If you have a motor impairment and must wear or use a device to go about your daily activities, and are insured under the Québec health insurance plan, you may be eligible for the program respecting devices that compensate for physical deficiencies.
If you think you qualify
See a physician. If applicable, you will receive a medical prescription attesting to the fact that you require permanent use of a device because of your disability.
In addition, insured devices and services must be provided by an institution or a laboratory that is accredited by the Régie de l'assurance maladie du Québec.
The Program for Devices That Compensate for Physical Deficiencies is intended for persons insured by the Québec health insurance plan who have a physical deficiency and need to wear or use a device to compensate for the deficiency.
Devices covered
The devices covered are orthotics, prosthetics, ambulation aids, standing aids, locomotor assists and posture assists (refer to the definitions), as well as their components, supplements and accessories. The devices must appear on the list of devices approved by the government.
Insured services
The insured services are the purchase, adjustment, replacement, repair and, in certain cases, adaptation of the insured devices. All such services must be provided in a facility or a laboratory authorized by the Régie de l'assurance maladie du Québec.
Three-wheeled or four-wheeled scooters are not insured device, but the adjustment and repair of such scooters is insured it they were paid for by the Office des personnes handicapées du Québec before November 12, 1998.
Procedure for obtaining an insured device or service
To obtain an orthotic, prosthetic, ambulation aid or standing aid, an insured person must
- obtain a written medical prescription describing the person’s physical deficiency or functional impairment, indicating that the person needs a device and giving instructions on how it should be used (such a prescription can be issued by an orthopedist, a physiatrist, a neurologist, a neurosurgeon, a rheumatologist or a geriatrician, or in some cases a general practitioner or a pediatrician attached to certain hospitals or rehabilitation centres; 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 de l’assurance maladie du Québec, where the specifications of the device needed can be determined and it can be fitted or adjusted.
To obtain a locomotor assist or posture assist, an insured person must
- obtain a written medical prescription describing the person’s physical deficiency or functional impairment and indicating that the person needs a device (such a prescription can be issued by an orthopedist, a physiatrist, a neurologist, a neurosurgeon, a rheumatologist or a geriatrician, or in some cases a general practitioner or a pediatrician attached to certain hospitals or rehabilitation centres; certain devices and services provided to persons suffering from severe cardiovascular or cardiorespiratory problems must be prescribed by a cardiologists or lung specialist);
- go to one of the facilities authorized by the Régie (laboratories are not authorized for this purpose), where a multidisciplinary team will determine the technical specifications of the device needed and the person will receive the insured services to which he or she is entitled.
Adjustment, repair or replacement during or after the warranty period
A medical prescription is not needed in order to adjust or repair a device. However, if a device has to be replaced due to a change in the insured person’s physical condition, a new medical prescription must be issued to confirm the change and the need for a new device.
Most devices are covered by the manufacturer’s warranty. If a device requires adjustment or repair during the warranty period, the insured person must contact the facility or laboratory that provided it to ensure compliance with the warranty.
Once the warranty has expired, the insured person must have the device repaired or adjusted by one of the authorized facilities or laboratories. However, in the case of a locomotor assist or posture assist, the insured person may have it adjusted or repaired only by one of the facilities authorized to supply or maintain such services (laboratories are not authorized for this purpose).
Insured persons are not charged for the services provided to them by authorized facilities, since these services are billed directly to the Régie.
However, the Régie will not pay for services unless they are rendered by one of the authorized facilities or laboratories.
The cost of replacing lost, stolen or damaged devices, as well as the cost of repairing devices damaged due to negligence, must be assumed by the insured person. Loss, theft or destruction of such devices can generally be covered by an insurance policy. Individuals should check with their insurer about such coverage.
Return of devices
Upper-limb prosthetics, wheelchairs, wheelbase systems, orthomobiles and children's strollers must be returned to a facility or laboratory authorized by the Régie when they are no longer being used. These devices may not be given away, sold or transferred in any manner.
Ambulation aid
A device that facilitates or permits walking. Ambulation aids include crutches, canes, walking frames and walkers.
Standing aid
A device that supports the trunk and lower limbs, thus enabling a person to assume an upright position (for example, a parapodium or an orthopodium).
Locomotor assist
A device used for moving about. Locomotor assists include manual and powered wheelchairs, wheelbase systems, orthomobiles and children's strollers.
Posture assist
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.
Orthotic
A device that 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, never fully developed or is affected by a birth defect (for example, a tibial orthotic).
Prosthetic
A device that is designed to fully or partially replace an amputated limb or a limb that is completely or partially missing, and to restore its primary function or original appearance (for example, a leg or foot prosthetic).
Clientele
Any person insured by the Québec health insurance plan who has a physical deficiency.
General requirements
The attending physician must
- describe the insured person’s physical deficiency or functional impairment;
- confirm that the person needs to wear or use a device;
- provide instructions on how the device should be used.
Also, the insured devices and services must be provided by a facility or laboratory authorized by the Régie de l'assurance maladie du Québec.
Special requirements
An orthotic is insured if, on the recommendation of a physician, it has to be worn every day for a minimum of
- 6 months, for a lower-limb orthotic;
- 3 months, for a spinal orthotic;
- 1 month, for an upper-limb orthotic.
Restrictions
An orthotic worn solely for the purpose of practising a sport is not insured. An ambulation aid is insured only if it is supplied as part of a rehabilitation process for use on a daily basis for at least 1 year.
