What this ground actually asks
Medical inadmissibility frightens people far out of proportion to how often it bites. It is not about your diagnosis, it is about the cost of the services you are likely to need, and for a great many applicants the cost question does not arise at all.
Check the exemptions before the threshold
Excessive demand does not apply at all to a spouse, common law partner or dependent child being sponsored in the family class, to an applicant for permanent residence as a Convention refugee or person in similar circumstances, to a protected person, or to prescribed family members of those groups, which include a conjugal partner of a sponsor, certain of their dependent children, and a person sponsored under the family class provision covering orphaned and other relatives. The conjugal partner exemption sits in a different provision from the rest, which matters only if you are checking the Regulations yourself.
If you are in one of those groups, no cost is calculated and no threshold applies. Public health and public safety are still assessed, and they are narrow grounds. A great deal of unnecessary worry, and a certain amount of unnecessary work, comes from reaching for the threshold before checking the exemption.
- No condition is automatically disqualifying. The department states that there is no specific health condition that automatically leads to inadmissibility, and that each applicant is assessed individually against the current state of the condition, the likely prognosis, the cost of services needed and the effect on waiting lists.
- Lifelong is not the same as expensive. Chronicity is not what the calculation measures. A condition that is well managed and inexpensive can sit far below the threshold no matter how long you will have it, because what is priced is the cost of the services over the five years, not the diagnosis or how long it lasts.
- It is rare. Findings of this kind affect a very small fraction of all medical examinations.
- Three grounds, and only one is about money. Danger to public health, danger to public safety, and excessive demand. The first two are narrow.
- The funding test is a real limit. A service only counts where more than half its funding comes from government, directly or through publicly funded agencies. Privately funded and employer insured provision falls outside the calculation.
- Three categories were removed from the calculation in 2018. Special education, social and vocational rehabilitation, and personal non professional support services, together with related devices. The current definitions in the Regulations make no reference to any of them, and the department stated when it made the change that it does not assess a dependant's need for those services either.
The threshold, and what it is made of
| Position | |
|---|---|
| The test | Anticipated costs exceeding three times the average Canadian per capita cost of health and social services over five consecutive years following your most recent medical examination. Alternatively, demand that would add to waiting lists and increase mortality and morbidity |
| The published figure | $27,162 a year, stated as of 1 January 2025. Revised annually, so we confirm the current figure on every file |
| The five year total | $135,810, which is our own multiplication and not a published figure. The department publishes a per year threshold only, so do not build a submission on a five year ceiling as though it were official |
| Where the figure comes from | Three times the previous year's Canadian per capita health and social services cost, as reported by the Canadian Institute for Health Information in its National Health Expenditure Trends report. That is why it moves every year, and why a figure can be arithmetically right and still not yet be the published one |
| Which figure applies to you | The one in force on the date the medical officer performs the assessment, not the date you applied. The instruction carries a historical table for exactly this reason, showing $26,220 for an assessment made during 2024 and lower figures before that |
| What counts as health services | Health services including devices, laboratory services and pharmaceuticals, where more than half the funding is governmental |
| What counts as social services | Residential or institutional care, including related devices, recommended by a health professional, where more than half the funding is governmental |
| What is excluded | Special education, social and vocational rehabilitation such as occupational, behavioural and speech language therapy, and personal non professional support services such as help with daily living, meal preparation and house cleaning |
The 2018 changes tripled the threshold and removed those three categories at the same time, and both were made permanent in the Regulations in March 2022. Any material describing the pre 2018 position is describing a different and much harsher rule.
A great deal of what you will read about this ground is out of date, including on government pages
Until 2022 the definition read five consecutive years unless significant costs were likely beyond that period, in which case no more than ten, and special education, social and vocational rehabilitation and personal support services were part of the calculation. An amending instrument in 2022 removed the ten year extension outright and left social services defined as residential or institutional care. The definition in force today says five consecutive years, full stop, and the anticipated costs must exceed triple the Canadian per capita average.
Two of the department's own help centre pages have not caught up. One still tells applicants the assessment covers the cost of services over the next five to ten years. Another still says the test is whether the services would cost more than the Canadian average, omitting that the figure is tripled, which makes the bar sound roughly three times harsher than it is. Both were modified this year and both are still live. Commercial and clinic websites repeat the old rule from them.
This is not a technicality. If a refusal in your file priced services over a six to ten year horizon, or counted special education or vocational rehabilitation, or measured you against the untripled average, it applied a rule that is no longer the law. That is worth having looked at.
On the figure itself. The operative instruction states the threshold as $27,162 a year as of 1 January 2025, and it commits to updating the figure annually. Higher figures circulate for later years, and because the threshold is simple arithmetic on a published statistic, a circulating figure can be entirely plausible and still not yet appear in the department's own instruction. We work from the figure in force on the date of the medical assessment, and we confirm it directly on every file rather than relying on any page, including this one.
What to do with a procedural fairness letter
- It is an opportunity, not a decision. It sets out the medical officer's findings and invites a response. There are three things you can do with it, and the strongest files do more than one.
- Correct the medical assessment itself. The diagnosis, the prognosis, or the services said to be required. The department relies on the panel physician and on the doctors treating you, so a treating specialist's letter is a direct input into the calculation rather than commentary on it.
- Attack the arithmetic. The calculation is itemised and priced, and medication is usually the dominant line. Evidence of the real cost of your treatment, of a generic equivalent, or of a lower priced supply, goes straight to the number that decides the case.
- Show the service is not publicly funded. Both definitions are funding gated, so evidence that a service is privately funded, employer insured or privately delivered takes it out of the count altogether.
- A mitigation plan comes by invitation, and has real limits. Not everyone can give one. The department says that if it applies to you, you will be invited to send one in, so do not assume the route is open. Where it is open, you cannot opt out of publicly funded health services, except outpatient prescription medication in some provinces or territories, so a plan works on outpatient drugs and on social services and cannot simply offer to pay for health care. It must be credible, detailed and individual to you, show how the services will be provided and how you will pay for them, cover your financial position for the entire time you need services with documents, and come with a signed Declaration of Ability and Willingness.
- Ask for humanitarian and compassionate relief where it applies. The instruction directs the officer to consider it where requested, and even where the application suggests it is being sought without saying so expressly.
- The response period is in the letter. We could not find a published number of days anywhere in the departmental material, so read the letter, diarise it, and ask for an extension in good time rather than late.
Whether the cost rule is even your question
The first question is whether the cost rule applies to you at all, because for a large group of applicants it does not. Only then does the threshold matter.
Your situation
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