Not every applicant to Canada has to complete an Immigration Medical Exam (IME), but every foreign national is still subject to the medical inadmissibility rules in section 38 of the Immigration and Refugee Protection Act (IRPA). In practice, an IME is normally required of permanent residence applicants, and of temporary residents who fall into one of a small number of categories: those who have lived for six months or more in a country IRCC designates as requiring an exam, International Experience Canada (IEC) applicants, and people coming to work with vulnerable populations. Everyone else is generally screened through the medical question on the application form rather than through a physical exam.
That distinction matters more than most applicants realise. Being waved through today without an IME does not mean a medical condition has been cleared. It means it has not yet been assessed.
Key Takeaways
- All foreign nationals are subject to IRPA s. 38, whether they are applying as temporary or permanent residents. Only some are required to complete an IME before entry.
- The three common IME triggers for temporary residents are residence of six or more months in a designated country, an IEC application, and work with vulnerable people such as patients, children, or seniors.
- Medical results are time-limited by design, which means a condition can be reassessed on a later extension or permanent residence application.
- Application forms ask a direct medical question. An inaccurate answer creates exposure under the misrepresentation provisions, separately from any s. 38 issue.
- Thresholds, designated country lists, and forms change. Verify the current IRCC posting before you rely on any figure in this article.
Who has to complete an immigration medical exam?
Permanent residence applicants
Applicants for permanent residence are normally required to complete an IME as part of processing, along with their accompanying family members. This is where medical inadmissibility questions most often surface, because permanent residence brings access to publicly funded health and social services and the assessment looks forward over a multi-year horizon.
Temporary residents
Most visitors, students, and workers do not complete an IME. The usual triggers are:
- Time spent in a designated country. Applicants who have resided for six months or more in a country IRCC lists as requiring an exam. The list is maintained by IRCC and changes periodically, so confirm the current version rather than relying on what applied to an earlier application.
- International Experience Canada. IEC applicants are generally required to complete an IME regardless of citizenship or how long they intend to stay.
- Work with vulnerable people. Foreign nationals seeking to work in health care, education, caregiving, and similar fields are generally required to complete an exam regardless of duration or country of citizenship.
If none of these applies, a traveller will usually clear the border without a medical assessment. An examination at a port of entry is legally possible but uncommon.
What is the exam actually screening for?
Section 38(1) sets out three separate and distinct grounds, and they are often confused with one another:
- s. 38(1)(a) danger to public health, aimed at infectious or communicable conditions that could affect others in Canada. Active tuberculosis and syphilis are the classic examples, and the governing list sits in the Regulations. HIV is not a public health ground.
- s. 38(1)(b) danger to public safety, aimed at a risk of sudden incapacity or of violent behaviour that would endanger others.
- s. 38(1)(c) excessive demand on health or social services, which is a cost-based assessment rather than a diagnosis-based one.
Only the third ground carries statutory exemptions. Under s. 38(2), the excessive demand ground does not apply to sponsored spouses, common-law partners, and children in the family class, to those applying as Convention refugees or persons in similar circumstances, to protected persons, or to certain prescribed family members. Danger to public health and danger to public safety have no such exemption and apply to everyone.
For the cost test itself, the individualized assessment, and how a procedural fairness response is built, see our IRPA s. 38 medical inadmissibility page. As a reference point, the five-year excessive demand cost threshold used for 2026 was reported at $144,300, or $28,878 per year, up from the prior year. Figures of this kind are adjusted regularly, so verify the current IRCC posting.
Where and when does the assessment happen?
Two moments matter. The first is when the exam is completed, at a panel physician, before a decision. The second, and the one applicants tend to overlook, is when the form question is answered.
Visa-requiring foreign nationals, and those extending temporary status from inside Canada, are asked directly whether they have any physical or mental disorder that would require social or health services, other than medication, during their stay. That question is the screening mechanism for everyone who does not complete a full IME.
How long do medical results last?
Immigration medical results are valid only for a limited period and then expire. That is deliberate. It allows a condition to be reassessed against current facts on a later application, which cuts both ways: a condition that was not a barrier on a short visitor stay can become the central issue on a permanent residence application years later, and equally, a condition that has stabilised or gone into remission can be re-presented on better evidence.
Practically, this means a temporary resident with a serious diagnosis should be advised about the medical picture on any future extension or permanent residence application at the time of the first entry, not later.
The disclosure question and the misrepresentation risk
Answering the medical question inaccurately is not a low-stakes error. An omission or inaccuracy can support a misrepresentation allegation, which is assessed under its own provisions and carries its own consequences, entirely separately from whether the condition would ever have caused a s. 38 refusal. In some cases the underlying condition would not have blocked the application at all, and the answer on the form becomes the only real problem. Our misrepresentation page explains how that analysis works.
The practical lesson is a familiar one for counsel: candid disclosure to your lawyer early is what allows the file to be structured properly. Legal advice is only as good as the facts it is built on.
If you have a serious medical condition, what should you gather first?
A preliminary assessment cannot be done on a diagnosis alone. The information that actually drives the analysis is:
- the specific diagnosis, with date, stage, and current symptoms;
- the treatment currently underway, including medication and dosage, and the routine for specialist visits and testing; and
- any procedures scheduled or anticipated.
With that in hand, counsel can research the typical prognosis, identify issues such as deteriorative elements or high prescription costs, and ask whether treatments exist that could lead to partial or full remission and whether they are realistically available on the applicant’s facts. Often the next step is a targeted request to the treating physician or specialist for a letter that speaks to prognosis and anticipated treatment, not just diagnosis.
Frequently Asked Questions
Do I need a medical exam for a Canadian visitor visa?
Usually not. Most visitors are screened through the medical question on the application form. An exam is generally required if you have resided six months or more in a designated country, or if you will be working with vulnerable people. Confirm the current IRCC requirements for your situation.
Can I be refused on medical grounds even if I never took an exam?
Yes. Every foreign national is subject to s. 38. The absence of an exam simply means no medical assessment has been made yet. The question can be revisited on a later application.
Does a medical condition affect my whole family’s application?
It can. A finding against one family member can affect accompanying family members, which is one reason these files are treated as high-stakes even when the condition itself is well managed.
Is my child’s autism diagnosis automatically a bar to immigrating?
No. The excessive demand assessment must be individualized and looks at anticipated cost, not diagnosis alone. Sponsored spouses, partners, and children in the family class are also exempt from the excessive demand ground under s. 38(2). Every case turns on its own evidence.
How current are the numbers in this article?
Cost thresholds and designated country lists are updated regularly. Treat any figure here as a reference point and verify the current IRCC or ESDC posting before acting on it.
Disclaimer: This article is for general information only and is not legal advice. Immigration law and IRCC/ESDC policy change frequently, and every case turns on its own facts. Reading this article does not create a lawyer–client relationship. Obtain advice tailored to your situation before you act.
Talk to a Canadian immigration lawyer. BridgePoint Law advises individuals and businesses across Canada — and on Canada–US–China cross-border matters — on medical admissibility and immigration medical exam requirements. Book a consultation with our team in Toronto and Kingston. We work in English, Mandarin, and Cantonese.
