Canada Immigration Medical Exam (IME): Requirements, Tests, and Costs

The immigration medical exam is a standardized health screening that Immigration, Refugees and Citizenship Canada requires from most people applying to live, work, or study in Canada. It is not a general check-up and it is not a test you pass or fail on fitness. IRCC uses it to answer one narrow question: are you admissible to Canada on health grounds.

The rules around when to complete it changed in August 2025, and the cost threshold used to assess medical inadmissibility changed again in January 2026. If you are applying for permanent residence through Express Entry, the timing rule in particular now works the opposite way from how it worked for most of 2024 and early 2025.

What Changed Recently

• August 21, 2025. IRCC reinstated the upfront medical exam requirement for permanent residence applications submitted through Express Entry. You now complete the exam before you apply and submit proof with your application.
• November 3, 2025. IRCC updated the list of countries and territories that trigger a medical exam requirement for temporary residents staying longer than six months. Some countries were added and others removed, so an old list is not reliable.
• January 1, 2026. The excessive demand cost threshold rose to $28,878 per year, or $144,390 over five years, up from $27,162 per year in 2025.

Who Needs an Immigration Medical Exam

Permanent Residence Applicants

Every permanent residence applicant needs an immigration medical exam, regardless of program. So does every family member listed on your application, including a spouse or dependent child who is not coming to Canada with you. This catches people out regularly. A non-accompanying dependant who skips the exam can hold up the whole file.

Temporary Residents

Whether you need one as a visitor, student, or worker depends on what you will do in Canada and where you have been.

• Staying six months or less. Usually no exam, unless you will work in an occupation where public health must be protected.
• Staying more than six months. You need an exam if you have lived in or travelled to a designated country or territory for six months in a row during the year before you arrive.
• Public health occupations. Health care, clinical laboratory work, child care, elder care, and teaching or supervising young children all require an exam regardless of how long you stay.
• Super visa applicants. Parents and grandparents applying for a super visa need an exam.

If you are applying for a study permit or a work permit and you are not sure, the safest approach is to wait for IRCC's instructions rather than paying for an exam you may not need.

When to Complete the Exam

There are two timing routes, and the one that applies to you depends on your application type.

Upfront medical exam. You book and complete the exam before you submit, then attach proof. For Express Entry permanent residence applications this is now mandatory rather than optional. The panel physician gives you proof of completion, either a printout from the eMedical system labelled Information Sheet or Health case details, or the first page of form IMM 1017B-Upfront. Keep that document. It is what you upload.

Exam after applying. For most other applications, you submit first and IRCC sends instructions if an exam is required. You then generally have 30 days to complete it.

The upfront route creates a practical squeeze for Express Entry candidates. You have 60 days from your invitation to apply to submit a complete application, and clinic wait times in busy cities can run one to three weeks. Booking should be one of the first things you do after an invitation arrives, not one of the last.

What Happens During the Exam

Only a panel physician, meaning a doctor IRCC has specifically approved, can perform the exam. Your own family doctor cannot do it unless they happen to be on the panel list. Results go directly from the physician to IRCC through eMedical, so you never see the full report.

The standard exam covers:

• Medical history. Past and current conditions, hospitalizations, surgeries, treatments, and medications. Bring a written list of your medications with dosages.
• Physical examination. Vital signs and an assessment of major systems, including heart, lungs, abdomen, skin, and limbs. It does not include breast, genital, gynecological, or rectal examination.
• Mental status observation. The physician observes your cognition, mood, and behaviour. This is an observation, not a psychiatric evaluation, though a referral can follow if something is flagged.
• Blood tests for applicants aged 15 and older. Screening for syphilis and HIV, along with kidney function.
• Chest X-ray for applicants aged 11 and older. This screens for tuberculosis. Pregnant applicants still have the X-ray, with shielding, so tell the clinic when you book.
• Further tests if needed. The physician can order additional investigations to clarify a finding, such as sputum testing after an unclear chest X-ray.

Older guides often describe a routine urine test as part of the exam. That is no longer part of the standard protocol, although a physician can still order one where a specific finding calls for it. Your clinic will tell you what your appointment includes when you book, and that instruction is the one to follow.

Two things worth knowing: the blood work does not screen for recreational drugs, COVID-19, pregnancy, or genetic conditions, and IRCC does not require you to be vaccinated. The physician may record your immunization history if you provide it.

