Desjardins Life Insurance Extended Health Coverage and Custom Orthotics
Foot orthotics and orthopaedic shoes
“Orthopaedic shoes” are custom-made shoes. “Off-the-shelf shoes” are prefabricated shoes. “Footwear modification” means a permanent modification madetoshoes, for example:•Arch support•Metatarsal insole•Scaphoid support•Plantar arch supportThe following documents are required when submitting a claim for foot orthotics and orthopaedic shoes:
From your physician/healthcare professional:1.Original recommendation/referral from the physician or authorized healthcare professional, including the diagnosis that determined that the foot orthotics or orthopaedic shoes were necessary. The orthotics or shoes must be prescribed before you buy them, and the recommendation/referral must be recent fortheexpenses to be eligible.
From the supplier:2.Original receipt with the provider’s name and address, date the provider received the foot orthotics or orthopaedic shoes, patient’s name andcost breakdown.3.The date you picked up your orthotics or orthopaedic shoes.4.Confirmation that the orthotics or orthopaedic shoes have been paid for in full.5.Copies of the biomedical exam results and gait analysis results, both dated and signed by the healthcare professional.
Note: The examination must be performed by a healthcare professional who is a member in good standing of a provincial or Canadian professional association recognized by Desjardins Insurance. The examination must be within the scope of the professional’s abilities and recognized field, and it must have been performed by the specialist identified on the receipt.6.Complete description of the process used to create the foot orthotics or orthopaedic shoes, including the casting technique and the raw material used. Only techniques using a three-dimensional (3-D) image or unique 3-D cast impression of the feet using a raw material are eligible.7.A copy of the manufacturing lab’s invoice with:•Patient’s name•Qualifications/credentials, including name, address and telephone number of the laboratory•Date the provider placed the order and thedate it was delivered to the provider•Type of orthoticsFor footwear modification claims, a receipt detailing the cost of the modifications is required, along with thedocuments listed above.