A Guide to Quebec Health Plan and RAMQ Card

Registering for Québec’s RAMQ

As we mentioned previously, applying for a RAMQ card is the first step in accessing free public health insurance. We recommend applying for RAMQ within fifteen days of arriving in Québec to avoid delays. You’ll need to complete the application form after verifying that you’re eligible and submit it to RAMQ in person or via post.

Eligibility Requirements

You are eligible for RAMQ Health Care if:

Applying for a RAMQ Health Card

The registration process for Québec’s RAMQ is quite simple, and if you happen to be eligible for it, you can register as soon as you arrive.

In case you’re a native of one of the following countries with which Québec has signed a security agreement, you can certainly benefit from it. The purpose of this agreement is to benefit both Québeckers and residents of other countries to help them pay for health insurance coverage when they spend time temporarily or take up residence in either place.

These countries are:

• Belgium
• Denmark
• Finland
• France
• Greece
• Luxembourg
• Norway
• Portugal
• Romania
• Serbia
• Sweden

One of the advantages of being a native to these countries is also the time it takes to get your RAMQ card since you have priority. If you’re not sure about your eligibility and belong to a country other than the ones listed above, you can check your eligibility for the RAMQ card on their website.

How to Apply in Person

Under regular circumstances, you can visit the local RAMQ reception desk and ask for an application form and submit it right away with the required documents.

However, at the moment, because of the COVID-19 pandemic, Québec and Montreal reception desks are not available for visitors, and the only way to get an application form right now is through the mail.

How to Apply Online

Unfortunately, you can only apply for the Québec Health Card in person or via mail. Since the application form is not available online, you have the alternative to call the Québec reception desk and ask for an application form that will be mailed to you. They will also give you information on how to process your application correctly.

You can contact them by calling 418-646-4636, 514-864-3411, or 1-800-561-9749 (this number is toll-free).

Forms and Documentation Required

To register for the Health Insurance Plan, you will need the following documents:

• The RAMQ application form
• Two original or certified true copies of your ID
• An original or certified true copy or proof of your Canadian citizenship, or proof of your legal right to be in Canada
• An original or certified true copy of your Québec selection certificate
• An original ID (passport, certificate of Canadian Citizenship, birth certificate, Québec Health Insurance Card, or health card from another province)
• A passport-sized photograph of yourself. (Depending on whether you are applying in person or via email, you will have them take your photo for a fee, or you’ll need to provide one yourself).

*All Documents in languages other than English or French will need to be translated before you submit your application.

How Long Does it Take for My RAMQ Card to Arrive?

After sending your application with the attached documents, you will receive a letter indicating whether your application was successful. Successful applications will also supply the date that the coverage begins.

Remember how we mentioned you get priority if your country has a security agreement with Québec? If you belong to any of those countries, your RAMQ card should arrive within thirty days after your application was sent. This thirty-day processing time is much faster than the 3 months waiting period which applies to newcomers to the province from other countries. Regardless of where you are from, you can apply for coverage for your children, spouse, other dependants, and even common-law partners with your application.

The province suggests you obtain private health insurance to cover you and your dependents while your applications are being processed since it’s mandatory to have some kind of insurance while staying in Québec.

Renewing or Replacing Your RAMQ Health Card

It is of the utmost importance that you renew or replace your Health Insurance Card before it expires. In case it gets lost or damaged, you will also need to go through the same process.

As per Québec law, you may be asked to verify your identity when you:

• Need to renew your Québec healthcare card.
• Request a correction on your cards, like last name, sex, or date of birth.
• Request a replacement of your card due to damage, loss, or robbery.

Renewing Your Health Card

Three months before your card expires, you should receive a Renewal Notice form from RAMQ. You have the option to visit either an SAAQ service outlet or a health network service point (CLSC) for a renewal application.

Note: You can visit the CLSC if you have only been residing in Québec for less than a year, or if your Renewal Notice is entitled “Renewal of Expired Card”.

What to Bring Along:

•  Two IDs (including at least one with a photo) for identification.
• Your Renewal Notice form was filled out accurately and duly signed.
• Your photograph (if you visit the CLSC)
• A copy of your appointment confirmation (if you visit the SAAQ service outlet). You can make the appointment here.
• The fee to pay for photograph services (available at SAAQ)

Once you have submitted your renewal application, it will take up to 10 days for your request to be processed. While renewal is done free of charge, it’s important to note that a surcharge of $25 applies for cards that had expired for more than six months at the time of the application.

Replacing Your Health Card

In case your RAMQ card gets lost or stolen, you can request a replacement directly with the RAMQ. You can either call them at 1-800-561-9749 or use the online form here to reach them. It’s important to note that a fee for the replacement may apply.

