A-29, r. 5 - Regulation respecting the application of the Health Insurance Act

Section 22 Disposition versions

2023-01-01

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(b.1)  any conversion therapy subject to the Act to protect persons from conversion therapy provided to change their sexual orientation, gender identity or gender expression (chapter P-42.2);

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  (paragraph revoked);

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a person who is a victim of a sexual assault;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered in person by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  (paragraph revoked);

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

iv.  this service is rendered for assisted procreation purposes under Division XII.2, in a centre for assisted procreation holding a licence issued under the Act respecting clinical and research activities relating to assisted procreation (chapter A-5.01);

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician, specialized nurse practitioner, physiotherapist or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services (chapter S-4.2);

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  (paragraph revoked);

(w)  any service rendered from a distance by a professional:

i.  on the basis of an agreement or contract with an employer, an association or a body for the purpose of providing insured services to its employees or to their members, as well as to the spouses or any dependants of its employees or their members;

ii.  under or incidental to an employee benefit plan or group insurance contract provided that their main purpose is not the provision of these services.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2; O.C. 446-2020, s. 1; S.Q. 2020, c. 28, s. 13; S.Q. 2020, c. 6, s. 53; S.Q. 2021, c. 13, s. 175; S.Q. 2021, c. 2, s. 31; O.C. 1347-2022, s. 1; O.C. 1794-2022, s. 1.

2022-07-28

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(b.1)  any conversion therapy subject to the Act to protect persons from conversion therapy provided to change their sexual orientation, gender identity or gender expression (chapter P-42.2);

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a person who is a victim of a sexual assault;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  (paragraph revoked);

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

iv.  this service is rendered for assisted procreation purposes under Division XII.2, in a centre for assisted procreation holding a licence issued under the Act respecting clinical and research activities relating to assisted procreation (chapter A-5.01);

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician, specialized nurse practitioner, physiotherapist or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services;

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  (paragraph revoked).

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2; O.C. 446-2020, s. 1; S.Q. 2020, c. 28, s. 13; S.Q. 2020, c. 6, s. 53; S.Q. 2021, c. 13, s. 175; S.Q. 2021, c. 2, s. 31; O.C. 1347-2022, s. 1.

2021-11-15

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(b.1)  any conversion therapy subject to the Act to protect persons from conversion therapy provided to change their sexual orientation, gender identity or gender expression (chapter P-42.2);

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a person who is a victim of a sexual assault;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  (paragraph revoked);

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

iv.  this service is rendered for assisted procreation purposes under Division XII.2, in a centre for assisted procreation holding a licence issued under the Act respecting clinical and research activities relating to assisted procreation (chapter A-5.01);

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician, specialized nurse practitioner or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services;

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  (paragraph revoked).

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2; O.C. 446-2020, s. 1; S.Q. 2020, c. 28, s. 13; S.Q. 2020, c. 6, s. 53; S.Q. 2021, c. 13, s. 175; S.Q. 2021, c. 2, s. 31.

2021-10-13

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(b.1)  any conversion therapy subject to the Act to protect persons from conversion therapy provided to change their sexual orientation, gender identity or gender expression (chapter P-42.2);

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a person who is a victim of a sexual assault;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  (paragraph revoked);

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician, specialized nurse practitioner or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services;

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  any assisted procreation service, except the artificial insemination services, including services required for ovarian stimulation, referred to in subparagraph e of the first paragraph of section 3 of the Act.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2; O.C. 446-2020, s. 1; S.Q. 2020, c. 28, s. 13; S.Q. 2020, c. 6, s. 53; S.Q. 2021, c. 13, s. 175.

2021-01-25

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(b.1)  any conversion therapy subject to the Act to protect persons from conversion therapy provided to change their sexual orientation, gender identity or gender expression (chapter P-42.2);

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a sexual assault victim;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  (paragraph revoked);

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician, specialized nurse practitioner or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services;

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  any assisted procreation service, except the artificial insemination services, including services required for ovarian stimulation, referred to in subparagraph e of the first paragraph of section 3 of the Act.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2; O.C. 446-2020, s. 1; S.Q. 2020, c. 28, s. 13; S.Q. 2020, c. 6, s. 53.

2020-12-11

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(b.1)  any conversion therapy subject to the Act to protect persons from conversion therapy provided to change their sexual orientation, gender identity or gender expression (chapter P-42.2);

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a sexual assault victim;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  (paragraph revoked);

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services;

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  any assisted procreation service, except the artificial insemination services, including services required for ovarian stimulation, referred to in subparagraph e of the first paragraph of section 3 of the Act.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2; O.C. 446-2020, s. 1; S.Q. 2020, c. 28, s. 13.

2020-05-07

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a sexual assault victim;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  (paragraph revoked);

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services;

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  any assisted procreation service, except the artificial insemination services, including services required for ovarian stimulation, referred to in subparagraph e of the first paragraph of section 3 of the Act.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2; O.C. 446-2020, s. 1.

