NIHB Handbook (PDF) - First Nations Health Directors Association

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Replacement of Contact Lenses Trial of Bifocals Tints and Coating for Lenses Frames • y One (1) pair of contacts every 24 months for regular soft, and gas permeable soft and hard lenses or twelve (12) pairs of disposable contact lenses per year, since the last date of service. • y When medically necessary as prescribed for a medical eye condition. • y Replacement contact lenses if there is a prescription change of + or – 0.50 diopters. • y Attempt full-time use for a three (3) month period and, if unsuccessful, the frames will be used for reading glasses and a separate pair of distance glasses can be dispensed. Medical documentation is required. • y Anti-Reflective Coating – in cases where the client is eligible for high index lenses. • y Scratch Resistant Coating – for all lenses. • y Tints – in some cases such as albinism, aniridia, and certain chronic conditions of the anterior segment of the eye causing photophobia, medical documentation is required. • y Ultraviolet Protection Filter – in some cases such as aphakia, cataracts, retinal degeneration or dystrophy, or photosensitivity. Will be evaluated on a case-by-case basis for approval of the following frames: • y Flex frames (only for those who are neurologically compromised); • y Frames and unifocal lenses (2 nd set) for those who cannot wear bifocals; or • y Oversized frames – over 57 mm. 6 Your Health Benefits n A GUIDE FOR FIRST NATIONS TO ACCESS NON-INSURED HEALTH BENEFITS
What is not covered / Exclusions ■■ ■■ ■■ ■■ ■■ ■■ ■■ ■■ Vision care goods and services covered by provincial/territorial health insurance plans Additional carrying cases for glasses or contact lenses Cleaning kit Esthetic products Shampoo (e.g., “no more tears” type shampoo solution) Vision exams required for a job, a driver’s license or to engage in a sports activity Vision exams at the request of a 3 rd party (e.g., completing a report or medical certificate) Contact lenses for esthetic purposes For additional information ■■ ■■ ■■ ■■ ■■ ■■ ■■ ■■ ■■ ■■ ■■ ■■ Contact lens solution Industrial safety frames or lenses for sports or professional use Sunglasses with no prescription Progressive or trifocal lenses Photocromic/photocromatic lenses Replacements or repairs as a result of misuse, carelessness or negligence Implants (e.g., punctual occlusion procedure) Refractive laser surgery Treatments with investigational/ experimental status Vision training Review the Vision Care Framework at the website address below. http://www.hc-sc.gc.ca/fniah-spnia/pubs/nihb-ssna/index-eng.php#eye-yeux Call your Health Canada regional office or a designated First Nations Health Authority. Please refer to the contact list included at the back of this handbook. Your Health Benefits n A GUIDE FOR FIRST NATIONS TO ACCESS NON-INSURED HEALTH BENEFITS 7
Page 1 and 2: Your Health Benefits A Guide for Fi
Page 3 and 4: NON-INSURED HEALTH BENEFITS (NIHB)
Page 5 and 6: THE ASSEMBLY OF FIRST NATIONS HEALT
Page 7: Replacement eyeglasses/ lenses Eyeg
Page 11 and 12: Preventive services Scaling (cleani
Page 13 and 14: Orthodontic services (braces) Oral
Page 15 and 16: ■■ Predetermination requests re
Page 17 and 18: 3. MEDICAL TRANSPORTATION BENEFITS
Page 19 and 20: Escorts (General) Criteria for Esco
Page 21 and 22: 4. When a client does not attend a
Page 23 and 24: 4. DRUG BENEFITS What is covered? W
Page 25 and 26: Who can prescribe drugs? ■■ ■
Page 27 and 28: General Principles 1. Eligible bene
Page 29 and 30: 6. SHORT-TERM CRISIS INTERVENTION M
Page 31 and 32: 7. APPROVED HEALTH BENEFITS OUTSIDE
Page 33 and 34: 8. PROCEDURE FOR APPEALS An eligibl
Page 35 and 36: Appeal for Dental, Medical Supplies
Page 37 and 38: 9. PROTECTING YOUR INFORMATION The
Page 39 and 40: 10. REGIONAL NAVIGATORS ARE HERE TO
Page 41 and 42: Northern Region Non-Insured Health

NIHB Handbook (PDF) - First Nations Health Directors Association

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