IRCC shifts Express Entry rules: Medical exams now required before PR applications

Starting August 21, 2025, applicants seeking permanent residence through Canada’s Express Entry system will need to complete immigration medical exams upfront. Immigration, Refugees, and Citizenship Canada (IRCC) announced the change on its website, marking a shift in how health admissibility is assessed for prospective permanent residents.

Previously, Express Entry applicants submitted their complete permanent residence applications first and only then received instructions from IRCC on medical exams. Applications submitted before August 21, 2025, will not be affected, and non-Express Entry permanent residence applications remain unchanged.

Medical admissibility

The principal applicant and accompanying family members must be medically admissible. Family members must meet health standards even if they do not relocate immediately with the principal applicant.

A primary reason for medical inadmissibility is a condition likely to place “excessive demand” on Canada’s public health system, defined as exceeding three times the national per capita healthcare cost—$27,162 annually. Chronic conditions such as diabetes, if stable and treated, may lower the risk of inadmissibility. Applicants may also be refused if their condition poses a public health risk, such as certain infectious diseases.

Immigration medical exams (IMEs)

Applicants must schedule IMEs with IRCC-approved providers. A list of panel physicians by country or territory is available on the IRCC website. IME costs typically range from $140 to $280 per person, covering doctor fees, tests, investigations, and specialist consultations.

Exams may include:

• Review of previous medical history, surgeries, and chronic illnesses

• Full-body physical examination, including eyes, heart, and lungs

• X-rays, including chest x-rays for tuberculosis

• Blood and urine tests

• Mental health assessments

• Immunisation record verification

Applicants should bring a list of current medications, previous medical reports, proof of vaccinations, identification, and four recent photographs.

Applicants in Canada who underwent an IME in the last five years for a work or study permit can provide their IME number or medical identifier. If IRCC determines previous results are unusable, applicants will be instructed to undergo a new exam.