Professionals offering covered services
Most health professionals participate in the Public Health Insurance Plan and offer insured persons services covered by the Health Insurance Act. However, some professionals practise their profession outside the scope of the public plan and this determines how they are remunerated.
Types of health professionals and services rendered
Only the following professionals can render covered services:
- General practitioners and specialists
- Oral and maxillo-facial surgeons
However, not all of the services rendered by these professionals are covered.
Some professionals render services that are not covered or that are covered only when rendered in a facility (e.g. hospital, CLSC, residential and long-term care centre, rehabilitation centre). Among these professionals are:
- Occupational therapists
- Massage therapists
Professionals practising within the scope of the public plan
Participating health professionals are those who practise their profession within the scope of the Health Insurance Plan. They are remunerated in accordance with the tariffs provided in an agreement between their representatives and the Ministère de la Santé et des Services sociaux.
The covered services rendered by these professionals are paid directly by RAMQ when you present your valid Health Insurance Card. If you do not have a card, you must pay for the services. However, you can request a reimbursement if you are eligible for health insurance.
Professionals practising outside the scope of the public plan
Some health professionals practise their profession outside the scope of the Public Health Insurance Plan. They are known as health professionals who are non-participating or have withdrawn (provisions for which are set out in the Health Insurance Act). They must inform you of their status when you consult them.
Non-participating professionals do not agree to be remunerated in accordance with the tariffs provided in the agreement. They themselves determine their tariffs and do not accept the Health Insurance Card.
You alone assume the payment of the fees of these professionals when you consult them. These fees will not be reimbursed to you by RAMQ.
Health professionals who have opted out agree to be remunerated in accordance with the tariffs provided in the agreement even if they practise their profession outside the scope of the Health Insurance Plan.
- After the consultation, the professional will give you a request for payment form.
- Mail us the form to the address indicated.
- Once you receive the cheque that we will send you, contact your professional to work out the best wat of reimbursing him or her.
You have no fee to pay for a visit for insured services. Payment will be required only once you have received the reimbursement cheque from RAMQ. You may be billed, however, if non-covered services were provided to you.