2016-12-29

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a sexual assault victim;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  among the services referred to in the second paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during a 12-month period by a dentist:

i.  examination, except an emergency examination or, where the insured person is followed for oncological purposes by a dentist practising in an institution which operates a hospital centre listed in Schedule E, a second examination;

ii.  teaching and demonstration of oral hygiene procedures;

iii.  cleaning of teeth;

iv.  scaling;

v.  topical fluoride application;

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, except in one or the other of the following cases:

i.  this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  this service is rendered by a radiologist;

iii.  this service is rendered, for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration , macular edema caused by vein occlusion, diabetic macular edema, retinopathy of prematurity, malignant myopia, neovascular glaucoma or neovascular diabetic retinopathy;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services (chapter S-4.2);

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  any assisted procreation service, except the artificial insemination services, including services required for ovarian stimulation, referred to in subparagraph e of the first paragraph of section 3 of the Act.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19; O.C. 1021-2016, ss. 1 and 2.

2015-11-10

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a sexual assault victim;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  among the services referred to in the second paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during a 12-month period by a dentist:

i.  examination, except an emergency examination or, where the insured person is followed for oncological purposes by a dentist practising in an institution which operates a hospital centre listed in Schedule E, a second examination;

ii.  teaching and demonstration of oral hygiene procedures;

iii.  cleaning of teeth;

iv.  scaling;

v.  topical fluoride application;

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre or is rendered for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D;

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services (chapter S-4.2);

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses;

(v)  any assisted procreation service, except the artificial insemination services, including services required for ovarian stimulation, referred to in subparagraph e of the first paragraph of section 3 of the Act.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1; S.Q. 2015, c. 25, s. 19.

2012-09-01

22. The services mentioned under this Division shall not be considered as insured services for the purposes of the Act:

(a)  every examination or service which is not related to a process of cure or prevention of illness; examinations or services for the following purposes shall in particular be considered as such:

i.  issue or renewal of an insurance policy;

ii.  employment, or examinations during employment, or when such an examination or service is required by an employer or his representative unless such an examination or service is required by an Act of Québec other than the Act respecting collective agreement decrees (chapter D-2);

iii.  passports, visas or other similar purposes;

(b)  psychoanalysis in every form, unless such service is rendered in a facility maintained by an institution authorized for such purpose by the Minister of Health and Social Services;

(c)  any service provided for purely esthetic purposes including the following in particular:

i.  rhytidectomy;

ii.  any correction of a scar located elsewhere than on the face or neck and which does not cause functional interference;

iii.  any excision or dermabrasion of a nontraumatic tattoo;

iv.  any capillary graft to correct hereditary alopecia;

v.  any electrolysis, except in the case of pathological hirsutism or of folliculitis;

vi.  any correction of a nonsymptomatic congenital deformation;

vii.  any correction of prominauries (protruding ears) in a person 18 years of age or more;

viii.  any mammoplasty, unless such a service is provided for:

(A)  correction of mammary applasia;

(B)  correction of severe asymmetry (at least 150 g) of severe bilateral hyperplasia (at least 250 g per breast);

or

(C)  ipsi or contralateral reconstruction following any breast surgery which is considered an insured service;

ix.  any excision of nonsymptomatic excess adipose tissue;

(c.1)  any refractive surgery, with the exception of the following cases, where there is a documented failure in respect of corrective lenses and contact lenses:

i.  astigmatism of more than 3 diopters, measured from the cornea, acquired subsequently to trauma, to corneal pathology or to corneal surgery considered as an insured service and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph ii;

ii.  anisometropia of more than 5 diopters, measured from the cornea, entailing a functional deficit in vision and not secondary to refractive surgery carried out for a condition other than that provided for in subparagraph i;

(d)  any service provided by correspondence or telecommunication, except the telehealth services referred to in section 108.1 of the Act respecting health services and social services (chapter S-4.2) for which payment is otherwise provided for under the Act;

(e)  any service rendered by a professional to his consort or his children;

(f)  any examination, expert appraisal, testimony, certificate or other formality required for the ends of justice or by a person other than the person who has received and insured service, except in the following cases:

i.  proof of death;

ii.  a medico-legal examination of a sexual assault victim;

iii.  an examination required under the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (chapter P-38.001);

iv.  an examination required under the Public Curator Act (chapter C-81);

v.  an examination required under the Act respecting the Québec Pension Plan (chapter R-9);

vi.  an examination required under the Individual and Family Assistance Act (chapter A-13.1.1) except the new examination required by the Minister of Income Security under section 31 of that Act;

vii.  an examination required under the Youth Protection Act (chapter P-34.1);

(g)  any visit made for the sole purpose of obtaining the renewal of a prescription;

(h)  any examination, vaccination, immunization or injection given:

i.  to a group of persons, unless the professional from whom such service is required has previously obtained the written authorization of the Board;

ii.  for schooling purposes at all levels, for purposes of summer or other camps, and for purposes of any association or body;

(i)  any service rendered by a professional on the basis of an agreement or contract with an employer, an association or a body for the purposes of providing insured services to its or his employees or to their members;