What the Exam Costs

IRCC does not set the fee. Panel physicians set their own prices, which vary widely by country and clinic. You pay for the consultation, the laboratory work, and the X-ray, and any specialist referral is billed separately. Most applicants pay a few hundred dollars in local currency. Provincial health insurance does not cover it, and neither does IRCC.

Ask for the full price when you book, including lab and imaging, because some clinics quote the consultation alone.

How Long Results Stay Valid

An immigration medical exam is valid for 12 months from the date it was performed. If your application is not finalized and you have not landed within that window, IRCC may require a new one. Occasionally only a component needs updating, but that call belongs to IRCC and the panel physician, not to you.

If you are already in Canada and completed an exam within the last five years, you may not need to repeat it. IRCC has run temporary public policies exempting certain lower-risk applicants from a second exam. If this may apply to you, provide the unique medical identifier number from your previous exam when you apply.

Medical Inadmissibility and the 2026 Threshold

This is the part that worries applicants most, and it is worth being precise about, because having a health condition and being medically inadmissible are very different things. Under the Immigration and Refugee Protection Act, a medical officer can find you inadmissible on three grounds:

• Danger to public health. An infectious condition such as active tuberculosis or untreated infectious syphilis.
• Danger to public safety. A risk of sudden incapacity, or unpredictable or violent behaviour.
• Excessive demand on health or social services. Care that would likely cost more than the published threshold, or add unreasonably to wait times for publicly funded services.

The threshold is not a fee and you do not pay it. It is a benchmark set at three times the average Canadian per capita cost of health and social services, and IRCC updates it annually. If the projected public cost of your care over five years falls below the figure, excessive demand does not apply.

Common chronic conditions such as controlled diabetes, asthma, treated high blood pressure, anxiety, and depression do not ordinarily come close to the threshold. The cases that do tend to involve high-cost ongoing therapies or significant social services support.

The excessive demand ground also does not apply at all to refugees and their dependants, protected persons, or family-sponsored spouses, common-law partners, and dependent children. If you are sponsoring a partner through spousal sponsorship, excessive demand is not a concern in that application, although the public health and public safety grounds still are.

If IRCC Raises a Concern

IRCC does not simply refuse an application on medical grounds without warning. If a medical officer has a concern, you receive a procedural fairness letter setting out the finding and giving you an opportunity to respond, normally within 90 days.

A response is not a plea. It is an evidence exercise. Depending on the case it can include an updated diagnosis, a specialist opinion disputing the projected cost or prognosis, evidence of lower-cost treatment or medication, or a mitigation plan showing how you would reduce reliance on publicly funded services. Deadlines are firm, and extensions have to be requested through the address given in the letter. This is the stage where professional help usually matters most, because the officer's estimate is being challenged on medical and cost evidence rather than on sympathy.

Medical Surveillance After Arrival

Some applicants are admitted but placed under medical surveillance. The usual reason is inactive or previously treated tuberculosis showing on a chest X-ray. You are not inadmissible, but you have to report to public health authorities in your province after arriving, normally within 30 days. Failing to do so can affect your status, and it is a condition people forget once they land.

Mistakes That Delay Files

• Not disclosing a medication or condition. If bloodwork reveals something you did not mention, IRCC treats it as withheld information, which is a far more serious problem than the condition itself.
• Skipping a non-accompanying family member. Everyone listed on a permanent residence application needs the exam.
• Booking with a non-panel doctor. Those results are rejected outright and the money is gone.
• Leaving the exam too late in the 60-day window. Clinic availability, lab turnaround, and result transmission all take time.
• Letting results expire. If processing runs long, watch the 12-month date rather than waiting to be told.
• Treating a procedural fairness letter as a formality. It is often the last chance to keep the application alive.

If you have a health condition you are worried about, or you have received a procedural fairness letter raising medical inadmissibility, our team can review your situation and explain your realistic options before you respond. Bring your diagnosis, treatment details, and any correspondence from IRCC.

You can confirm current requirements on IRCC's pages for temporary resident medical exams and IRCC's own guidance on issuing instructions for medical examinations, and the Express Entry change is set out in IRCC's program delivery update on upfront medical examinations.

This page is general information, not legal advice. Medical exam requirements, designated country lists, and the excessive demand threshold change regularly, and the threshold is updated every January. Confirm current requirements on canada.ca or with a licensed representative before you act.