Changing the Address on Your Health Card

You can request to have changes on your health insurance card if there’s information to be corrected, or if you happen to change your address.

We recommend notifying the SQCA desk if you plan to move out of Québec or change your residential address in advance. In either case, you must apply for an address change with the RAMQ within the first 30 days of your move.

You have two options available to change your address on the RAMQ card:

• Online on the Service Québécois de changement d’adresse (SQCA) website
• By calling at 1-877-644-4545

You will have to provide the following information:

• Details of the old and new address
• Your Social Insurance Number (SIN)
• Your mother’s maiden name
• Your Health Insurance card number

RAMQ Coverage Summary

The Québec health plan is intended to cover the full cost of certain medical services for people authorized to reside in Canada, as long as these services are offered by professionals who practise their profession within the scope of the provincial health plan coverage. Some examples of these are:

• Medical procedures (e.g. surgery)
• Anesthetics
• Cortisone application
• Medical examinations
• Eye drops
• Diagnostic mammogram
• Urine and glycemic tests
• Vaccinations provided under the Québec Immunization Program 
• Vasectomy

Also, this plan covers medical care at health facilities, such as:

• Hospitals
• Private clinics
• Rehabilitation centers
• Patient’s homes

If you have found yourself in a situation where you don’t have your RAMQ card, the RAMQ also offers reimbursement for covered services. You get an entire year to apply to be reimbursed, as long as you still have coverage under the public health plan at the time the incident occurred and the payment was made.

Québec’s RAMQ Health Plan Coverage Details

Even though the RAMQ covers a wide range of medical services, some services you require may not be included in their insurance plan. Health professionals who practice outside the scope of the plan can bill you for their services, and only the ones who are actively participating in the plan are likely not to do so.

The services covered by RAMQ may be provided in different places like hospitals, medical clinics, pharmacies, etc. They include:

• Medical services are performed by a physician, dentist, optometrist, or surgeon as per the Québec Health Insurance Act.
• Optometric services if you’re under 18 or over the age of 65.
• Some in-hospital dental services, depending on your age. Children under the age of 10 receive one examination per year as well as some routine services.
• Pharmaceutical services
• Cost of drugs listed on the RAMQ drug formulary.
• Cost of ambulance services if you have been injured in a work or road accident; are 65 years or older, or need to be transported between two medical facilities.
• Cost of hearing aids for people eligible under the Hearing Devices Program.
• Temporary and long-term nursing benefits and home care at the local CLSC, depending on your needs.
• Cost of artificial limbs, canes, walkers, and other medical supplies (if eligible). More information can be found here.

Prescription Drugs

Many pharmacy services are covered by the Québec Health Insurance Plan. These include:

• Administration of a drug to demonstrate its appropriate use
• Administration of certain drugs in an emergency
• Adjustment of a prescription to attain therapeutic targets
• Initiating a drug therapy (including emergency oral contraception)
• Consultation request from another health professional
• Modification of a drug therapy
• Prescription of a drug
• Case management after hospitalization
• Case management of clientele receiving palliative care
• Assessment to extend a prescription and its extension
• Therapeutic substitution of a drug
• Vaccination at a pharmacy under the conditions of the Québec Immunization Program

Drug Coverage Details

As we mentioned before, if you reside in Québec permanently, it is mandatory to have prescription drug insurance coverage. You can opt from two available options:

• A public plan administered by RAMQ
• A private insurance plan (can be an employee benefit plan or a group insurance one)

It is important to remember that, as it is mandatory, you will automatically be eligible to receive coverage under the public plan if you don’t have access to a private one. Adults who opt for a private prescription plan will need to add their spouse and children to the same plan.

There are, however, some special provisions to protect the elderly and minors under this program. Anyone under the age of 18 living in Québec becomes invariably eligible for the public healthcare plan if their parents don’t have a private one, regardless of their residential status. If a minor resides in Québec for more than six months, they are also automatically qualified for the Public Prescription Drug Insurance Plan, even if their parents have a private one. Similarly, anyone over the age of 65 that doesn’t have a private plan automatically qualifies for eligibility.

Prescription Drug Costs

To be able to receive covered services, you must present your Health Insurance Card. Otherwise, you will have to pay the total cost of the services and later apply for reimbursement.

It’s important to note that not all pharmacy services are covered and you are required to pay for others out of your pocket. These include:

• Placing drugs in a pill organizer at your request, if not medically justified
• Samples were taken by a nurse at a pharmacy (e.g. blood test)
• Group A Strep-test
• Travel vaccination

Even when presenting your card, normally you will be asked to pay a small portion of the cost: this is your contribution to co-pay payments.

