Understanding orthotics and orthopaedic shoes

Sore feet? Sore back? Do you think orthotics or orthopaedic shoes will help? Well, it's best you find out from the right people. Your benefits plan is designed to help pay only for orthotics and orthopaedic shoes that are medically necessary, and that is best determined by your doctor or a specialist.

What are orthotics?

Orthotics are designed to treat or adjust various foot disorders. The orthotics covered by your health plan are custom-made specifically to meet your particular needs. They fit inside regular shoes and help keep the foot in proper alignment.

There are a number of commercially-made devices, such as cushioned heel cups or insoles for shoes that are sold over-the-counter in pharmacies or other retail stores. These are not covered under our benefits plan.

What are custom-made orthopaedic shoes?

Custom-made orthopaedic shoes are made from raw materials (from the ground up). A qualified foot care specialist takes an impression of your foot in order to make a shoe specifically designed to meet the needs of your medical condition.

Be sure you're getting the 'real thing'

Choose a practitioner who is qualified to perform orthopaedic assessments and who is properly licensed within your province. Podiatrists and chiropodists are regulated by provincial colleges and must abide by certain standards of practice. You can check their credentials by calling the appropriate college or by visiting their website.

• Orthotics for sports, recreational activities or for your general comfort are not covered under your plan.
• Shoes that are advertised in catalogues are not custom-made orthopaedic shoes and therefore aren't covered by your plan. Stay away from 'specialists' who try to pass these off as custom-made.
• It is improper for practitioners to offer discounts or coupons as an incentive to buy orthopaedic footwear. Don't accept these offers from anyone for orthotics or orthopaedic shoes. If it sounds too good to be true, it probably is.

Coverage Details (Updated March 14, 2007)

Orthotic devices( that are custom-made from the cast of the foot) are eligible at 85% of your combined maximum of $1,500 per calendar year. Please note that one pair of orthotics is eligible per individual per benefit (calendar) year. The reasonable and customary amount considered for each pair of orthotics is $623. In addition, the orthotics must be prescribed by a medical doctor, a podiatrist, or a chiropodist. The prescription must be submitted with the first claim, and it is valid for a life time. 

Also while orthopaedic shoes and orthotics are eligible expenses under Sun Life policies, they are a combined maximum. The employee would be eligible for either orthopaedic shoes or orthotics (not both).

• Complete an Extended Health Care Claim Form 
• You will need to include a copy of the recommendation or referral from your specialist, which should indicate the medical condition and the orthotic or orthopaedic shoe is being prescribed.
• Attach your receipt showing the products have been paid in full and received.

 From Physician/practitioner:

• Original recommendation/referral from the prescribing physician, podiatrist/chiropodist, which includes the medical condition(s) which necessitate the orthotic appliance. (medically necessary for everyday activity) Orthotics must be prescribed prior to date of purchase.

From Supplier:

• Copies of the biomechanical examination and gait analysis reports.

• Complete description of the process used to create the orthotics, including the

               casting technique and the raw materials used.

• Confirmation that the orthotics have been paid in full.

• Who manufactured the orthotics and their qualifications/credentials 

Contacting Sun Life:

When you contact Sun Life, it is important to have your policy information readily available.  Each group's policy information is summarized below.

It is HIGHLY recommended that a predetermination be sent to Sun Life to ensure coverage. Your doctor can fax  the documentation to Sun Life at 416 490 0224.