Starting August 21, 2025, Canada is making a big change to its Express Entry permanent residence (PR) system. From this date, applicants must complete their immigration medical exam (IME) before submitting their application—a shift from the previous process where you applied first, then waited for medical instructions.
What’s Changing?
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Old Rule: Apply first, do medical exam later when IRCC asks.
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New Rule (from Aug 21, 2025): Medical exam must be completed upfront before you hit “submit.”
This only applies to Express Entry applications. Other PR streams like family sponsorship or refugee claims are not affected. Applications submitted before Aug 21 also remain under the old process.
Why the Change?
The goal is to speed up decision times by reducing back-and-forth delays. But it also means applicants need to prepare earlier and budget for the medical exam cost.
Who Needs It?
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All main applicants and dependents included in the Express Entry application (even if dependents aren’t moving right away).
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Exemptions apply only if you’ve had an IRCC-approved medical exam in the last 5 years (for study or work permits) and it’s still valid.
What’s in the Medical Exam?
The exam must be done by an IRCC-approved panel physician and includes:
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Review of medical history & ongoing conditions
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Physical exam (heart, lungs, eyes, etc.)
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Chest x-ray, blood & urine tests
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Mental health screening
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Vaccination record check
Cost: Around $140–$280 CAD per person (varies by country/clinic).
Medical Grounds for Refusal
Applications can be refused if:
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You pose a public health risk (e.g., untreated TB).
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Your condition is expected to cause an excessive demand on healthcare (more than CAD $27,162/year in treatment).
Next Steps for Applicants
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Check IRCC’s panel physician list for your country.
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Book your medical exam before applying.
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Keep all documents (passport, medical history, vaccination proof, medications, photos) ready.
Final Thought
For those applying after August 21, 2025, the medical exam is now part of your early checklist. Getting it done upfront can save time, avoid surprises, and bring you one step closer to your Canadian PR.