Since August 21, 2025, anyone who receives an Express Entry invitation has to complete the medical exam before submitting the application. There is an exception for people who already had one in the last five years, and on September 22, 2026, IRCC spelled out who it reaches: only applicants residing in Canada.

What changed on September 22

IRCC published an update to its operational instructions titled “Clarified eligibility for TPP exemption from immigration medical exam in Canada”. The change sits in the page officers use to check whether an Express Entry application is complete.

We compared the previous version with the current one. A single sentence changed, inside the note about the exemption:

Everything else stayed the same: the exemption runs until October 5, 2029, the previous exam has to be from the last five years, and its number has to go in the application.

How the exemption works

Since August 21, 2025, anyone who receives an Express Entry invitation has to complete the medical exam before applying. This is the upfront medical exam. It is done by an IRCC panel physician; your own doctor cannot do it.

The exception is a temporary public policy in place since October 5, 2022. It lets certain people already in Canada skip a repeat exam. According to IRCC’s public page, you must meet all of these conditions:

• you applied or are applying for permanent or temporary residence
• you already live in Canada
• you completed your previous exam in the last five years
• that exam indicated a low risk or no risk to public health or public safety

If you meet all four, instead of a new exam you include in your application the number from your previous one, which is the IME number or the unique medical identifier, UMI.

What the policy text says

The policy text, signed by the minister on September 27, 2024, is more technical than the public page. Three details matter:

• The previous exam must have included a physical examination. Not every medical check counts.
• The result must be coded a certain way. IRCC classifies exams with internal codes. The policy accepts three: no danger to public health or public safety (M1); a health condition present but not expected to place an excessive demand on health or social services (M3); and a potential risk to public health, provided the person complied with the requirement to report to provincial health authorities for medical surveillance (M2 or M2/3). Exams coded M3, M2 or M2/3 but flagged as valid only for temporary residence (“TR only”) or only for excessive demand assessment (“EDE only”) are excluded.
• The person must be residing in Canada at the time of applying. This is what the September 22 instruction made explicit.

In practice, applicants do not see their code. What they can know is whether their previous exam ended without follow up requests, and whether it was done by a panel physician in the last five years.

Who this changes things for

• If you live in Canada and your exam is under five years old. Nothing changes. You include the IME or UMI number in the application. IRCC checks whether the policy applies. If it does not, it sends you instructions for a new exam.
• If you had the exam in Canada and then left. This is the case the clarification closes. Having lived in Canada is not enough: you have to be residing in Canada when you apply. If you are abroad, you need an upfront exam with a panel physician in the country where you are, before applying.
• If you live abroad and never had an exam. Nothing changes. You always had to do it before applying.
• If you are in Canada but your exam is over five years old. The exemption does not apply. New exam.

The cost of getting it wrong

The medical examination confirmation is a mandatory document in Express Entry. Under IRCC’s instructions, an application that does not include it is rejected as incomplete, and applications received on or after October 21, 2025, without an exam may be rejected.

A rejection for incompleteness is not a refusal: IRCC refunds the fees. But it has a real cost. The invitation is lost, and to be considered again you have to create a new Express Entry profile and wait for another round. There have been no general rounds in 2026: every round has been program based or category based, so a lost invitation is not recovered in two weeks.

IRCC accepts exceptions only in circumstances outside the applicant’s control, for example if the panel physician cancelled the appointment at the last minute. In those cases it may accept proof that an appointment is scheduled or a letter explaining best efforts. The instruction itself says this is not a guarantee of acceptance.

What to do before you apply