New Vision Care Framework and Vision Care Benefit List

Questions and Answers

Why has the Vision Care Framework been updated?

The Vision Care Framework explains the overarching policies that guide the administration of the vision care benefit under the Non-Insured Health Benefits (NIHB) Program of Health Canada. The Framework was last printed in 2005 and needed to be updated to ensure that available benefits are more representative of today's standard of health care and to better meet the needs of clients.

How is the 2011 Vision Care Framework different from the 2005 Framework?

In order to be in line with other NIHB Program benefits that have a benefit list (Medical Supplies and Equipment and Pharmacy) and to ensure that vision care coverage is regularly updated and reflective of the current standard of care, the list of vision care benefits covered by the NIHB Program was removed from the Vision Care Framework and will now be a separate document known as the Vision Care Benefit List.

The 2011 Vision Care Framework provides a broad overview of the policies associated with the administration of the vision care benefit under the NIHB Program and the Vision Care Benefit List contains a comprehensive list of the vision care benefits eligible for coverage under the Program and will be updated on a yearly basis.

What new vision care benefits are now listed on the Vision Care Benefit List?

The following new vision care benefits are now listed on the Vision Care Benefit List:

• Additional vision examinations (posterior segment examination with pupil dilation, gonioscopy of the angles);
• Yearly testing for certain medical conditions when not insured by the province or territory (evaluated on a case-by-case basis);
• Provision of coverage for disposable contact lenses when clients meet eligibility criteria; and
• More inclusive coverage for lenses including scratch resistant coating.

When will the new NIHB Vision Care Framework and Vision Care Benefit List be implemented?

The new Vision Care Framework, the Vision Care Benefit List and the start of coverage for new benefits will become effective in January 2012.

How do eligible clients obtain vision care benefits under the NIHB Program?

• Clients must be examined by an optometrist or an ophthalmologist to obtain a prescription;
• Clients should take the prescription to a recognized vision provider, such as an optician or an optometrist; and
• That provider will contact the Health Canada regional office for prior approval of the benefit required by the client.

Where can I obtain a copy of the Vision Care Framework and the Vision Care Benefit List?

To obtain a copy of the new Vision Care Framework and the Vision Care Benefit List, please contact your Health Canada regional office or visit the Health Canada website under the Benefit Information section.

How do I contact the Health Canada regional office in my area?

A list of Health Canada regional offices is available on the Health Canada website.