Regulations Amending the Immigration and Refugee Protection Regulations (Exempting Protected Persons in Canada from Medical Examinations when Applying for Permanent Residence): SOR/2025-223
Canada Gazette, Part II, Volume 159, Number 24
Registration
SOR/2025-223 October 30, 2025
IMMIGRATION AND REFUGEE PROTECTION ACT
P.C. 2025-747 October 30, 2025
Whereas under subsection 5(2)footnote a of the Immigration and Refugee Protection Act footnote b, the Minister of Citizenship and Immigration has caused a copy of the proposed Regulations Amending the Immigration and Refugee Protection Regulations (Exempting Protected Persons in Canada from Medical Examinations when Applying for Permanent Residence) to be laid before each House of Parliament;
Therefore, Her Excellency the Governor General in Council, on the recommendation of the Minister of Citizenship and Immigration, makes the annexed Regulations Amending the Immigration and Refugee Protection Regulations (Exempting Protected Persons in Canada from Medical Examinations when Applying for Permanent Residence) under subsection 5(1) and section 17 of the Immigration and Refugee Protection Act footnote b.
Regulations Amending the Immigration and Refugee Protection Regulations (Exempting Protected Persons in Canada from Medical Examinations when Applying for Permanent Residence)
Amendment
1 Subsection 30(1) of the Immigration and Refugee Protection Regulations footnote 1 is amended by striking out “and” at the end of paragraph (e), by adding “and” at the end of paragraph (f) and by adding the following after paragraph (f):
- (g) foreign nationals who are applying to remain in Canada as a permanent resident and on whom refugee protection has been conferred under paragraph 95(1)(b) or (c) of the Act, as well as their accompanying family members in Canada, if both of the following conditions apply:
- (i) they have previously undergone a medical examination that indicates their health condition is not likely to be a danger to public health or public safety or have complied with the medical surveillance conditions imposed under section 32, if any,
- (ii) they have not resided or stayed for a period of six consecutive months since their most recent medical examination in an area that the Minister determines, after consultation with the Minister of Health, has a higher incidence of serious communicable disease than Canada.
Coming into Force
2 These Regulations come into force on the day on which they are registered.
REGULATORY IMPACT ANALYSIS STATEMENT
(This statement is not part of the Regulations.)
Issues
Protected persons in Canada are considered a vulnerable population given that they have left their home country and have sought protection in Canada because they cannot return home safely. The vulnerability of a protected person in Canada can be exacerbated by financial instability, particularly when fees associated with making a permanent residence application delay their application.
On average, an immigration medical examination, which is a requirement for a permanent resident application, costs $400. To ensure that the cost associated with this examination does not act as a barrier to protected persons in Canada making a permanent resident application, a temporary public policy was put in place to exempt eligible protected persons in Canada from this requirement.
The Immigration and Refugee Protection Regulations (the Regulations) need to be amended to formalize the exemption and replace the public policy.
Background
To protect the health and safety of Canadians, the Immigration and Refugee Protection Act (the Act) requires that all foreign nationals who make an application for permanent residence submit to an immigration medical examination. The Regulations further specify that all applicants for permanent residence, including protected persons and family members included in the protected person’s application to remain in Canada as permanent residents, must undergo an immigration medical examination to determine whether they are inadmissible to Canada on health grounds.
Protected persons in Canada undergo an immigration medical examination at the time they make their refugee claim. The cost of the immigration medical examination is covered by the Interim Federal Health Program. Protected persons in Canada are also required to complete a subsequent immigration medical examination once their refugee claim is accepted and they apply for permanent residence. The subsequent immigration medical examination is paid for by the applicant. The health screening process for protected persons in Canada was identified as an area where processing efficiencies could be gained without introducing significant public health or program integrity risks by waiving the requirement to complete a subsequent immigration medical examination for the permanent residence application.
Immigration, Refugees and Citizenship Canada (the Department) conducted a risk assessment, reviewing factors related to public health, public safety, and the potential impact on Canada’s publicly funded health-care system. Based on this assessment, it was determined that eliminating the subsequent immigration medical examination requirement for eligible protected persons in Canada is low risk.
Firstly, protected persons in Canada are required to undergo an immigration medical examination at the time they make their refugee claim in Canada. Any protected persons in Canada who pose a risk to public health or public safety are then linked to and managed by health-care services in Canada. In particular, asylum claimants who were previously treated for active pulmonary tuberculosis or diagnosed with latent tuberculosis are referred to provincial/territorial public health authorities for follow-up, surveillance, and/or treatment, if needed. If such conditions are imposed, provincial/territorial public health authorities must provide the Department with proof of compliance. This regulatory requirement helps to prevent the spread of the disease in Canada by integrating applicants at risk of reactivation into health-care services in Canada.