How does this work? There is a maximum contribution to the payment of covered drugs you must reach each month. Once this amount is reached, you will be able to obtain the remaining medications free of charge until the end of the month.

Some people are covered by the Public Prescription Drug Insurance Plan free of charge. These include:

• Holders of a claim slip (carnet de réclamation)
• Children of people covered under the public plan
• People with a functional impairment
• People ages sixty-five or over

Dental

Even when there are certain dental services covered by RAMQ at hospitals, you have to pay for tooth and root extractions. The only exceptions to these are cases of children under age 10 and recipients of last-resort financial assistance.

According to the Québec health insurance plan, oral surgery services covered by RAMQ include:

• Removal of a cyst or tumour
• Drainage of an abscess
• Reduction of a fracture
• Repair of a soft tissue laceration (e.g. cheek, tongue, palate)
• Treatment of bone tissue inflammation (osteitis)
• Treatment of the temporomandibular joint (which connects the jawbone to the skull)
• Treatment of salivary glands

In addition to this, children under the age of ten receive the following services without a cost when administered at a dental clinic or a hospital in Québec:

• Annual examination and emergency examination
• X-rays
• Local or general anesthesia
• Gray amalgam fillings on the premolar and molar teeth
• Fillings using esthetic materials (in certain cases)
• Tooth and root extractions
• Endodontics, including root canal treatment, apexification, pulpotomy, pulpectomy, the emergency opening of the pulp chamber, and sedative dressings
• N.B.: Pulpotomy and pulpectomy are covered only for the primary teeth. For the permanent teeth, a pulpotomy is covered only under general anesthesia
• Prefabricated crowns
• The oral surgery services covered for all

Dental Costs

Besides the services listed above, dental costs of the following services must be covered by you, regardless of your age or the location where these services are performed:

• Apicoectomy-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

Student Coverage

To be eligible as an international student for the Québec health plan, you need to:

• Be a full-time student
• Be a citizen or a resident of one of the countries that will be listed in the following section, which have a social security agreement with Québec
• Or, be a student with a diplomatic visa.

Either way, international students are required to have health insurance while staying in Québec, and if for some reason you don’t qualify for the RAMQ, you are automatically registered for medical insurance from Sun Life Financial, the cost of which is applied to your school fees.

You may also opt to have private insurance coverage as long as it covers the entire duration of your stay in Québec.

Coverage When Traveling in Canada and Outside of Canada

If you are planning to travel outside Québec, you’ll still be able to receive healthcare services covered by your Québec Health Insurance Plan, but it’s important to note that in the majority of cases, RAMQ will reimburse only a part of the total cost. For this, you’ll need to keep the original receipts (credit card payment receipts showing the name of the hospital or health professional) and obtain an operative report (in case you had major surgery).

Whether you’re travelling outside Québec or Canada, the reimbursement for professional healthcare services will NOT exceed the Québec rates, even if you paid more for these services. On the other hand, if you need to be hospitalized and have private insurance, you can request that the bill be sent to your insurance company, which will claim the amount reimbursed by RAMQ. This is why it is recommendable to buy private travel insurance when travelling outside Québec, and especially when travelling outside Canada.

How Does RAMQ Reimburse You for Treatments Administered Outside Québec

How does the reimbursement as per Québec rates work? To put it into perspective, imagine a scenario where you need to be hospitalized in say, Ontario for a femur fracture. Let’s say, the amount charged for this service is $928. RAMQ will only reimburse you for $422 as this is the maximum amount covered for this service in Québec. This means that you as a patient are responsible to pay $506 out of your pocket.

While that may still seem digestible, the out-of-pocket costs become much more significant if you’re travelling outside Canada, like in the USA, where the healthcare services are way more expensive. You’ll be responsible for almost the total cost and may require immediate cash payment.

To illustrate, emergency hospitalization in an ICU in Florida for a heart attack, including hospital services and professional services, can cost a whopping $26,000 for just three days. This same service in Québec is available for only $735; so the RAMQ will only be able to reimburse the $735 —  which leaves you responsible for the remaining $25,265.

This data only makes a stronger case for why private health insurance is a much more preferable option when travelling outside Québec.

Not to mention some services are not covered by the RAMQ at all, for example:

• Services offered by a health professional other than a doctor, dentist, or an optometrist
• The cost of a private or semi-private hospital room
• Emergency transportation (by ground or air)
• The cost of bringing a person back to Québec
• Drugs are purchased outside Québec, even if the prescription is given by a physician (normally, people who take prescription drugs ask their pharmacist if they may obtain the drugs before leaving Québec).

