Regional Financial Assistance Program Form - For Travel by Clients (200 kilometres or more)

Sep 19, 2026

Regional Financial Assistance Program Form for patients in Gaspésie-Iles-de-la-Madeleine who must travel 200 km or more to access medical care and services not available locally. The program covers eligible travel and accommodation costs through mileage allowances or public transport ticket costs, plus a per-night lump sum for meals and lodging. It defines eligibility requirements, exclusions, special conditions, and the claims procedure, including submission timelines, required documents, and contact information for financial resources offices across the region.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

ELIGIBILITY

EXCLUSIONS

FINANCIAL ASSISTANCE GRANTED

Travel expenses

Accommodation and living expenses

SPECIAL CONDITIONS

Certain special conditions may apply for a recipient who:

CLAIMS PROCEDURE

WHO TO CONTACT

This financial assistance program aims to support patientsin Gaspésie-Iles-de-la-Madeleine who,at their physician'srequest,must travel long distances to receive care and servicesnot available locally.Payment is granted as an allowance to helpalleviate the costs associated with travel and accommodationexpenses. # ELIGIBILITY ·Must be Quebec residents living in the Gaspesie-iles-de-la-Madeleine region; ·Must have a prescription from their physician for care andservices covered by the Régie de I'assurance maladie duQuébec(RAMQ); ·Must travel to the nearest network institution¹,Located 200km or more²from their residence or the establishment wherethey usually receive basic care and services; ·The physician must indicate on the claim form whether apersonal attendant/companion is required,unless the patientis under 18 years or suffering from a severe disability. # EXCLUSIONS ·Accommodation and travel expenses eligible forreimbursement by another financial assistance program(15tpaying agency)will not be reimbursed to the patient; ·The patient must assume all costs related to the travel if theyelect to be referred to an institution other than the one nearestwhere the service is offered,for personal reasons or at thephysician's recommendation. # FINANCIAL ASSISTANCE GRANTED Travel expenses ·ALlowance of S0.13 per kilometre³for a round trip between thepatient's place of residence and the establishment that willprovide the required services,minus a 200 kilometre (or 100kilometre for one way only)deduction when a car is used fortravel; OR ·Cost of the cheapest round-trip ticket by public transport(plane,train or bus)from the patient's place of residence to theinstitution that will provide the required services (supportingdocumentation required).If the physician has prescribed afamily companion or personal care attendant,their publictransport costs willaso be reimbursed (supporting documentsrequired). # Accommodation and living expenses ·A lump sum of S75 per night is allocated to the recipientfor meals and accommodation.If the physician hasprescribed a family companion or personal careattendant,an additional lump sum of S20/night will begranted for meals; ·The number of nights is calculated based on thedestination region for a maximum of two nights: -Gaspésie and Bas-St-Laurent:one night -Other regions:two nights # SPECIAL CONDITIONS ## Certain special conditions may apply for a recipient who: ·resides West of the Avignon MRC and must travel for afollow-up visit at an institution in New Brunswick ·must receive radiation oncology services or other cancer-related treatment,or while waiting for a transplant orpost-transplant ·travelsto an institution,other than the nearest one offeringthe service,for a speciality which has longer waiting timesthan the expected waiting times. The recipient should,in any of these cases,contact thehealth institution that they normally visit to check the specialarrangements. # CLAIMS PROCEDURE Recipients must submit the duly completed claim form signedby the relevant persons and the required supporting documentswithin 90 days following travel(originals required).These mustbe forwarded to the health institution located in the area wherethe recipient is residing.(Incomplete forms or forms containinginaccurate information may be rejected.) Note:For any clarification or additional information about thisprogram,view the Travel Policy for Gaspésie-les-de-la-Madeleine clients on the Agency website at the followingaddress:www.agencesssgim.ca/deplacementdesusagers 100 WHO TO CONTACT:FINANCIALRESOURCES DEPARTMENT Côte-de-Gaspé 215,boulevard de York Ouest Gaspé (Quebec)G4X2W2 Tel.:418-368-3301,ext.3276 Fax:418-368-7150 Rocher-Percé 451,rue Mgr Ross Est PO Box 3300 Chandler (Quebec)GOC1K0 Tel:418-689-2261,ext.2157 Fax:418-689-4104 Haute-Gaspésie 50,rue du Belvédere Ste-Anne-des-Monts(Quebec)G4V1X4 Tel:418-763-2261,ext.2030 Fax:418-763-1670 B

FAQs

Who is eligible for this regional financial assistance program?

Eligibility requires being a Quebec resident in the Gaspésie-Îles-de-la-Madeleine region, having a physician prescription for RAMQ-covered services, and traveling to the nearest network institution located 200 km or more from the usual residence or basic care establishment.

What travel costs are reimbursed and how is the amount calculated?

Reimbursement includes either an allowance of $0.13 per kilometre for a round trip (with a 200 km deduction when a car is used), or the cost of the cheapest public transport round-trip ticket (with supporting documentation). Public transport costs for a prescribed companion or attendant are also reimbursed when applicable.

How are accommodation and living expenses determined?

A lump sum of $75 per night is provided for meals and accommodation. A further $20 per night is granted for meals if a family companion or personal care attendant is prescribed. The number of nights is based on the destination region, capped at two nights.

What are the main steps and deadlines for submitting a claim?

Recipients must submit the completed and signed claim form with required supporting documents within 90 days following travel. The submission is sent to the health institution located in the recipient’s area of residence, and incomplete or inaccurate forms may be rejected.

Sep 19, 2026

Uploaded by Anna Hans