Eligibility for the plan
The persons who may be insured under the plan are determined by the Health Insurance Act and the Regulation respecting eligibility and registration of persons in respect of the Régie de l'assurance maladie du Québec.
Since November 1, 1970, coverage under the Health Insurance Plan has been compulsory for every resident or temporary resident of Québec who fulfills the conditions provided for by law.
Persons taking up residence in Québec
Persons arriving from another province to take up residence in Québec become eligible for the Québec Health Insurance Plan when they cease to be covered by the plan of their province of origin. For as long as they remain covered by the health insurance plan of their former province, they must present their health insurance card of that province when receiving healthcare from a doctor in Québec. The health insurance plan of their former province will cover the cost. However, if the Québec doctor does not accept that card, they will have to pay the doctor's fee and then apply for a refund with the organization administering the health insurance plan of their province of origin. Usually, coverage under the Québec plan begins on the first day of the third month following the month of arrival in Québec.
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. Apart from certain exceptions the Régie does not reimburse the cost of the healthcare received during the waiting period.
Persons in Québec temporarily
Depending on the document that authorizes them to be in Québec and the duration of their stay, persons from outside Canada who are temporarily residing in Québec may qualify for coverage. They are:
- temporary or seasonal workers;
- holders of a study or training scholarship within the scope of an official program of the Ministère de l'Éducation et de l’Enseignement supérieur;
- the spouse Spouse
Two persons (of the opposite sex or the same sex) are considered spouses if they are: (1) married and have entered into a civil union (2) have been living together for 12 months (separations of less than 90 days do not interrupt the 12-month period) (3) are living together (regardless of for how long) and together have had or have adopted a child. who is accompanying a worker or trainee;
- dependants who are accompanying a worker or trainee.
Persons who are ineligible for the Health Insurance Plan
Certain persons who spend time in Québec are ineligible for coverage under the Health Insurance Plan. These include:
- the children born of parents in Québec as tourists;
- students and any other persons from another Canadian province who are in Québec temporarily. The healthcare they receive in Québec is covered by the health insurance plan of their province of origin;
- students from countries other than those with which Québec has concluded a social security agreement providing for student coverage;
- refugee claimants. These persons may, however, benefit from coverage under the Interim Federal Health Program.
Remaining covered by the plan
If you have taken up residence in Québec, you must be present here more than half of the year in order to remain covered.
To retain the right to use your Health Insurance Card as a person in Québec for a temporary stay, you must be present in Québec for the entire duration of your stay, not including periods of 21 consecutive days or less. If you leave Québec for more than 21 consecutive days, you will not be covered by the Health Insurance Plan during your entire period of absence from Québec. As a temporary resident, you must notify the Régie when absent from Québec for more than 21 consecutive days.
Please refer to the section Temporary stays outside Québec for further information on eligibility for and coverage under the Health Insurance Plan during your temporary stays outside Québec.
Application for review
If you disagree with a decision of the Régie, you can apply for an administrative review. You have 6 months, from the date the letter of decision is deposited in your mailbox or handed to you in person, to contest the decision.
Form to fill out
First, you must fill out an Application for review.
To appeal a decision regarding healthcare received outside Québec, a technical aids program or a financial assistance program, you must use the form also.
It is important that you enclose the relevant original documents (bills, proof of payment, medical documents, etc.) and you specify the matter being contested, and any facts and dates to be corrected. If you need more space than that provided on the form, attach a separate, signed sheet.
Send your application for review to the following address:
Direction de la révision
Régie de l'assurance maladie du Québec
Case postale 6600
Québec (Québec) G1K 7T3
We recommend that you keep copies of the documents provided.
Analysis of your application for review
The agent of the Régie who analyzes your application for review will contact you, if required, to clarify your expectations. If necessary, the agent will assist you in the process of gathering relevant information to complete the file.
The review of your application is based on the new information provided by you and the documents already on file. Those documents must cover the entire period at issue. Missing information may delay the processing of your file.
After the agent has reviewed your file, he/she will notify you in writing of the Régie's new decision.
The Régie's commitment
We will process your application in keeping with our values: respect, integrity and equity.
We also undertake to follow up on your application for review within 40 days of receiving it, if your file is complete.
The Régie's decision
Under the Health Insurance Act, the Régie has 90 days to render its decision following an application for review.
If, after you've filed your application, you wish to provide supporting documents or comments, the 90-day time limit will run from the date the Régie receives the documents.
Moreover, if the Régie deems that it needs additional documents or information, it may extend the time limit by another 90 days.
Finally, if the Régie does not meet the deadlines, you may wait for its new decision, or contest the previous decision before the Tribunal administratif du Québec (TAQ).
Do you disagree with the Régie's new decision?
If you believe that the decision rendered in follow-up to your application for review does not respect your rights, you have 60 days (from the date the decision is delivered to your address) to contest it before the TAQ.