Hi, I applied for Express Entry under CEC class on June 2017. Currently I live in Manitoba. Recently I got a procedural fairness letter from CIC regarding my health. My all other things have been passed. The reason is I am having an injection call Humira which was suggested by my doctor as a trial for a year. Its yearly cost is 20000 cad which is currently funded by the provincial government (pharmacare). Here is the letter from CIC: Dear “X”: This letter concerns your application for permanent residence in Canada. Based on a review of your file, it appears that you or your family member may not meet the requirements for immigration to Canada. I have determined that you are a person whose health condition might reasonably be expected to cause excessive demand on health or social services in Canada. An excessive demand is a demand for which the anticipated costs exceed the average Canadian per capita health and social services costs, which is currently set at $6,655 per year. Pursuant to subsection 38(1) of the Immigration and Refugee Protection Act, it therefore appears that you may be inadmissible on health grounds. You, “X”, have the following medical condition or diagnosis: Ankylosing Spondylitis. In particular: The applicant has a diagnosis of ankylosing spondylitis. The diagnosis was confirmed based on all information gathered. This 26 year old man has applied to immigrate to Canada in an economic class category (CEC), his intended province of destination is Manitoba. The applicant has longstanding ankylosing spondylitis, an inflammatory arthritis with no known cure. The applicant was assessed by a Rheumatology Specialist in March 2017, who confirmed that his ankylosing spondylitis is reasonably controlled and he is to start the medication Humira shortly following completion of treatment for latent tuberculosis. The dosage is 40 mg every two weeks. Specifically the client has ankylosing spondylitis that might reasonably lead to his requiring ongoing treatment with the biologic medication Humira, the cost of which would likely exceed the average Canadian per capita costs over 5 years. The required health services are costly and publicly funded. Source of Information: http://www.gov.mb.ca/health/pharmacare/profdocs/dhcd.pdf Date Accessed: November 29, 2017 Other Information: The expected cost for health related services for this applicant is $20,818.20 per year over 5 YEARS. This amount exceeds the average per capita threshold of $6,655.00 annually. A detailed list of services required, cost implications as well as sources used to determine these costs are included in Appendix I. Based upon my review of the results of this applicant’s immigration medical examination and all the reports I have received with respect to the applicant’s health condition, I conclude that this applicant is inadmissible under Section 38(1)(c) of the Immigration and Refugee Protection Act which states that “A foreign national is inadmissible on health grounds if their health condition might reasonably be expected to cause excessive demand on health or social services.” Medical Officer - Immigration, Refugees and Citizenship Canada (IRCC) Appendix I: Expected Costs of Services Medication The cost of Humira 40 mg every two weeks is $800.70 or $20,818.20 per year in Manitoba. Source of Information: http://www.gov.mb.ca/health/pharmacare/profdocs/dhcd.pdf Date Accessed: November 29, 2017 TOTAL COST OF ALL LISTED SERVICES: $20,818.20 per year Before I make a final decision, you have the opportunity to submit additional information that addresses any or all of the following: • the medical condition(s) identified; • medication(s) required in Canada for the period indicated above; and • your individualized plan, including financial arrangements as applicable, to ensure that no excessive demand will be imposed on Canadian social services for the entire period indicated above and your signed Declaration of Ability and Intent. The expected cost for health related services detailed above represents the publicly funded cost or subsidy provided by your province of destination. Therefore, your individualized plan, should include your ability to cover the total, non-subsidized cost of your specific treatment. Please include documentation to substantiate your projected total non-subsidized medication costs. You must provide any additional information by February 5, 2018. Please upload these documents to your MyCIC account. If you choose not to respond, I will make my decision based on the information before me, which may result in your application being refused. In order to demonstrate that you will not place an excessive demand on health or social services if permitted to immigrate to Canada, you must establish to the satisfaction of the assessing officer that you have a reasonable and workable plan, along with the financial means and intent to implement this plan, in order to offset the excessive demand that you would otherwise impose on health or social services, after immigrating to Canada. ****IMPORTANT INSTRUCTIONS**** Please ensure that you provide one response that contains all of the supporting documents you wish to submit. Include a detailed list of every supporting document that: a. describes the type of document b. includes how many pages are in the document c. includes the date of the document For example: “Lab report, 3 pages, dated February 25, 2016” Please ensure that you quote the file number indicated at the top of this letter on any information you submit. Please note: • Any documents submitted which are not in English or French must be accompanied by a notarized translation in either English or French. • Do not submit originals, unless otherwise stated, as documents submitted will not be returned. • Please note that we can only accept unzipped PDF, JPG or .doc files that are attached to an email, totaling less than 5 MB. Sincerely, AK8334 Immigration, Refugees and Citizenship Canada | Immigration, Réfugiés et Citoyenneté Canada Government of Canada | Gouvernement du Canada Now I need help on writing the procedural fairness response which I did not find a sample online. My current plan includes: 1. Ask doctor to change the medicine if possible, because it was a trial. I believe this is not mandatory for my treatment. 2. I have my private insurance, which cover 80% of the cost. If it pays 80% still I have to pay 325 cad per month which I believe I can manage from my salary. 3. I have asked help from a private organization as well if they can help me 4. I have my continuing full time job and savings of almost 27K which I am going to show. 5. Can I show my parents fund as well if they agree to support in case needed. They will be able to show the overall cost for 5 years that they can bear (more than 100K CAD) Kindly help me regarding the letter and if you think the plan is good enough to manage the officer.