Student Benefits

When turning eighteen, you can continue to benefit from the Public Prescription Drug Insurance Plan as a dependent if you are pursuing full-time studies.

Students from ages eighteen to twenty-five who are enrolled as full-time students at the secondary, college, or university level get to have extended coverage if they meet the following requirements:

• They are eligible for health insurance as a Québec resident
• They don’t have a spouse
• Are living with their parents or tutor
• Do not have access to a private plan

Please note that you might be asked to show proof of school attendance to verify you’re a full-time student. This proof must be provided by the educational institution, and it must indicate the student’s name, period of studies, and confirm that they are enrolled in full-time studies.

Seniors Benefits

Under the Québec Healthcare Insurance Plan, seniors receive coverage for additional services, which are not available to others:

• Free flu vaccination for people above the age of 60.
• Better reimbursements for some healthcare services received outside of Québec.
• Free phone consultation with a healthcare professional at any time for advice or information about health issues under Info-Santé 811. The senior may also consult the service on behalf of a relative.
• Free phone consultation with a psychosocial intervention worker for the senior or a relative under Info-Social 811.
• People over the age of 65 receive some free optometric services, such as eye exams.

What Insurance Plan You Should Choose As a Senior

As soon as you turn sixty-five, you are automatically registered with the public plan, without having to take any action. Still, you may be eligible for a private insurance plan, and in this case, you have options and things to consider.

First, you must know that insurers offer two types of coverage:

• Basic coverage is equal to the coverage provided by the public plan
• Supplemental coverage (complements the public plan coverage).

It’s crucial to educate yourself about the kind of coverage you seek to make an informed decision. For instance, some people may opt for an insurance plan that covers visits to a naturopathic clinic or an acupuncturist, provides additional coverage for prescription drugs and medical services, and also covers additional costs such as funeral expenses and the costs of these before making a final decision. The best thing you can do is contact your insurer and ask any questions you may have because certain contracts establish that the decision to waive private plan coverage is irrevocable.

In case you choose to join a private-only plan, you have to let the RAMQ know before you turn 65. Otherwise, you will automatically be registered for a public one, which may conflict with your contract with your private insurer.

What Is Not Covered Under Québec’s RAMQ’s Health Plan

Despite its popularity and the fact that the Régie de l’assurance maladie du Québec (RAMQ) covers a lot of the general medical expenses, some services are not included in their insurance.

Some of them are only covered partially and others aren’t covered at all. It’s important to know what these services are.

Also, some factors influence whether you are covered by the RAMQ, like your age, and whether or not you are a recipient of financial assistance of last resort.

The services that are typically not covered by RAMQ are:

If you need medical services that are beyond the scope of RAMQ, there’s always an option for you to extend the coverage that RAMQ provides through Extended Health Care benefits.

This means you can get major medical benefits that the government plan doesn’t cover in addition to your existing health insurance.

Why is it a good option? These kinds of extended plans provide you protection against high-cost medical services and treatments that public life insurance doesn’t cover.

This includes services like:

• Ambulance services
• Hospital accommodations
• Medical supplies and equipment
• Drug coverage
• Psychologist
• Dental services
• Vision care
• Chiropractor
• Emergency, out-of-country travel insurance
• Wheelchairs, among others

Remember that this is meant to supplement your RAMQ Health Coverage Plan, and not replace it. Typically, you’ll need to cover the expenses of your treatment first and file for reimbursement with your insurer later. The amount spent on covered services will be reimbursed to you in full later by your insurer.

This type of insurance coverage can be obtained individually or under a group plan. What’s the difference between these two options? Primarily the amount of money you pay. Since employers who provide health insurance to their employees are required to cover a minimum of 50% of the total insurance cost, you will only have to pay the remaining percentage.

In the case of individual insurance, you’ll have to cover the total cost, since there is no one to share it with. This individual extended health care is ideal for people who work as freelancers and don’t have an employer.

Should You Opt For An Extended Insurance Plan?

Although the Québec health plan covers a lot of the basic health services, you may find yourself at risk of having to pay huge medical expenses out of pocket, especially if you’re someone who travels a lot within and outside of Canada. Many people with health conditions that require visits to health practitioners such as psychologists, osteopaths, acupuncturists, massage therapists, naturopaths, or more may also require additional coverage.

On the other hand, in comparison to other countries, Canada has one of the best public health insurance systems in the world — And the Québec Health Care Card coupled with extended healthcare plans can help you make full use of it. Ultimately, you must decide if you require extended coverage and are willing to pay a small premium for that peace of mind.

Whatever you decide, if you need help picking insurance plans, we at Insurdinary can help you select one that fits your family’s health needs the best. Don’t hesitate to reach out to us if you have any concerns!