Obtain information on covered services RAMQ pays for services covered by the Health Insurance Plan when rendered to insured persons. Health professionals participating in the plan cannot bill you for these services. Covered services If you receive healthcare through the public system, these services are generally covered. They may be received in hospitals, CLSCs, residential and long-term care centres (CHSLDs), medical clinics or pharmacies, for example). Medical services Optometric services Dental services Pharmaceutical services Examples of services or items covered Medical procedures such as surgeryCancer screeningGuided ultrasound related to a covered service (cortisone injection into a joint, for example)Medical examinationsEyedrops, anesthetics, cortisoneImaging (mammogram, for example)Installation of an intrauterine device (IUD)Radiographies prescribed by a physician, specialized nurse practitioner, dentist or physiotherapistAllergy tests and desensitizationVaccinationsVasectomy Professionals who participate in the public plan and those who do not For services to be covered, they must be provided by a health professional who participates in the public plan (physician, dentist, optometrist, denturist, dental hygienist, or pharmacist). Other professionals practise their profession outside the scope of the plan and offer services that are not covered. For more information, consult the webpage Professionals offering covered services. Administrative fees In general, you cannot be billed for an administrative procedure related to a covered service provided by a physician participating in the public plan. Conversely, you may be billed for an administrative procedure if it is requested for your personal file or by a third party, such as an insurer, a health professional not participating in the plan or an employer. Examples of covered administrative fees Return to work noteOpening of a record related to a covered serviceDrafting of a report, recommendation, or attestation, the copying a medical record or the transfer of a record made under the treatment plan of the participating physician consulted or at the request of another participating physicianReplacement of a misplaced prescriptionCompletion of certain medical certificates and their associated examinationsCompletion of forms required under a request for authorizationRenewal of a prescription (if covered medical services are also rendered) Examples of non-covered administrative fees Completion of a form at the request of your insurance company (disability insurance, for example)Completion of certain forms requested by the Société de l’assurance automobile du Québec (SAAQ), except those required for employment purposesFees for missed appointments Reimbursement of covered services Fees billed by health facilities Although related to covered services, we do not administer the fees billed by health facilities (hospitals, CLSCs, residential and long-term care centres (CHSLDs), rehabilitation centres, for example). The rules governing them are different. You must contact the relevant facility directly to find out the reimbursement or complaint procedures. Expired card or card not presented If you had to pay for covered services when your Health Insurance Card had expired, or you were unable to present it, you can ask us for a reimbursement. Accessory costs and wrongfully billed fees Accessory costs are related to covered services for which professionals are already paid by RAMQ. Physicians, dentists, optometrists and pharmacists are not allowed to charge you for them, just as they cannot charge you for a covered service. If you believe that you were wrongfully charged by a health professional, keep the invoice and proof of payment. Then, send us an application for reimbursement. Exceptions for the transportation of samples There is one exception for the transportation of samples. However, the amounts billed may not exceed the following amounts: $15 for the transportation of a blood sample$5 for the transportation of any other sample, such as culture for a bacteriological examination You may be billed for these fees only once per sample collection session, even if there is more than one sample to be transported. Non-covered services You must pay for services that are not covered by the Health Insurance Plan. Services that are not rendered for the purpose of preventing, healing or curing illnesses or diseases are among such services. In addition, some services are not covered in a medical clinic whereas they are when rendered in a hospital. These fees are not reimbursable. Examples of non-covered services Consultations in acupuncture, audiology, chiropractic, occupational therapyServices rendered by professionals not participating in the planServices rendered for cosmetic reasons Examples for non-covered services in medical clinics Echography conducted by a physician other than a radiologistMagnetic resonance imaging (MRI)Computerized axial tomography (CAT)Treatment or purchase of a device for sleep apnea Medical clinic’s obligations: waiting rooms and invoices Physicians practising in medical clinics and specialized medical centres have certain obligations to fulfil with respect to information displayed in their waiting rooms. They must also provide you with a detailed invoice for any payment required. You cannot be asked to pay any amount of money other than the amount shown. The display in the waiting room must indicate the following information: Fees that can be billed to you (fees for missed appointments, fees for non-covered medical services, for example)A statement indicating the right to claim a reimbursement from us for wrongfully billed fees The detailed invoice must contain the following information: The cost of each service renderedA statement indicating the right to claim a reimbursement from us for wrongfully billed fees Report wrongdoing You can report wrongdoing, such as the following: Fees illegally billed to insured personsA breach of the laws and regulations by a healthcare professional or worker, or other service provider Frequently asked questions Does RAMQ reimburse the fees billed by health facilities (hospital centres, CLSCs, residential and long-term care centres, rehabilitation centres, etc.)? 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 their fees (their salary), fill out a request for reimbursement online. May I request that a non-covered service be covered, exceptionally? 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. Is transport by ambulance a covered 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 the webpage Cost of ambulance transportation on the Québec.ca website. See also Request a reimbursement for covered servicesProfessionals offering covered services
