Ocular prostheses or artificial eyes
The Ocular Prostheses Program provides financial assistance for the purchase, maintenance and replacement of ocular prostheses, also called “artificial eyes”. A lump-sum amount is also granted for the purchase and fitting of conformers (plastic shells).
Who is eligible?
To qualify, you must be insured under the Health Insurance Plan. In addition, you must need an ocular prosthesis for any of the following reasons:
- You have lost an eye, for instance, during surgery or an accident
- You have an eye that is atrophied or without useful vision
- At birth, you suffered from an eye disease (ophthalmia or microphthalmia)
Ocular prostheses serve an esthetic purpose only, they do not help recover sight.
Services covered under the program
The program provides for a maximum amount for the following services:
- Purchase and replacement of an ocular prosthesis per eye, once every 5 years
- Maintenance and repair of the ocular prosthesis once a year
- Purchase and fitting of a conformer, a temporary shell used to hold the shape of the eye socket once the eye has been removed, before fitting the prosthesis
You will have to pay the difference if the invoice exceeds the maximum amount provided under the program. Inquire with your insurer.
Exception to the 5-year time limit
The replacement of an ocular prosthesis may be covered even if the 5-year period has not passed if an ophthalmologist recommends the replacement following a change in your orbital cavity. To qualify for the maximum reimbursement, you will have to submit a prescription confirming the recommendation.
Maximum amounts granted
- $585 for a custom prosthesis made by a ocularist certified by the Canadian Society of Ocularists or the U.S. National Examining Board of Ocularists
- $225 for a manufactured prosthesis
- $25 per year for maintenance and repair, excluding the year following the purchase
- $187 for each custom-made conformer
- $112 for each prefabricated conformer
Procedure for obtaining a prosthesis
Obtain a prescription for an ocular prosthesis from an ophthalmologist
First ocular prosthesis covered by the program
For your 1st application, you must obtain a prescription from an ophthalmologist, confirming that your orbital cavity or eyeball is able to accommodate an ocular prosthesis.
Book an appointment with an ocularist
When you see the ocularist, present your prescription and valid Health Insurance Card. If you receive last-resort financial assistance, present your valid claim slip (carnet de réclamation) as well.
Reimbursement conditions: Ocularists with or without an agreement
Certain ocularists have signed an agreement with RAMQ. We reimburse them directly the amount provided under the program. If you purchase your prosthesis from other ocularists, you will have to pay for it and then apply for a reimbursement.
Select the situation that applies to your ocularist to find out the reimbursement conditions.
- Present your valid Health Insurance Card and, if applicable, your valid claim slip (carnet de réclamation)
- Supply the prescription from the ophthalmologist
We will reimburse the ocularist directly, taking into account the maximum covered amount to which you are entitled. You will have to pay the difference on the spot.
When you purchase your prosthesis, you will have to pay the full amount to the ocularist who has not signed an agreement with RAMQ. Then follow these instructions to apply for a reimbursement:
- Prepare an application for reimbursement including the following:
- Your first and last names
- Your address
- Your date of birth
- Your Health Insurance Number and, if applicable, your claim slip number
- The eye concerned (right or left)
- Attach an original detailed purchase receipt.
- Attach the prescription from the ophthalmologist, if this is your 1st prosthesis covered by the program.
- Mail your application and the required documents to us. Write “Programme de prothèses oculaires” on top of the address.
Claim slip (carnet de réclamation)
If you hold a claim slip (carnet de réclamation), the cost of an ocular prosthesis and conformer are fully reimbursed under the program. Just present your valid Health Insurance Card and claim slip to your ocularist.
Application for review
You can apply for an administrative review if you disagree with a RAMQ decision. To find out more, refer to the page Request a review of a decision.