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Statement of services

For more than 50 years, the RAMQ has played a central role in the Québec’s health care system. This declaration of services to citizens and health workers is part of our desire to make the customer experience central and to ensure a digital shift in our service delivery to the population. We are committed to offering our clienteles simple, accessible services that meet their expectations, in a secure and confidential manner.

Our core services

  • Manage the eligibility of persons
  • Provide coverage for the health care and services available under the plan
  • Produce and issue Health Insurance Cards

  • Administer the Public Prescription Drug Insurance Plan
  • Provide coverage for the drugs and supplies on the List of medications

We administer more than 40 programs targeting certain needs:

  • Visual impairment
  • Hearing impairment
  • Loss of an eye
  • Mastectomy
  • Stoma
  • Lymphedema
  • Physical impairment
  • Medical and hospital services received outside Québec

We establish the financial contribution or exemption applied toward the cost of:

  • Domestic help services
  • Accommodation in a public facility
  • Accommodation in an intermediary resource

We make certain online services available to you. With them, you can:

  • Have your lost, stolen or damaged Health Insurance Card replaced
  • Register or deregister with the Public Prescription Drug Insurance Plan
  • Order the forms to register for organ and tissue donation and advance medical directives
  • Register with the Québec Family Doctor Finder
  • Consult your health information in the Québec Health Booklet

Our clienteles

Citizens

  • All persons insured or seeking to be insured by the Québec Health Insurance Plan
  • All persons insured or seeking to be insured by the Public Prescription Drug Insurance Plan and those wishing to deregister from the plan
  • Clienteles with special needs

Health workers

  • Health professionals (physicians, dentists, optometrists, pharmacists) and other prescribers
  • Any other type of health workers supporting health professionals
  • Service providers

Commitments on service quality

The RAMQ is committed to giving its clienteles a voice in order to improve and meet their expectations. To do so, we carry out various consultations throughout the year, by project or initiative, in order to involve insured persons and health workers in the development of solutions or services offered to them.

Reliability and diligence

  • Ensuring that the information provided to you is complete, understandable, accurate and useful.
  • Providing you with adequate information to enable you to fully understand the reasons for decisions.
  • Delivering the services within the set timeframe.

Respect and equity

  • By ensuring courteous and non-discriminatory exchanges.

Respect of your rights

  • Ensuring that your information is protected and used in accordance with our legal obligations.
  • By ensuring the confidentiality of your personal information.

Simplicity and accessibility

  • Making it easy to obtain our services.
  • By offering you a customer service adapted to your profile and taking into consideration your particular needs.
  • By promoting mechanisms that allow you to be autonomous during your procedures to obtain services.

Listen

  • By consulting you in order to know your expectations and to meet your needs.
  • By involving you in the development of our services.

Commitments on organization’s service standards

We have set standards for serving you in a timely manner. Barring certain exceptional situations, we strive to meet them.

Answer your call within 5 minutes or less:

  • For 75 % of calls to Centre de relations clientèle (CRC)
  • For 80 % of calls to Centre de relations avec les professionnels (CRP)

For 80% of requests from health workers, reply to your email request within:

  • 3 business days for general services
  • 5 working days for specialized services
  • 15 working days for any request which requires more complex assessments

First application or return to Québec: For 90% of applications, render a decision on your eligibility for health insurance within 60 working days of receiving the complete application.

Sending of your Health Insurance Card: For 90% of applications, send you your Health Insurance Card upon receipt of a complete application within 10 working days (excluding postal delays).

Online service to replace a lost, stolen or damaged card: For 90% of applications, send you your new card within 7 working days upon receipt of a complete application (excluding postal delays).

For 95% of requests regarding exceptional medication:

  • Reply to an authorization request for an exceptional medication required on a priority basis within 1 working day.
  • Reply to an authorization request for an exceptional medication within 25 working day.

For 90% of applications regarding a reimbursement of costs incurred within the scope of financial assistance programs, process your request (upon receipt of a complete application) within 50 working days for the following programs:

  • External Breastforms Program
  • Ostomy Appliances Program
  • Program Regarding Bandages and Compression Garments Used to Treat Lymphedema
  • Ocular Prostheses Program

Application for reimbursement of fees billed by a health professional – other than a pharmacist – to an insured person who has not presented a valid Health Insurance Card: Render a decision within 60 working days for 85% of applications.

Application for reimbursement of fees billed by a health professional – other than a pharmacist: Render a decision within 60 working days for 85% of applications.

Authorization request for plastic surgery: Render a decision to the health professional and the insured person within 60 working days for 80% of requests.

Responsibilities, recourse and complaints

Your cooperation is key to enabling us to carry out our commitments. Anytime you submit a request to us, we are counting on you to:

  • Be well informed by carefully reading the communications sent and visiting our website for general information before calling us.
  • Provide us with complete, accurate and up-to-date information.
  • Send us, before the set timeframe, the information and documents that we require.
  • Inform us, as soon as possible, of any change that could have a bearing on your request or your file.

We are committed to providing you with quality services and meeting your needs. However, you may disagree with a decision or be dissatisfied with the services provided. If you are in one of these situations, here are the different recourses available to you.

If you are dissatisfied with a decision rendered by the Régie, you may request a review. To exercise this right, you must complete the form Application for review: https://www.ramq.gouv.qc.ca/en/contact-us/request-review-decision.

You have 6 months, from the date on which you are notified of the RAMQ decision, to do so. There is no cost involved. You may also provide documents related to a request already in progress.

If you wish to contest a decision rendered by RAMQ following your application for review, you have 60 days from the date the decision was communicated to you to contest it before the Tribunal administratif du Québec.

Despite our best efforts to provide you quality services, you may be dissatisfied with a service that you received and wish to let us know. You may also make your comments to improve service delivery:

We will contact you within 2 working days and process your complaint within 20 working days.