The three medical grounds
- Danger to public health: mainly communicable diseases such as active tuberculosis. These are usually resolved by treatment and follow-up.
- Danger to public safety: conditions that could cause sudden incapacity or unpredictable or violent behaviour.
- Excessive demand: the expected cost of publicly funded health and social services over five years (or ten, in limited cases) would exceed the threshold, or the person would add to waiting lists in a way that increases risk to Canadians.
The excessive demand threshold
The threshold is three times the average Canadian per-person cost of health and social services and is updated each year. For 2026 it is about $28,900 per year, roughly $144,400 over five years. Since 2022, some social services, including special education, social and vocational rehabilitation, and personal support services, are no longer counted.
Who is exempt from the excessive demand test
The excessive demand ground does not apply to sponsored spouses, common-law and conjugal partners, and their dependent children; to refugees and protected persons and their dependants; and to some other groups. They still undergo a medical exam and can be found inadmissible on public health or public safety grounds.
The process
- Immigration medical examWith an IRCC-approved panel physician.
- AssessmentAn IRCC medical officer reviews the results and estimates the cost of care.
- Procedural fairness letterIf costs appear to exceed the threshold, you receive a letter with the officer’s cost estimate and a deadline to respond.
- ResponseWe can challenge the diagnosis or cost estimate with specialist evidence, and submit a credible plan showing how costs will be covered or reduced.
- DecisionThe officer decides whether you are inadmissible, taking the response into account.
What makes a strong response
- Updated specialist reports on the actual treatment needed, not the worst case.
- Evidence of cheaper treatment options, generic medications or private coverage.
- A signed declaration of ability and intent to cover costs, with proof of funds or insurance.
- For social services, evidence of family support that reduces reliance on public programs.
Where the finding cannot be avoided, a TRP or a humanitarian exemption may still help.
Last reviewed November 2026. This page is general information, not legal advice. Immigration law and IRB procedure change often; we confirm the current rules for your file at your consultation.