not covered by the Health Insurance Plan. Doctors must therefore determine whether a requested service is or is not medically necessary.
Services for which you must see a doctor in order to know whether they are covered by the Health Insurance Plan include:
- an abdominal lipectomy (surgery to remove fatty tissue and surplus skin from the lower abdomen);
- a blepharoplasty (excision of any excess eyelid tissue);
- electrolysis to correct hirsutism (excessive pilosity of the male type in women);
- correction of a scar elsewhere than on the face or neck;
- capillary grafts required as a result of trauma.
Consult your doctor to find out whether the desired service is covered by the Health Insurance Plan since authorization from the Régie must be obtained before providing the service.
Doctors who provide insured services
Most doctors participate in the Health Insurance Plan, which means that they accept the Health Insurance Card as payment for their fees. In that case, insured persons have nothing to pay. The Régie remunerates these doctors directly for the services they provide. You may therefore wish to ask the doctor you consult whether he/she participates in the plan.
Although very few in number, some doctors, who have opted out of the Health Insurance Plan, do not accept the Health Insurance Card as payment for their fees. Instead, they bill their patients for their services. The patients, upon presentation of a form obtained during the appointment, receive from the Régie an amount equivalent to the fee billed. They then pay the doctors. Doctors who have withdrawn from the Health Insurance Plan are required to inform their patients of their status.
Other doctors, also very few in number, are known as "non-participating physicians:" they do not accept the Health Insurance Card, and the Régie is not able to issue reimbursements for the cost of their services. They, too, must inform their patients of their status.
The Régie makes available the list of health professionals (French only) who have opted out of or do not participate in the Health Insurance Plan.
Services covered outside Québec
When a service is not available in Québec
The Health Insurance Plan covers a wide range of essential medical services. However, in exceptional cases, some services may not be available in Québec. In such cases, and as a last resort, it is possible to request the Régie's authorization to receive healthcare outside Québec.
How to proceed
The Régie must be provided with the following:
- a brief description of the medical care required;
- a written request signed by 2 Québec medical specialists having recognized expertise concerning the disease from which the insured person suffers and attesting that the services required are not available in Québec;
- the name and address of the hospital recommended for the hospitalization;
- a summary of the person's medical record.
The Régie's decision
The Régie will evaluate the request and inform the insured person and that person's medical specialists of its decision.
If the Régie 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).
Healthcare received during the waiting period
Generally speaking, if you arrive in Québec from outside Canada, 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.
The Régie does not reimburse you for healthcare you receive during the waiting period. To save you from having to pay for any healthcare services that you or your family members may need, the Régie 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 OmbudService for Life & Health Insurance (OLHI).
Pending receipt of your 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.
Medical services not covered
Healthcare services not medically necessary are not covered by the Health Insurance Plan. Presentation of a Health Insurance Card does not entitle anyone to receive such services free of charge, regardless of the doctor provides them. You are required to pay for those services, which include:
- services rendered for cosmetic reasons;
- treatment of varicose veins by injection and the examination made at that time, in a private medical office;
- psycho-analysis (except when rendered in a facility authorized for this purpose by the Minister of Health and Social Services);
- consultations by phone, fax, email or regular mail;
- appointments for the sole purpose of having a prescription renewed;
- most laboratory services (unless provided in a hospital);
- certain highly specialized examinations when provided at other than a facility, such as ultrasound (except as part of assisted procreation activities), computer axial tomography (CAT or CT scans) and magnetic resonance imaging (MRIs).
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. These services are not covered because they are not related to preventing or curing an illness. They include medical visits and examinations for the purpose of:
- 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.
Notwithstanding certain exceptions, examinations required for the administration of justice are not covered.