Reimbursement
When the card is not presented
To be entitled to insured healthcare services, you must present your valid Health Insurance Card.
If you don't have your Health Insurance Card with you or if your card has expired, you must pay for the services you receive and then apply to the Régie for a reimbursement.
To do so, obtain the form entitled Demande de remboursement à la personne assurée, available from your doctor, and send it to the Régie as soon as possible, not later than one year after the service date. The Régie will reimburse you only if you were eligible for the Health Insurance Plan when you received the services.
When a service is not available in Québec
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 in 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).
Please note
You must obtain the Régie's authorization before leaving Québec. Please consult your doctor, as he/she is familiar with the procedure.
Fees billed by a doctor
Do you believe that the fee billed was too high? You may request a reimbursement from the Régie by writing at the following address:
Request for reimbursement
Direction des affaires professionnelles
Régie de l'assurance maladie du Québec
Case postale 6600
Québec (Québec)
G1K 7T3
You must attach the original detailed invoices and proof of payment demonstrating that the fee has been paid. Without those documents, the Régie cannot process your request.
Role of the Régie
The Régie will examine the request for reimbursement. If the amounts paid out were unfairly billed, it will reimburse the insured person and recover from the doctor or clinic the amount reimbursed. The Régie thus acts as an intermediary between the insured person and the doctor.
Time limit for applying for a reimbursement
You have one year, from the date the services were paid, to request a reimbursement from the Régie.
Application for review
If you have not been reimbursed by the Régie or if you disagree with the reimbursement amount obtained for a fee billed by a doctor, dentist or optometrist, you may apply for a review. Submit a writtent request to the Régie at:
Service de la logistique et de la révision
Régie de l'assurance maladie du Québec
Case postale 500
Québec (Québec)
G1K 7B4
Persons coming from another Canadian province
While they remain covered under the health insurance plan of their province of origin, persons coming from another province who need healthcare in Québec must present their health insurance card from that province to the doctor treating them. The health insurance plan of that province will bear the costs. If the Québec doctor refuses the card, however, the persons must pay the doctor and then apply for a reimbursement with the agency managing that province's health insurance plan.