Canada’s Immigration, Refugees and Citizenship Canada (IRCC) will require upfront immigration medical exams for all permanent residence applications filed through Express Entry, starting August 21, 2025. The change means applicants must complete their medical exams with an approved panel physician before they press submit, reversing the 2023–2024 practice where IRCC issued medical instructions after an application was filed.
This change applies only to Express Entry candidates who submit after the change takes effect. Files sent before that date, and permanent residence applications outside Express Entry, will keep the current process.
IRCC says moving medical checks to the front of the line should speed decisions and reduce refusals that occur late in the process because of medical inadmissibility. It also lets families weigh costs and risks earlier, rather than after months of work on forms, documents, and fees.
Policy changes overview
Under the new rule, the immigration medical exam (IME) is now a pre-submission step for Express Entry.
- Who must complete an IME: every principal applicant and all family members, including spouses and children who are not accompanying the applicant to Canada.
- Effective date: August 21, 2025
- Scope: Express Entry permanent residence applications only
- Exemptions: Applications submitted before August 21, 2025, and all non-Express Entry permanent residence streams
Medical admissibility remains the standard. IRCC can refuse an application if a person is likely to pose a danger to public health or create an “excessive demand” on services. Excessive demand is defined as care expected to cost more than three times the national average per-person health cost.
Typical IME components:
– Medical history review and physical exam
– Age-based tests such as chest X-rays and blood work
People with chronic conditions (for example, diabetes) should demonstrate that their condition is stable and controlled to lower the chance of a refusal on health grounds.
The requirement is posted on IRCC’s website and applies to any Express Entry application submitted on or after the effective date. IRCC’s stated goals are faster decisions and reduced backlogs by confirming medical results earlier in a file’s life. According to analysis by VisaVerge.com, front-loading medical exams also gives applicants clearer go/no-go information before paying the full application fee.
Impact on applicants and processing
The biggest tangible changes for candidates are timing and cost.
- Medical exams must be booked and completed before submitting an Express Entry application.
- In cities with few panel physicians, wait times could delay submission.
- Families must budget earlier because every family member requires an exam.
Benefits:
– Earlier screening can prevent months of work and the emotional and financial cost of a late refusal.
– Employers using Express Entry–linked programs may see quicker start dates for hires once invitations are issued.
Pressure points and equity concerns:
– In parts of Africa, Asia, and the Middle East, the number of IRCC-approved panel physicians is often small relative to demand.
– This can add travel costs and waiting lists that stretch for weeks.
– Community groups worry this may disadvantage lower-income families or those far from major cities.
Example scenario:
– A software engineer in Lagos planning to apply via Express Entry may need to travel to a city with an available panel physician.
– The spouse and child each need exams too.
– Upfront exams could add two to three weeks, but they may prevent a late-stage refusal that would waste fees and time.
This policy shift aligns with other 2025 updates to Express Entry, including occupational draws and priority streams tied to labor needs. Moving medical exams earlier is another step toward making selection and processing more predictable for applicants and for Canada’s health system.
Implementation steps and practical tips
- Find an IRCC-approved panel physician in your country and book the IME early.
- Attend the appointment with identity documents and any specialist reports.
- Keep the confirmation sheet or information printout provided after the exam.
- Submit your Express Entry application and include proof you completed the medical exam.
- Monitor your online account for updates—IRCC will process files with medical results already on record.
Important operational notes:
– Applicants who already submitted full applications before the change do not need to take action.
– Files sent on or after August 21, 2025 must include proof of completed medical exams at submission.
– If an applicant cannot secure an appointment before a planned submission, they may need to delay applying or seek a panel physician in another city.
Preparation checklist:
– Check panel physician wait times now.
– Gather health records: medication lists, recent lab results, and letters from treating doctors.
– Bring these records to the IME to help panel physicians assess condition stability and possibly avoid follow-up tests that could add weeks.
IRCC’s official guidance for applying for permanent residence through Express Entry, including medical exam rules and approved doctor lists, is available on the government website: IRCC — Apply for permanent residence under Express Entry.
Additional clarifications and likely next steps
- This is a clear reversal from 2023–2024, when Express Entry applicants typically filed first and waited for IRCC to send medical instructions.
- The responsibility now shifts fully to applicants to complete IMEs in advance and include proof with their submission.
Common family question:
– What if a non-accompanying spouse or child fails the IME?
– The rule is unchanged: all family members must be admissible, even if they are not moving to Canada immediately. Plan appointments for everyone early to avoid mismatched timelines.
IRCC is expected to monitor the effect of this change on processing times and the applicant experience through the end of 2025. If the model reduces delays and improves outcomes, similar upfront requirements could be considered for other immigration pathways. For now, the rule applies only to Express Entry, which remains Canada’s main economic immigration system.
Key takeaway: Book IMEs early, budget for all family members, and include medical proof with any Express Entry application submitted on or after August 21, 2025 to avoid delays or refusals later in the process.
Frequently Asked Questions
This Article in a Nutshell
Starting August 21, 2025, IRCC mandates pre-submission immigration medical exams for Express Entry applicants, requiring every declared family member to complete IMEs before filing, raising timing and cost challenges while aiming to reduce late refusals and speed processing for Canada’s economic immigration system.