(j)  among the services contemplated in subparagraph c of the first paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during 2 consecutive calendar years by an optometrist to an insured person who holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act and who is 18 years of age or over and less than 65 years of age or if they are rendered more than once during a calendar year by an optometrist to any other insured person contemplated in section 34;

i.  complete eyesight examination;

ii.  extensive study of colour vision;

(j.1)  (paragraph revoked);

(k)  any adjustment of spectacles or contact lenses;

(k.1)  among the services referred to in the second paragraph of section 3 of the Act, the following services shall not be considered insured services if they are rendered more than once during a 12-month period by a dentist:

i.  examination, except an emergency examination or, where the insured person is followed for oncological purposes by a dentist practising in an institution which operates a hospital centre listed in Schedule E, a second examination;

ii.  teaching and demonstration of oral hygiene procedures;

iii.  cleaning of teeth;

iv.  scaling;

v.  topical fluoride application;

(l)  any surgical extraction of a tooth or dental fragment performed by a physician, unless such a service is provided in a facility maintained by an institution which operates a hospital centre in one of the following cases:

i.  to an insured person less than 10 years of age;

ii.  to an insured person who holds a valid claim booklet issued under section 71.1 of the Act; or

iii.  by antrostomy;

(m)  all procedures of acupuncture;

(n)  the injection of sclerotial substances into:

i.  telangiactases;

ii.  arteriovenous vessels;

iii.  varicosities of the lower limbs; or

iv.  varicose veins of the lower limbs where such a service is not provided in a facility maintained by an institution which operates a hospital centre, and the examination made at that time;

(o)  i.  thermography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

ii.  mammography for detection purposes, unless that service is rendered by medical prescription, in a place designated under subparagraph b.3 of the first paragraph of section 69 of the Act, to an insured person 35 years of age or older and provided that the person has not been so examined for 1 year;

(p)  the use of radionuclids in vivo in a human, unless this service is rendered in a facility maintained by an institution which operates a hospital centre;

(q)  ultrasonography, unless this service is rendered in a facility maintained by an institution which operates a hospital centre or is rendered for obstetrical reasons, in a facility maintained by an institution which operates a local community service centre referred to in Schedule D, or is required for the purposes of medically assisted procreation in accordance with section 34.4, 34.5 or 34.6;

(q.1)  computer tomography, unless the service is provided in a facility maintained by an institution which operates a hospital centre;

(q.2)  magnetic resonance imaging, unless the service is rendered in a facility maintained by an institution that operates a hospital centre;

(q.3)  optical tomography of the ocular globe and confocal scanning laser ophthalmoscopy of the optic nerve, unless those services are rendered in a facility maintained by an institution that operates a hospital centre or they are rendered as part of an intravitreal injection of an antiangiogenic drug for treatment of age-related macular degeneration;

(r)  any radiological service provided by a physician:

i.  if it is required with a view to dispensing an uninsured service or one not considered insured under the Act or regulations;

ii.  if it is required by a person other than a physician or dentist; or

iii.  if it is provided in a laboratory under an agreement entered into with the operator of a specialized medical centre under the first paragraph of section 333.6 of the Act respecting health services and social services (chapter S-4.2);

(s)  any anesthetic service provided by a physician if it is required with a view to dispensing an uninsured service or a service not considered insured by the Act or regulations, with the exception of a dental service provided in a facility maintained by an institution which operates a hospital centre;

(t)  any surgical service provided for the purposes of transsexualism unless that service is provided in a facility maintained by an institution which operates a hospital centre and upon the recommendation of the head of the clinical department responsible for transsexualism services at the Hôtel-Dieu de Montréal or at the Montreal General Hospital, and upon the recommendation of a psychiatrist practising in one of those 2 hospital centres;

(u)  any service that is not related to a pathology and that is rendered by a physician to an insured person at least 18 years of age or over and less than 65 years of age, unless the insured person holds a valid claim booklet issued in accordance with section 71 or 71.1 of the Act, for a problem of daltonism or refraction for the purpose of getting or renewing a prescription for spectables or contact lenses.

R.R.Q., 1981, c. A-29, r. 1, s. 22; O.C. 2448-82, s. 1; O.C. 3018-82, ss. 1-3; O.C. 1374-84, s. 1; O.C. 1813-84, s. 1; O.C. 1556-87, s. 1; O.C. 1823-88, s. 1; O.C. 922-89, s. 133; O.C. 1214-89, s. 1; O.C. 1064-91, s. 1; O.C. 1192-92, s. 1; O.C. 1244-92, s. 1; O.C. 1469-92, s. 2; O.C. 729-93, s. 1; O.C. 896-94, s. 1; O.C. 386-95, s. 1; O.C. 1179-95, s. 2; O.C. 323-96, s. 1; O.C. 1287-96, s. 1; O.C. 1563-96, s. 1; O.C. 924-97, s. 1; O.C. 1190-2001, s. 1; O.C. 329-2007, s. 1; S.Q. 2007, c. 21, s. 44; S.Q. 2009, c. 29, s. 39; O.C. 894-2009, s. 1; O.C. 645-2010, s. 1; O.C. 1088-2011, s. 1.