Secondly, protected persons in Canada are unlikely to have spent significant time outside of Canada, since they are required to surrender their passports while awaiting a decision on their claim for refugee protection or their pre-removal risk assessment. While some protected persons in Canada are issued a refugee travel document after their claim has been accepted, they are asked to provide their travel history as part of their application forms for permanent residence. Officers check application forms for indications they have been outside Canada (particularly in areas where the rates of tuberculosis are higher than in Canada), and conduct necessary follow-up to determine whether applicants meet eligibility conditions. This limits the possibility of re-exposure to tuberculosis infection outside of Canada, a health condition that would lead to inadmissibility on health grounds related to public health, until treated.
Finally, protected persons in Canada are exempt from the excessive demand provision of the Act. As a result, when protected persons in Canada undergo their subsequent immigration medical examination at the permanent residence application stage, they are not assessed for health conditions that might reasonably be expected to cause excessive demand for health and social services, even if their health status has changed.
As a result of the low risk of exempting protected persons in Canada from the immigration medical examination when applying for permanent residence, and given the financial burden the examination can put on a financially vulnerable population, the Temporary public policy to exempt in-Canada protected persons from the Immigration Medical Examination requirement when applying for permanent residence (the Temporary Public Policy) was implemented beginning on September 10, 2020.
Objective
The objectives of the Regulations Amending the Immigration and Refugee Protection Regulations (Exempting Protected Persons in Canada from Medical Examinations when Applying for Permanent Residence) [the Amendments] are to remove a potential financial barrier to protected persons in Canada completing a permanent residence application and to streamline the permanent residence application process. These objectives align with the Department’s efforts to advance a risk-based approach to health screening, where screening is commensurate with the level of risk that an applicant poses.
Description
The Amendments exempt protected persons in Canada, and their accompanying family members in Canada who meet the criteria, from the requirement to undergo a subsequent immigration medical examination as part of their application for permanent residence.
An exemption from the immigration medical examination requirement is restricted to protected persons in Canada and their accompanying family members in Canada who have
- submitted a new application or have a pending application for permanent residence (with an immigration medical examination that has not been started);
- previously completed an immigration medical examination that indicates they are not likely to be a danger to public health or safety or who have complied with mandatory medical surveillance conditions; and
- not left Canada, since their initial immigration medical examination, to spend six or more months in a tuberculosis-designated country or territory.
Applicants who are required to submit to medical surveillance after their initial immigration medical examination and are found to be non-compliant cannot benefit from this exemption. They must complete their subsequent immigration medical examination when they apply for permanent residency.
Regulatory development
Consultation
The implementation of the Temporary Public Policy was shared with the Canadian Council for Refugees, who welcomed the changes as they alleviate the burden on a vulnerable population. No further consultations took place, since the Amendments are a low risk, facilitative measure to ease operational pressures and enhance the applicant’s experience.
As a result, the Amendments were not prepublished in the Canada Gazette, Part I.
Indigenous engagement, consultation and modern treaty obligations
As required by the Cabinet Directive on the Federal Approach to Modern Treaty Implementation, an assessment of modern treaty implications was conducted. The assessment examined the geographical scope and subject matter of the initiative in relation to modern treaties in effect and did not identify any potential modern treaty impacts or obligations.
Instrument choice
Temporary public policies are not meant to stay valid indefinitely. The Temporary Public Policy to exempt protected persons in Canada and their accompanying family members in Canada who meet the criteria from the requirement to undergo a subsequent immigration medical examination as part of their application for permanent residence was implemented on September 10, 2020. The stipulation was that changes would either be formalized through regulatory amendments or the Minister would revoke the policy. Because the requirements surrounding immigration medical examinations are set out in the Regulations, regulatory amendments are needed to ensure the policy remains in place indefinitely. As a result, other instruments were not considered.
Regulatory analysis
Benefits and costs
An important first step in developing a cost-benefit methodology is establishing a baseline scenario against which options may be measured. For this analysis, the baseline is a scenario where the Temporary Public Policy would not continue to be in effect, whereby protected persons in Canada who were exempted through the Temporary Public Policy would no longer be exempted from a subsequent immigration medical examination when they apply for permanent residence. The regulatory scenario is one where Regulations would exempt eligible protected persons in Canada from the subsequent immigration medical examination requirement when they apply for permanent residence, resulting in net cost savings to the Government and to eligible protected persons in Canada.
