VISION CARE\OPTICAL
- For certain services relating to eye and vision examination. Optometrists and Ophthalmologists must be able to attest to oculo visual condition justifying the examination.
- Eligibility criteria as set forth herein represents standard conditions only. Any requests which fall outside criteria will require special authorization
WHAT IS COVERED?
Eye Examination
Every 2 years for ages 19 to 64
Every year for children ages 0-18
(Covered by Alberta Health Care Premiums)
Every year for seniors 65 years or older
(Covered by Alberta Health Care Premiums)
Diabetic Clients: Mahor annual eye exam and dilated fundus exam
(Bigstone NIHB requires a letter from a licensed Medial Doctor)
Specific
Bigstone NIHB may assist in obtaining specific examinations, when severe abnormality in ocular or visual conditions have been identified by an optometrist or ophthalmologist as medically neccessary for the following:
- Visual Field Test
- Diabetic Fundus Examination
Follow-Up
Bigstone NIHB may assist in abtaining a partial follow-up examination when ocular or visual condition is identified by an Optometrist of Ophthalmologist as medically necessary.
Initial Eyewear
Clients are entitled to a pair of glasses, if their oculo-visual condition in at least one eye is the spherical equivalent of 0.50 diopters: Cylindrical power must be negative:
- Lenses: Unifocal, Bifocal and High Index
- Anti-Glare Treatment
- Hardened/Impact Resistant Treatment
- Scratch Resistant Coating
- Every year for children ages 0-17
- Unifocal Lenses
- Bifocal Lenses
Specific Benefits
- Eye prosthesis (as approved for eligible clients by Medical Supplies & Equipment)
Repairs
Major and Minor
- Material and fees cannot exceed $50.00
- Case-by-case Exceptions
Depending on the circumstances and supporting medical documentation, the request may be considered as an exception.
WHAT'S NOT COVERED?
- Esthetic products and services
- Eye exam required for work, driver's license or sports
- Eye exam required for completing a medical report or certificate
Tint
May be considered as an exception with medical justification, when prescribed by an Optometrist or Ophthalmologist for the following conditions:
- Aphakia
- Kerato-conjunctivitis
- Iritis
- Xerosis of the cornea
Monocular Clients
May be considered as an exception when client is functionally monocular and Bigstone NIHB has documentation on file from an Optometrist or Ophthalmologist.
WHO CAN PRESCRIBE AND PROVIDE BENEFITS?
A licensed professional registered to practice in the in the Province they are located in may dispense their expertise in a specific benefit area as follows:
- Optometrist (Eye Doctor)
- Ophthalmologist (Eye Specialist)
- Any other personnel specializing in a specific area of expertise
HOW CAN YOU ACCESS THE BENEFIT?
Phone our office to confirm eligibility:
- Make an appointment with a licensed optometrist
- Take your prescription to a recognized provider
- The provider will phone or fax the information to Bigstone NIHB to get approval for coverage.
WHAT ARE YOUR RESPONSIBILITIES?
When you schedule an appointment with an Optometrist that you are not familiar with inform them that:
- You are a registered Bigstone Cree Nation member
- You are a recipient of the Bigstone NIHB Pilot program
- You have coverage under another health care insurance plan (If you have other coverage other than Bigstone NIHB)
- Keep your scheduled appointment.
- Ensure that you pick-up\receive your eyewear.
Jeannie Lindsey -
Vision Care and Mental Health/Crisis Intervention Clerk
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