The Medical Services Program is a universal program, which means that anyone insured by the Health Insurance Plan is eligible. To benefit from this program, just present your valid Health Insurance Card.
The medical services covered by the Health Insurance Plan are those that are medically necessary and rendered by a general practitioner (also called a "family doctor") or a medical specialist. These services include:
- diagnostic procedures
- therapeutic procedures
- psychiatric treatments
- certain radiology services provided by a doctor
Barring rare exceptions, the above services are covered regardless of where they are rendered, for instance in:
- medical clinics
- local community service centres (CLSCs)
- residential and longterm care centres (CHSLDs)
- rehabilitation centres
- the patient’s home
Regarding accessory costs…
You can no longer be billed for a covered service, nor for anything relating to that service. For details, refer to the page entitled Obtain information on covered services.
Medical services covered under special authorization
Services rendered only for cosmetic reasons are not covered by the Health Insurance Plan. Doctors must therefore determine whether a requested service is or is not medically necessary. Here are some examples:
- lipectomy (surgery to remove fatty tissue and surplus skin)
- blepharoplasty (excision of any excess eyelid tissue)
- electrolysis to correct hirsutism (excessive pilosity of the male type in women)
- correction of a scar elsewhere than on the face or neck
- capillary grafts required as a result of trauma
Consult your doctor to find out whether the desired service is covered by the Health Insurance Plan since authorization from RAMQ must be obtained before providing the service.
Medical services covered outside Québec
The Health Insurance Plan covers a wide range of essential medical services. However, in exceptional cases, some services may not be offered in Québec. In such cases, your doctor can request RAMQ’s authorization to receive healthcare outside Québec.
Your doctor must provide RAMQ with the following:
- a brief description of the medical care required
- a written request signed by 2 Québec medical specialists having recognized expertise in the disease from which you suffer and attesting that the services required are not available in Québec
- the name of the doctor whose services are required and the address of the hospital where he/she practices (the hospital being recommended)
- a summary of your medical record
RAMQ will evaluate the request and inform you and your medical specialists of its decision. If RAMQ grants an authorization, it will pay the full cost of:
- hospital services (services related to a hospital stay, such as nursing care and accommodation)
- professional services rendered in a hospital setting (such as the services of a doctor)
Medical services covered during the waiting period eligibility
Generally speaking, if you arrive in Québec from outside Canada to settle in Québec, even if you are a Canadian citizen, you will be eligible for the Québec Health Insurance Plan after a waiting period of up to 3 months following your registration.
RAMQ does not reimburse you for healthcare you receive during the waiting period. To save you from having to pay for any healthcare services that your family members may need, RAMQ strongly recommends that you take out private insurance within 5 days following your arrival in Québec. Thereafter, coverage is more difficult to obtain. For information about private insurance, contact the Ombud Service for Life & Health Insurance (OLHI).
Pending receipt of your Health Insurance Card, be sure to keep the letter indicating that you are subject to a waiting period, because some healthcare services are available free of charge to persons waiting for their coverage to take effect, such as services:
- needed by victims of conjugal or domestic violence or of sexual assault
- related to pregnancy, child birth or termination of pregnancy
- needed by people suffering from infectious diseases that have an impact on public health
Medical services not necessary or required are not covered by the Health Insurance Plan. You cannot present your Health Insurance Card to receive them. You must pay for these services on your own. Non-covered services include:
- services rendered for cosmetic reasons
- Corrective laser surgery or other eye surgery aimed at doing away with eyeglasses or contact lenses
The surgery is covered if the following 2 conditions are met:
- documented failure regarding the wearing of corrective eyeglasses or corneal lenses
- anisometropia of more than 5 diopters or astigmatism of more than 3 diopters
- treatment of varicose veins by injection and the examination made at that time, in a private medical office
- psycho-analysis (except when rendered in a facility authorized for this purpose by the Ministère de la Santé et des Services sociaux)
- consultations by phone, fax, email or regular mail
Non-covered medical visits and examinations
If you see a doctor and undergo examinations for the sole purpose of obtaining a certificate attesting to your state of health, you are required to pay for these services. They are not covered because they are not related to preventing or curing an illness. They include medical visits and examinations for the following reasons:
- obtaining or renewing an insurance policy
- starting or holding a job (unless the examination is required under a Québec law other than the Act respecting collective agreement decrees)
- being admitted to an educational institution, an association, an organization, a summer camp, a health centre, a sports club, a daycare centre or a recreational service
- being assessed for the ends of justice
Professionals who participate in the public plan and those who do not
Some professionals practise their profession outside the scope of the public plan. This determines how they are remunerated. For more information, consult the webpage Professionals offering covered services.
Frequently asked questions
No. We do not reimburse fees billed by health facilities. To make a claim or file a complaint concerning a health facility, you will need to contact the service quality and complaint commissioner of the facility in question.
However, if the physician of a health facility bills you for his or her fees (his or her salary), complete the form Demande de remboursement (carte expirée ou non présentée) and mail it to us. It is the physician who must give you this form.
We are unable to dedicate sums to persons who have paid for non-covered services and therefore cannot reimburse you the costs associated with the service.
No. We do not cover the cost of transport by ambulance. For more information on the cost of ambulance transport as well as the government exceptional assistance measures, please consult thewebpage Ambulance Services on the Québec.ca website.