During a Trip or a Temporary Stay – Outside Canada
Emergency professional services are covered. Emergency hospital services received as a result of a sudden illness or an accident are also covered, but for either type of service the Régie de l'assurance maladie reimburses only part of the cost.
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, accommodation in a ward (a room with three 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.
The following persons, as well as their spouse and dependants, who are outside Québec temporarily, have different coverage for hospital services:
- students;
- unpaid trainees;
- Québec government employees;
- employees of non-profit organizations.
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:
Services not covered
Some healthcare 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).
