Persons who receive healthcare services outside Québec and who have a valid health insurance card are covered for such services under the Québec health insurance plan. In most cases, however, the Régie de l'assurance maladie du Québec reimburses only a portion of the costs incurred.
Healthcare services available in Québec
Where the healthcare services received outside Québec are available in Québec, the Régie pays for the services or reimburses their cost if certain conditions are met concerning duration of the trip or stay outside Québec. In all cases, contact the Régie before leaving Québec.
Note
It is highly recommended that any person, before leaving Québec for a few hours or a few weeks, should take out travel insurance to cover all or part of the costs not covered by the Régie.
Healthcare services not available in Québec
Any person who is insured by the Québec health insurance plan and whose condition requires specialized medical services that are not available in Québec can be reimbursed by the Régie for the cost of those services, provided that the service is covered in Québec, is medically required and that two physicians specialized in the pathology recommend it. Additional information is also required (e.g.: the name of the physician, the institution recommended, etc.).
The clientele and the conditions are indicated individually for each service, since they may differ in each case.
Services available in Québec and covered elsewhere in Canada
The Régie de l'assurance maladie du Québec pays for or reimburses the cost of the professional services provided by doctors, dentists or optometrists, as long as the same services are covered in Québec by the Québec health insurance plan. If the healthcare professional accepts the health insurance card, the person receiving services has nothing to pay. If the health insurance card is not accepted by the professional, the cost of the professional services is paid by the insured person. Subsequently, the insured person can apply to the Régie to receive a reimbursement. The cost of these professional services can be reimbursed up to the rates applicable in Québec.
Hospital services (including outpatient care received at a hospital), such as nursing care, diagnostic services, ward accommodation and medications administered during hospitalization, are covered throughout Canada under interprovincial agreements.
Services available in Québec and covered outside Canada
A person who has received healthcare services outside Canada is entitled to
- reimbursement of costs related to professional services provided by doctors, dentists or optometrists, as long as the same services are covered in Québec, up to the rates applicable in Québec;
- payment of costs related to hospital services solely in cases where those services are received in an emergency as a result of a sudden illness or an accident. The amounts paid are
- a maximum of CAN$100 per day of hospitalization,
- a maximum of CAN$100 for an outpatient surgery,
- a maximum of CAN$50 per day for healthcare received at an outpatient clinic or at an emergency room without being hospitalized,
- a maximum of CAN$220 per hemodialysis treatment and the related medications.
A person who is living abroad temporarily as
- a student;
- an unpaid trainee;
- a Québec government employee;
- an employee of a non-profit organization having its head office in Canada who is working within the scope of an international aid or cooperation program recognized by the ministère de la Santé et des Services sociaux;
- a dependant of any of the above-mentioned persons.
is reimbursed in full for all hospital costs incurred in an emergency and at the rate of 75% in other situations. However, if a person in any of the above-mentioned situations is vacationing away from his or her usual place of study, training or work, the general rule for reimbursement of hospital expenses outside Canada applies.
Restrictions
The Régie does not pay the following costs:
- transportation of the patient (by ambulance, taxi or aircraft);
- the supplement for a private or semi-private room;
- medications and medical supplies;
- the services of a psychologist, nurse, acupuncturist or podiatrist;
- services received at a spa;
- services received for cosmetic reasons;
- withdrawal treatment;
- costs related to obtaining a medical report or a case summary.
Services not available in Québec
A person who receives healthcare services outside Québec that are not available in Québec is entitled to a full reimbursement of the following costs, provided that these services were approved by the Régie before the person left Québec:
- costs related to hospital services (accommodation, nursing care, diagnostic services, medications, etc.);
- costs related to professional services rendered in a hospital setting.