Benefits
The cost savings to eligible protected persons in Canada would consist of avoided costs from obtaining an immigration medical examination when applying for permanent residence. The Amendments support applicants that may lack the resources required to pay the immigration medical examination fees, thereby preventing permanent resident application delays, as a result of financial vulnerability. This client service measure will enable applicants to more quickly become permanent residents and obtain the benefits that this status affords, including health coverage. A complete immigration medical examination costs approximately $400 per person, including doctor fees, blood work, exams and X-rays. From the time the public policy came into effect until May 14, 2024, 36 022 subsequent immigration medical examinations for protected persons in Canada have been exempted, representing a cost savings of roughly $14.4 million for this vulnerable population. The Amendments are expected to exempt approximately 9 820 protected persons in Canada per year. The total cost savings to eligible protected persons in Canada are estimated at $3,928,000 annually.
Cost savings to the Government of Canada consist of minimal avoided costs related to time and effort spent by medical or migration officers to review and process immigration medical examinations that are not automatically cleared. It is estimated that over 80% of immigration medical examinations would be automatically cleared and would not require a review by medical or immigration officers. The Government of Canada would save three to six minutes in time effort per application for approximately 20% of immigration medical examinations for this cohort of applicants. The cost savings to the Government of Canada are estimated at $4,513 annually.
Costs
The Amendments will result in incremental costs to the Government of Canada. These consist of communication costs to update bulletins and websites with the regulatory change, as well as updating program guidance materials for officers and adapting the immigration medical examination auto-clear process for protected persons in Canada. These one-time costs are estimated at $16,160. Additionally, the Government of Canada will incur ongoing costs related to updates to web content and communications products. Ongoing costs are estimated at $4,311 annually.
Lastly, panel physicians (doctors who perform immigration medical examinations), radiologists and laboratories that provide X-ray and blood work as part of the immigration medical examination requirement may face foregone revenue from the immigration medical examination exemption for eligible protected persons in Canada. However, this decrease in demand would be low, and the foregone revenue will be offset by panel physicians, radiologists and laboratories not incurring time costs for providing this service for this cohort of patients. The time saved can be reallocated to provide services to other patients.
Small business lens
Analysis under the small business lens concluded that the Amendments would not impact small businesses.
Panel physicians, radiologists and laboratories that provide examinations, X-rays and blood work as part of the immigration medical examination services may face foregone revenue from the subsequent immigration medical examination exemption for eligible protected persons in Canada. This loss in revenue will be offset by health professionals and businesses no longer incurring time costs for providing immigration medical examination services for this cohort of patients, and this time can be reallocated to other patients. A portion of the impacted businesses would be small businesses.
One-for-one rule
The one-for-one rule does not apply, as there is no incremental change in administrative burden on businesses.
Regulatory cooperation and alignment
There are no regulatory cooperation and alignment implications associated with the Amendments.
Effects on the environment
In accordance with the Cabinet Directive on Strategic Environmental and Economic Assessment, a preliminary scan concluded that a strategic environmental and economic assessment is not required.
Gender-based analysis plus
The Amendments result in positive gender-based analysis plus (GBA+) impacts. Protected persons in Canada are also financially vulnerable. The cost associated with the requirement to complete a second immigration medical examination when applying for permanent residence has acted as a barrier to protected persons in Canada becoming permanent residents due to their financial vulnerability. As a result, the removal of this requirement will result in positive GBA+ impacts to protected persons in Canada.
The exemption will apply equally to all protected persons in Canada and their accompanying family members in Canada who meet the requirements regardless of ethnicity, gender or other intersecting identity criteria.
Implementation, compliance and enforcement, and service standards
Implementation
The Amendments come into force upon registration. Since the Temporary Public Policy was implemented on September 10, 2020, the policy changes relating to the exemption of subsequent immigration medical examinations for eligible protected persons in Canada and their accompanying family members in Canada are already in effect and are being followed. The Temporary Public Policy ceases to have effect when the Amendments come into force.
Program delivery instructions for migration offices are already available internally and indicate how to operationalize this initiative. Minor updates will be made following the implementation of the Amendments to reflect that it has come into effect.
The Department will monitor the performance of the health screening program on an ongoing basis and will report progress as part of its departmental performance reporting process.
Compliance and enforcement
Officers will continue to verify that applicants have previously completed an immigration medical examination and were found to pose no risk to public health or safety and/or have complied with mandatory medical surveillance conditions, and have not left Canada since their initial immigration medical examination to spend six or more months in a tuberculosis-designated country or territory.
Protected persons in Canada and their accompanying family members in Canada who do not meet the criteria will not be exempted from a subsequent immigration medical examination.
Contact
Andrea Currie
Director
Health Operations Policy and Support
Migration Health Branch
Immigration, Refugees and Citizenship Canada
Telephone: 613‑295‑5536
Email: IRCC.MHBDGO-BDGDGMS.IRCC@cic.gc.ca