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. As well, you cannot be billed for any costs related to covered services, also called "accessory costs". However, you can be billed for certain other services: all services that are not covered and those offered by professionals who practice their profession outside the scope of the plan.
Residents may stay outside of Québec for a total of up to 183 days in a calendar year to keep their provincial health care insurance.
- What is covered: Basic routine services are covered for children under the age of 10 (cleaning, scaling, fluoride application, and orthodontics are NOT covered). At hospitals, the Quebec health insurance plan covers certain oral surgery services. Examinations, local or general anesthesia, and x-rays related to surgery are also covered. However, you have to pay for tooth and root extractions, except in the case of children under age 10 or if you are a recipient of last-resort financial assistance.
- What is NOT covered: You have to pay for the following services, regardless of your age, situation, or the location where you receive them: Apectomy-Definition; Whitening; Veneers; Dental implants; Orthodontics (e.g. fitting of braces, palate expansion, space maintainer); Periodontics (e.g. root planing, gum grafts, periodontal surgery); Recementing of crowns other than prefabricated; Pit and fissure sealants.
Each month, you contribute toward the payment of the covered drugs you purchase until you reach your maximum contribution. When you attain this amount, you can usually obtain other covered drugs free of charge until the end of the month. As a rule, your contribution includes the following amounts:
A deductible: A set monthly amount of $21.75 that you pay through your first purchases of the month.
Your portion of the co-insurance: An amount corresponding to 37% of the cost of covered drugs. It applies once the deductible has been paid, until you reach your maximum monthly contribution, if applicable.
The other portion of the co-insurance is paid by RAMQ, without you having to do anything. The rates for the deductible and co-insurance are adjusted each year on July 1.
- What is covered: RAMQ reimburses, at pre-set rates, the cost of hospital services received as a result of a sudden illness or an accident, as follows: a maximum of CA$100 per day for hospitalization; up to CA$50 per day for healthcare received at a hospital outpatient clinic. For hemodialysis and the required medication, the Régie reimburses up to $220 per treatment, regardless of whether the person is hospitalized.
- What is NOT covered: Quebec Health insurance does NOT cover hospital expenses after the first $100 per day.
When spending time outside Québec, it’s a good idea to take out private insurance before leaving. Generally speaking, RAMQ does not reimburse the full cost of healthcare services received outside Québec and certain services are not covered by the Health Insurance Plan at all. If you receive healthcare outside Québec but don’t have private insurance, you are responsible for the portion of the cost not reimbursed by RAMQ.
- What is covered: You may benefit from optometric services free of charge if you are insured by the Québec Health Insurance Plan and in any of the following situations:
- You are under the age of 18 or age 65 or over;
- You are age 18 to 64 and have been a recipient of last-resort financial assistance for at least the past 12 consecutive months;
- You are age 60 to 64 and have been receiving a spouse’s allowance under the Old Age Security Act for at least the past 12 consecutive months and, without this allowance, you would be eligible for last-resort financial assistance benefits;
- You have a visual impairment (additional condition: you must register with a recognized facility specialized in visual aids);
- What is NOT covered: Quebec health insurance plan RAMQ does not cover eyeglasses, contact lenses, laser surgery and eye exams for age 18 to 64 (unless you are eligible for assistance).
No coverage for paramedical, except for physiotherapy when performed by a physician in an accredited facility (e.g. hospital, CLSC, residential and long-term care centre, rehabilitation centre).
- What is covered: Coverage for standard ward rooms only.
- What is NOT covered: Quebec health insurance plan RAMQ does NOT cover private and semi-private hospital rooms.
PRIVATE DUTY NURSING AND MEDICAL EQUIPMENT
- What is covered: Coverage for home care services – nurses, doctors, social workers, occupational therapists – provided through the CLSC (Centres locaux de services communautaires) free of charge. Medical Supplies - The purchase, adjustment, replacement, and repair of orthotics, prosthetics, and other assistive devices are covered after meeting eligibility requirements.
- What is NOT covered: Medical Supplies are not covered for Quebec residents who do not meet the eligibility requirements.
- What is covered: If you are eligible, the Hearing Devices Program covers the costs related to hearing aids and assistive listening devices. This includes the purchase, repair, and replacement of the aids you need to carry out your daily activities.
- What is NOT covered: Hearing Aids are not covered for Quebec residents who do not meet the eligibility requirements.
- What is covered: The Government of Québec, through its departments and public organizations, covers the entire cost of ambulance transport for people injured in a road accident; People injured in a work accident (cost covered by the employer); People transported between two institutions in the health and social services network (cost covered by the two institutions involved); Persons 65 years of age and over, and persons receiving Income Security (cost covered by the hospital where the person has been transported or by the ministère du Travail, de l'Emploi et de la Solidarité sociale, subject to the approval of the attending physician).
- What is NOT covered: Quebec health insurance plan RAMQ does NOT cover the cost of transport by ambulance (except if eligible for a government exceptional assistance measure service).
Visit www.ExtendedHealth.ca or call toll free 1-877-838-0020 to get a quote or apply for Extended Health care insurance.
IMPORTANT NOTE: The information on this web page is for illustration purposes only. Every effort has been made to ensure the accuracy of the information. Coverage details are subject to change. For complete benefits, terms, conditions, limitations, and exclusions, please contact the Régie de l’assurance maladie Québec.
Last revised in September 2020.