Did you need healthcare services while on holiday outside Québec? Even though Québec’s health insurance plan covers many services, you will probably have to pay a portion of the bill out of pocket. Here's what you need to know.
As a rule, you can receive health care covered by the Québec health insurance plan when you travel outside the province. The Régie de l'assurance maladie du Québec (RAMQ) will reimburse all or part of the fees charged.
Important: in most cases, RAMQ does not reimburse the full cost of services received outside Québec. RAMQ recommends that you take out private insurance before you leave. Your private insurance will reimburse you for the portion of the costs that RAMQ does not repay.
Eligibility
For services received outside Québec to be covered by the province’s health insurance plan, they must be covered in Québec. You must also receive these services while eligible for health insurance coverage.
To remain eligible, make sure you comply with the rules on presence in Québec. With a few exceptions, you must not be absent from Québec:
- 183 days or more per year if you have lived there for at least one year;
- More than 21 consecutive days if you have a temporary resident permit (usually more than 6 months) or if you have been living there for less than a year.
Reimbursement for services covered
When you use your Québec health insurance card to receive a covered service, RAMQ pays the professional or institutional provider directly, so there’s no outlay for you.
If you can’t use your card, you must pay the required fee and then apply to RAMQ. In the case of services received outside Québec, the amount of reimbursement varies depending on the type of service (professional or hospital) and, sometimes, the country where it was provided.
Professional services
They include services provided in a private practice or hospital by a doctor, dentist or optometrist. Fees for professional services are reimbursed up to the rates in force in Québec.
In Canada, present your Québec health insurance card. The professional may accept or refuse it. If they accept it, they agree to be paid according to Québec rates and you won’t have to pay for anything.
Hospital services
The services covered are those received during a hospital stay or at a hospital outpatient clinic, for example:
- Certain diagnostic procedures
- Surgery further to an accident
- Accommodation in a ward (a room with 3 or more beds)
- Prescription drugs administered during hospitalization
In Canada, present your Québec health insurance card. You won't have to pay for anything.
Hospital services received outside Canada are reimbursed only if they were provided due to a sudden illness or an accident. The maximum reimbursement is:
- 100 CAD per day of hospitalization;
- 50 CAD per day for care received in a hospital outpatient department.
Questions or problems?
For more information, visit RAMQ’s website.
If you have any problems with RAMQ when making your claim, don't hesitate to call on the Protecteur du citoyen. Our services are free and there’s no complicated red tape.
Also see: Snowbirds and teleworkers: planning an extended stay outside Québec
