Know which services are covered 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, RAMQ 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 Inform RAMQ of a departure from Québec.

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.

RAMQ issues reimbursements for professional services at amounts not exceeding Québec rates, even if you 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. RAMQ 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 RAMQ 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, certain diagnostic procedures, 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 RAMQ under an interprovincial agreement. Don’t forget to present your Health Insurance Card.

Examples of the amount reimbursed by RAMQ

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.

RAMQ issues reimbursements for professional services at amounts not exceeding Québec rates, even if you 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 RAMQ 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, accommodation in a ward (a room with 3 or more beds) and prescription drugs administered during hospitalization.

We reimburse, 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, we 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 RAMQ.

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 RAMQ for a reimbursement. The amount reimbursed for hospital services will be determined according to the rule explained in the boxed text above.

Examples of the amount reimbursed by RAMQ

The following examples show the amount payable by an insured person who:

Special coverage

The following persons, as well as their spouse 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 Inform RAMQ of a departure from Québec.

For persons who remain covered by the plan even though they are absent from Québec, RAMQ 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)