Services covered during a temporary stay outside Québec
When travelling or when outside Québec temporarily, persons holding a valid Health Insurance Card can receive healthcare services covered by the Québec Health Insurance Plan. However, in most cases, the Régie de l'assurance maladie reimburses only part of the cost.
In order for these services to be covered, persons spending time outside Québec must fulfill certain conditions regarding the duration of their trip or temporary stay. Information about remaining eligible for the Health Insurance Plan is available in the section on eligibility during a stay outside Québec.
Private insurance: to avoid unfortunate consequences
When spending time outside Québec, it's a good idea to take out private insurance before leaving. Generally speaking, the Régie does not reimburse the full cost of healthcare services received outside Québec and certain services are not covered by the Health Insurance Plan at all. If you receive healthcare outside Québec but don't have private insurance, you are responsible for the portion of the cost not reimbursed by the Régie.
Information about private insurance is available from the OmbudService for Life & Health Insurance
(OLHI).
During a trip or a temporary stay in 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.
The Régie de l'assurance maladie issues reimbursements for professional services at amounts not exceeding Québec rates, even if the insured person paid more.
Procedure to follow
If you receive healthcare in a private office or at a hospital and are covered by the Health Insurance Plan, you must present your Québec Health Insurance Card.
If the doctor accepts your card, you have nothing to pay. The Régie pays the doctor at the Québec rate for the services you receive.
However, a doctor who does not agree to be paid at the Québec rate might not accept your Health Insurance Card, in which case you must:
- pay the doctor's fee;
- keep the originals of your invoices and receipts (credit card payment slips or photocopies of both sides of your cashed cheques showing the name of the hospital, doctor, dentist or optometrist);
- obtain an operative report from the doctor, if you underwent major surgery.
You can then apply to the Régie for a reimbursement. The amount reimbursed for professional services will be determined according to the rule explained above.
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 include nursing care, 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., accommodation in a ward (a room with 3 or more beds) and prescription drugs administered during hospitalization.
You are not required to pay for hospital services you receive, because their cost is paid in full by the Régie de l'assurance maladie under an interprovincial agreement. Don't forget to present your Health Insurance Card.
Examples
The following examples show the amount payable by an insured person who:
Services not covered
Some services received outside Québec are not covered by the Health Insurance Plan. If you don't 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, persons who regularly take prescription drugs can ask their pharmacist whether they may obtain the drugs they will need during their absence).
During a trip or a 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.
The Régie de l'assurance maladie issues reimbursements for professional services at amounts not exceeding Québec rates, even if the insured person paid more.
Procedure to follow
If you consult a doctor in a private office or at a hospital and have private insurance, you can ask the doctor whether the invoice can be sent directly to your insurance company.
If it cannot, you must:
- pay the doctor's fee;
- keep the originals of your invoices and receipts (credit card payment slips or photocopies of both sides of your cancelled cheques showing the name of the doctor, dentist or optometrist).
You can then apply to the Régie for a reimbursement. The amount reimbursed for professional services will be determined according to the rule explained in the boxed text above.
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 include nursing care, 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., accommodation in a ward (a room with 3 or more beds) and prescription drugs administered during hospitalization.
The Régie de l'assurance maladie reimburses at pre-set rates the cost of hospital services received as a result of a sudden illness or an accident, as follows:
- a maximum of CA $100 per day for hospitalization;
- up to CA $50 per day for healthcare received at a hospital outpatient clinic.
For hemodialysis and the required medication, the Régie reimburses up to CA $220 per treatment, regardless of whether the person is hospitalized.
Procedure to follow
If you are hospitalized and have private insurance, you can request that the invoice be sent to your insurance company, which will then claim the amount reimbursed by the Régie.
If you don't have private insurance, you must:
- pay for the services you receive;
- keep the originals of your invoices and receipts (credit card payment slips or photocopies of both sides of your cancelled cheques showing the name of the hospital or health professional);
- obtain an operative report from the hospital, if you underwent major surgery.
You can then apply to the Régie for a reimbursement. The amount reimbursed for hospital services will be determined according to the rule explained in the boxed text above.
Examples
The following examples show the amount payable by an insured person who:
Special coverage
The following persons, as well as their spouse Spouse
Two persons (of the opposite sex or the same sex) are considered spouses if they are married and have entered into a civil union, or have been living together for 12 months (separations of less than 90 days do not interrupt the 12-month period), or are living together (regardless of for how long) and together have had or have adopted a child. and dependants, who are outside Québec temporarily, have different coverage :
- students;
- unpaid trainees;
- Québec government employees;
- employees of non-profit organizations.
They may, under certain conditions, remain covered by the Health Insurance Plan when temporarily outside Québec. For further information, consult the section on eligibility during a stay outside Québec.
For persons who remain covered by the plan even though they are absent from Québec, the Régie pays the full cost of hospital services received in an emergency and 75% of the cost in other circumstances.
However, if these persons are vacationing away from their usual place of study, training or work, the regular coverage for hospital services applies, not the special coverage.
In all cases, these persons benefit from the same coverage for professional services as do other insured persons.
Services not covered
Some services received outside Québec are not covered by the Health Insurance Plan. If you don't 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, persons who regularly take prescription drugs can ask their pharmacist whether they may obtain the drugs they will need during their absence).
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, responsibility, fairness and attentiveness.
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.