Appliances for ostomates

Who is eligible?

To qualify for the program, you must meet the following 2 conditions:

• Be insured by the Québec Health Insurance Plan
• Have undergone a permanent or temporary colostomy, ileostomy or urostomy

Covered services

For each ostomy, the program provides for an annual lump-sum payment of:

• $1,382 for a permanent ostomy
• $921 for a temporary ostomy

The amount granted is intended for the purchase of your supplies (bags and other products) and their replacement. You have to pay the overcost if the amount of your invoice exceeds the lump-sum amount granted under the program. If you have private insurance, check with your insurer to find out if it covers the difference.

Specific conditions for a temporary ostomy

Persons with a temporary ostomy (recent or not) have been eligible for the annual lump-sum payment only since October 1, 2018. You may qualify if you register and provide the required documents. As of April 1, 2019, this amount has been paid out in instalments indexed annually:

• Half of the lump-sum as soon as the application is admissible
• Every 6 months after the surgery

Procedure for obtaining the lump-sum payment

You must carry out the 3 following steps for each ostomy, as part of your 1st application for registration. If necessary, we may request other documents necessary for the assessment of your application.

1. Complete and print the form Registration for the Ostomy Appliances Program
2. Obtain a medical prescription (or have part 2 of the form completed)
3. Mail the completed form and medical prescription to the following address:
   
   Régie de l’assurance maladie du Québec
   C. P. 6600, succ. Terminus
   Québec (Québec)  G1K 7T3
   
   We recommend that you keep copies of the documents that you send us.

Information necessary on the medical prescription

The medical prescription must contain the following clearly legible information:

• Your first and last names
• Your date of birth or Health Insurance Number
• The date and type of surgery (colostomy, ileostomy or urostomy)
• Confirmation of the permanent or temporary character of the ostomy
• The first and last names, and the permit number of the physician or specialized nurse practitioner
• The date of the prescription
• The signature of the physician or specialized nurse practitioner

Receipt of the lump-sum payment

After registering with the program, you will automatically receive the lump-sum payment granted for the purchase and replacement of your appliances. We will mail the amount to the address that we have on file for you. For this reason, remember to notify us if you move.

Processing time

Claim slip (carnet de réclamation)

The purchase and replacement of ostomy appliances are fully reimbursed under the program if you hold a valid claim slip (carnet de réclamation). To qualify, you must be registered with the program and send us your detailed invoices, along with proof of payment, within 12 months following the date of purchase.

In this regard, an agreement may be concluded on a voluntary basis so that we pay the actual cost of the appliances directly to the provider. You can discuss the matter with the provider of your choice and then contact us to conclude the agreement, if applicable. Signing this agreement will terminate the automatic payment of all lump-sum payments.

Contents of your detailed invoices

Any detailed invoice must contain the following information:

• The name, address and telephone number of the business where the appliance was purchased
• The date of purchase
• A description of the appliance and its price
• Your first and last names