Know which services are covered outside Québec When travelling or when outside Québec temporarily, you can receive healthcare services covered by the Québec Health Insurance Plan if you have a valid Health Insurance Card. However, in most cases, we reimburse only part of the cost. The proportion of services received abroad that are covered depends on several factors: the duration of their trip or temporary stay outside Québec, destination, etc. To find out the conditions of coverage abroad, refer to the Inform RAMQ of a departure from Québec webpage. Private insurance: To avoid unfortunate consequences We recommend that you take out private insurance before leaving. We do not reimburse the full cost of healthcare services received outside Québec. If you receive healthcare services but don’t have private insurance, you are responsible for the portion of the cost not reimbursed by us. Information about private insurance is available from the OmbudService for Life & Health Insurance (OLHI). Trip or temporary stay in Canada Professional services The professional services covered are those rendered by doctors, dentists and optometrists, if they are covered in Québec. We issue reimbursements for professional services at amounts not exceeding Québec rates, even if you paid more. Procedure to follow When you receive healthcare from a private office or at a hospital, you must present your Québec Health Insurance Card. The doctor may accept the card or refuse it if they do not agree to be paid according to the applicable Québec rates. If the doctor accepts the card: you do not have to pay for the healthcare, and we pay them for the services rendered. If the doctor refuses the card: you must pay the doctor’s fee. Subsequently, you may apply for a reimbursement. Make sure you obtain and keep the following documents: Operative report, if you underwent major surgeryOriginal of your invoices and receipts (credit card payment slips or photocopies of both sides of your cashed cheques showing the name of the hospital or health professional) 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 services include: Nursing careCertain diagnostic proceduresAccommodation in a ward (a room with 3 or more beds)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 regarding these services. Don’t forget to present your Health Insurance Card! Examples of the amount reimbursed by RAMQ Consultation at the clinic of a general practitioner in Alberta Professional services Amount charged: $125Amount reimbursed by RAMQ: $40.80Amount for which the patient is responsible: $84.20 Hospitalization in Ontario for an open fracture of the femur Hospital services (upon presentation of the Health Insurance Card) Amount charged: $0Amount reimbursed by RAMQ: $0Amount for which the patient is responsible: $0 Professional services Amount charged: $928Amount reimbursed by RAMQ: $422Amount for which the patient is responsible: $506 Trip or 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. We issue reimbursements for professional services at amounts not exceeding Québec rates, even if you paid more. Procedure to follow If you have a private insurance and consult a doctor at a hospital or in a private office, you may ask the doctor to submit the invoice to your insurance company. If you do not have a private insurance, you must pay the doctor’s fee. Subsequently, you may apply for a reimbursement. Make sure you obtain and keep the original of your invoices and receipts (credit card payment slips or photocopies of both sides of your cashed cheques showing the name of the hospital or health professional). 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 services include: Nursing careDiagnostic proceduresAccommodation in a ward (a room with 3 or more beds)Prescription drugs administered during hospitalization We reimburse the cost of hospital services received as a result of a sudden illness or an accident. The preset rates are as follows: A maximum of CA$100 per day of hospitalizationA maximum of CA$50 per day for healthcare received at a hospital outpatient clinic For hemodialysis and the required medication, we reimburse up to CA$220 per treatment, whether you are hospitalized or not. Procedure to follow If you have a private insurance, you may ask the hospital to submit the invoice to your insurance company. They will request reimbursement on your behalf. If you do not have a private insurance, you must pay for the services you receive. Subsequently, you may apply for a reimbursement. The amount reimbursed for hospital services will be determined according to the applicable Québec rates. Make sure you obtain and keep the following documents: Operative report, if you underwent major surgeryOriginal of your invoices and receipts (credit card payment slips or photocopies of both sides of your cashed cheques showing the name of the hospital or health professional) Examples of the amount reimbursed by RAMQ Consultation with a general practitioner in Florida Professional services Amount charged: CA$262.64Amount reimbursed by RAMQ: CA$52.53Amount for which the patient is responsible: CA$210.11 Hospitalization in intensive care for 3 days in Florida for a heart attack Hospital services Amount charged: CA$25,000Amount reimbursed by RAMQ: CA$300 (CA$100 per day)Amount for which the patient is responsible: CA$24,700 Professional services Amount charged: CA$1,000Amount reimbursed by RAMQ: CA$435Amount for which the patient is responsible: CA$565 Hospitalization in intensive care for 8 days in South Carolina for pneumonia Hospital services Amount charged: CA$27,493Amount reimbursed by RAMQ: CA$800 (CA$100 per day)Amount for which the patient is responsible: CA$26,693 Professional services Amount charged: CA$10,543Amount reimbursed by RAMQ: CA$1,103Amount for which the patient is responsible: CA$36,133 Special coverage Certain situations allow you to benefit from a special coverage and extend it to your spouse and dependants. Under certain conditions, you remain covered by the Health Insurance Plan during a temporary stay outside Québec if you are: A students An unpaid traineeA Québec government employeeA non-profit organization employee Refer to the Inform RAMQ of a departure from Québec webpage to find out if you are eligible for special coverage in your situation. When you benefit from a special coverage, we pay on certain conditions the full cost of hospital services received in an emergency and 75% of the cost in other circumstances. However, is you are vacationing away from your usual place of study, training or work, the regular coverage for hospital services applies, not the special coverage. In all cases, the special coverage does not apply for professional services. Services not covered Certain services received outside Québec are not covered by the Health Insurance Plan. If you do not 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 QuébecServices rendered by a health professional other than a doctor, a dentist or an optometrist The cost of a private or semi-private hospital roomEmergency transportation, by ground or airThe cost of bringing a person back to QuébecDrugs purchased outside Québec, even if prescribed by a physician (before leaving Québec, if you regularly take prescription drugs, ask your pharmacist whether you may obtain the drugs you will need during your absence Application for review You can apply for a review of a RAMQ decision. To find out more, refer to the page Request a review of a decision.
