Devices that compensate for a physical deficiency
Who is eligible?
This program is intended for persons insured under the Québec Health Insurance Plan who have a physical deficiency and meet the program's eligibility requirements.
If you are covered by the Health Insurance Plan and meet the program's eligibility requirements, you are insured for:
- the purchase, adjustment, replacement, repair and, in certain cases, adaptation of walking aids, standing aids, locomotor assists and posture assists as well as their components, supplements and accessories;
- the purchase, adjustment, replacement and repair of orthotics and prosthetics.
The program does not cover 3-wheeled or 4-wheeled scooters, but does cover the adjustment and repair of these devices if they were paid for by the Office des personnes handicapées du Québec prior to November 12, 1998.
For details about the products and services covered by the Régie and about the amounts the Régie pays, refer to the Tariff for insured devices which compensate for a motor deficiency and related services.
Procedure to follow
If you need an orthotic, a prosthetic, an ambulation aid or a standing aid, you must:
- obtain a written medical prescription from an orthopedist, a physiatrist, a neurologist, a neurosurgeon, a rheumatologist or a geriatrician, or in some cases from a general practitioner or a pediatrician. Under certain conditions, general surgeons may write prescriptions for lower-limb prosthetics, while plastic surgeons may prescribe upper-limb or lower-limb orthotics;
- go to one of the facilities or laboratories authorized by the Régie, to obtain the insured device or service.
Please note that ambulation aids are insured only if they are made available as part of a rehabilitation process and are used every day for at least 1 year.
Descriptions of devices
An orthotic is designed to correct a deficient function, to compensate for a deficiency, or to increase the physiological performance of the trunk or of a limb that has lost its primary function, that has never fully developed or that is affected by a birth defect. An example of an orthotic is a tibial orthotic.
A prosthetic is designed to fully or partially replace an amputated limb or a limb that is completely or partly missing, and to restore its primary function or original appearance. An example of a prosthetic is an artificial leg.
An ambulation aid is a support that facilitates or permits walking. Ambulation aids include crutches, canes, walking frames and walkers.
A standing aid (a parapodium or an orthopodium) supports the trunk and lower limbs, thus enabling a person to assume an upright position.
An orthotic is insured if a physician recommends that it be worn every day for a minimum period of:
- 6 months, for a lower-limb orthotic;
- 3 months, for a trunk orthotic;
- 1 month, for an upper-limb orthotic.
However, a person under age 19 whose orthotic is designed to correct a deformity does not have to wear the orthotic for the entire minimum period, but a physician must have recommended that it be worn on a daily basis. Orthotics worn only for the practice of a sport are not insured.
A locomotor assist is used for moving about. Locomotor assists include manual and powered wheelchairs, wheelbase systems, orthomobiles and children's strollers.
A posture assist is a device that supports one or more parts of the body (head, upper or lower limbs, spine) while a person is seated in a wheelchair or in a wheelbase system.
If you need a locomotor assist or a posture assist (a wheelchair or an adapted support), you must:
- obtain a written medical prescription from an orthopedist, a physiatrist, a neurologist, a neurosurgeon, a rheumatologist or a geriatrician, or in some cases from a general practitioner or a pediatrician. Certain devices and services provided to persons suffering from severe cardiovascular or cardiorespiratory problems must be prescribed by cardiologists or lung specialists;
- go to one of the facilities authorized by the Régie, where a multidisciplinary team will determine the technical specifications of the device you need and will provide you with the insured services you are entitled to receive.
You do not need a medical prescription to have a device adjusted or repaired. However, if your device has to be replaced because of a change in your physical condition, you must obtain a new prescription confirming the change and attesting to your need for another device.
Most devices are covered by the manufacturer's warranty. If your device requires adjustment or repair during the warranty period, contact the facility or laboratory that supplied it to you, which will ensure that the work is done under warranty. Once the warranty on your device has expired, adjustments or repairs must be carried out by authorized facilities or authorized laboratories.
The cost of replacing lost, stolen or damaged devices, and the cost of repairing devices used negligently, must be paid by the insured person or by private supplemental insurance.
The Régie pays only for the cost of services rendered by authorized facilities or laboratories.
The program does not cover such items as orthopedic shoes, cloth upright supports or elasticized socks.
For more information on the obligations related to the use of a wheelchair, consult the guide entitled Important Things to Know About Your Wheelchair.
Application for review
If you disagree with a decision of the Régie, you can apply for an administrative review. You have 6 months, from the date the letter of decision is deposited in your mailbox or handed to you in person, to contest the decision.
Form to fill out
First, you must fill out an Application for review.
To appeal a decision regarding healthcare received outside Québec, a technical aids program or a financial assistance program, you must use the form also.
It is important that you enclose the relevant original documents (bills, proof of payment, medical documents, etc.) and you specify the matter being contested, and any facts and dates to be corrected. If you need more space than that provided on the form, attach a separate, signed sheet.
Send your application for review to the following address:
Direction de la révision
Régie de l'assurance maladie du Québec
Case postale 6600
Québec (Québec) G1K 7T3
We recommend that you keep copies of the documents provided.
Analysis of your application for review
The agent of the Régie who analyzes your application for review will contact you, if required, to clarify your expectations. If necessary, the agent will assist you in the process of gathering relevant information to complete the file.
The review of your application is based on the new information provided by you and the documents already on file. Those documents must cover the entire period at issue. Missing information may delay the processing of your file.
After the agent has reviewed your file, he/she will notify you in writing of the Régie's new decision.
The Régie's commitment
We will process your application in keeping with our values: respect, integrity and equity.
We also undertake to follow up on your application for review within 40 days of receiving it, if your file is complete.
The Régie's decision
Under the Health Insurance Act, the Régie has 90 days to render its decision following an application for review.
If, after you've filed your application, you wish to provide supporting documents or comments, the 90-day time limit will run from the date the Régie receives the documents.
Moreover, if the Régie deems that it needs additional documents or information, it may extend the time limit by another 90 days.
Finally, if the Régie does not meet the deadlines, you may wait for its new decision, or contest the previous decision before the Tribunal administratif du Québec (TAQ).
Do you disagree with the Régie's new decision?
If you believe that the decision rendered in follow-up to your application for review does not respect your rights, you have 60 days (from the date the decision is delivered to your address) to contest it before the TAQ.