Applying through Express Entry with a pre-existing medical condition? This is what you have to know
It’s possible to have your application for Canadian permanent residence (PR) refused on the basis of medical inadmissibility, but there are steps you can take to reduce the risk of refusal.
As of August 21, 2025, all new Express Entry applicants now need to provide an upfront immigration medical exam (IME) as part of their application for permanent residence.
Prior to this change, medical exams would only be requested by Immigration, Refugees and Citizenship Canada (IRCC) after an applicant had submitted their application.
See your eligibility for all Express Entry streams
This article will cover how to address the the three reasons IRCC may find you medically inadmissible
1. Excessive demand on health or social services
For most Express Entry applicants, this is the most common medical inadmissibility issue. IRCC may determine that your health condition could place excessive demand on Canadian public resources.
In determining whether your condition(s) are likely to pose excessive demand, IRCC considers
The results of your Immigration Medical Exam (IME);
The current state of your health conditions;
The likely prognosis;
Whether the services you need
Would increase wait times for others; and/or
Exceed the cost threshold for Canadian health or social services.
For 2025, this excessive demand cost threshold is set at $27,162 per year or $135,810 over the course of five years. This figure is periodically revised by IRCC.
Conditions that may trigger excessive demand review
Conditions that can lead to excessive demand include, but are not limited to
Chronic conditions like diabetes, kidney disease, or cardiac issues;
Psychiatric conditions (e.g., bipolar disorder, schizophrenia);
Developmental conditions (e.g., Down syndrome, autism);
Mobility or neurological disorders (e.g., cerebral palsy, total knee replacement); or
Infectious diseases requiring ongoing treatment (hepatitis B/C, tuberculosis).
A more complete list of medical conditions that could trigger excessive demand can be found on our dedicated website.
Even if your condition appears on the list above, it doesn’t mean you’ll automatically be found inadmissible.
What you can do if you are at risk of being medically inadmissible for this reason:
You may wish to include supporting documentation to show that your condition will not place excessive demand on Canada’s public health system, for instance
Providing proof of private health insurance for your treatment, showing evidence that this will reduce the monetary demand on Canada’s public health care system;
Providing the most recent test results and medical opinion(s) of doctors treating you, in support of a likely positive prognosis; and/or
Providing additional test results, specific to your condition, in support of the current effective management of your condition.
This kind of documentation is also pertinent to overcoming inadmissibility for this reason, through a mitigation plan (covered later).
2. Danger to public health
IRCC may refuse your application if it believes your health condition poses a risk to public health in Canada.
In determining this, IRCC considers
The results of your IME;
Specialist reports (if requested by IRCC);
Whether you have (or were exposed to) infectious diseases; and
How your condition may affect others in Canada
What you can do if you are at risk of being medically inadmissible for this reason
You may wish to include supporting documentation in your application that attests that your condition does not pose any danger to public health, for instance
Providing up-to-date specialist or general medical reports showing your condition is not contagious or is being actively treated, and that you are in compliance with this treatment;
Submitting lab results and documentation showing you are receiving effective care; and/or
If you’ve been treated or cured, submitting proof of treatment and follow-up test results indicating no current infection.
IRCC assesses these cases individually. Just because you’ve had or been exposed to an illness doesn’t mean you’ll be refused.
See your eligibility for all Express Entry streams
3. Danger to public safety
If IRCC concludes that your condition may compromise public safety, your application can also be refused.
In determining this, IRCC considers
Your risk of sudden incapacity (e.g., unpredictable seizures or loss of consciousness); and
Unpredictable or violent behaviour tied to mental or neurological conditions.
What you can do if you are at risk of being medically inadmissible for this reason
You may wish to include supporting documentation in your application that attests that your condition does not pose any danger to public safety, for instance
Submitting medical documentation that shows your condition is under control and being monitored;
Providing specialist assessments confirming that you are not a risk to others;
Including evidence of treatment compliance, such as prescriptions, therapy reports, or behavioural assessments; and/or
Submitting documentation showing IRCC that you do not have a history of violence during the time you have been dealing with your condition.
Again, this decision is based on your individual health profile. IRCC will look for signs of stability and responsible management of your condition.
Overcoming medical inadmissibility
Responding to a Procedural Fairness Letter
Before making a final decision, IRCC will usually send you a Procedural Fairness Letter if there is a chance that you may be found medically inadmissible.
This letter will include
An explanation of the officer’s concerns;
A request for additional documentation; and
A 90-day deadline to respond.
In responding to a procedural fairness letter, you may wish to include supporting documentation, including (but not limited to)
Medical updates and specialist reports;
Proof of treatments received or adjusted (e.g., new medication regimens);
Cost-effective care options (e.g., switching to generic drugs, showing private funding, etc.); and/or
Evidence that your condition is stable and under control.
You may request an extension to the 90-day deadline if you need additional time to respond.
Submit a mitigation plan (if invited)
In cases where medical inadmissibility due to excessive demand is a concern, IRCC may invite you to submit a mitigation plan.
This is a plan to demonstrate how you’ll manage your condition without relying on public resources and prove how services will be provided and funded.
In creating a mitigation plan, you may wish to include
Private health insurance coverage (e.g., prescription drugs);
Financial documents showing the ability to pay for ongoing care and treatment;
Letters from your physician(s) confirming care plans; and
A personal history of medical costs and coverage.
In addition to the above, applicants submitting a mitigation plan must also include a signed Declaration of Ability and Willingness form, accepting full responsibility for their care in Canada.
Note: You can’t opt out of public healthcare in Canada, but you can show that your outpatient needs (such as medication) will be privately covered.
For more information on overcoming medical inadmissibility, find our dedicated webpage.
