Vision Care Framework
Vision Care Exceptions
Items which are not on the NIHB Vision Care Benefit List, and are not exclusions under the NIHB Program, may be considered on an exception basis.
*N.B.: Ocular prosthesis, scleral shell and low vision aids are available to eligible NIHB clients through the Medical Supplies and Equipment Benefits Program. For information, please contact the NIHB Regional Office in your region.
For all exception items, a written prescription with proper medical justification by the ophthalmologist or optometrist is required as well as a completed NIHB Prior Approval form.
Items that may be provided on an exception basis may include contact lenses, tints and coatings and in applicable regions eye exams, specific examinations and follow-up examinations.
Clients may be eligible for initial contact lenses when the detailed medical justification/prescription from an ophthalmologist or an optometrist demonstrates one of the following:
- astigmatism of at least 3 diopters in glasses prescription
- anisometropia or antimetropia of at least 2 diopters
- corneal irregularities
- treatment of certain ocular pathologies
Clients who meet the above criteria and also have a neurological or arthritic condition which makes it difficult for them to physically handle contact lenses, may be eligible for extended wear contact lenses.
Contact lens wearers are eligible for one back-up pair of eyeglasses in accordance with the conditions and rates set out in the relevant NIHB Program regional payment schedule for initial eyeglasses.
- Contact Lenses
- Regular soft, left
Regular soft, right
- Gas permeable, soft, left
Gas permeable, soft, right
- Gas permeable, hard, left
Gas permeable, hard, right
- Replacement Guidelines
- Contact Lenses
- Extended wear, soft, left
Extended wear, soft, right
- Replacement Guidelines
- Reviewed on a case by case basis
*N.B.: Contact lens solution is an exclusion to the NIHB Program.
If replacement contact lens(es) is/are required outside of the regular replacement guidelines, NIHB will provide funding when the prescription from the ophthalmologist or optometrist demonstrates one of the following:
- a negative or positive change of at least 0.50 diopter over the sphere or cylinder AND the new power meets the eligibility criteria for initial contact lenses
- a change of cylinder axis of more than 10 degrees AND the new prescription meets the eligibility criteria for initial contact lenses.
When requesting any of the following, details of the client's medical condition supporting the request must be provided in writing by the attending ophthalmologist or optometrist.
Anti-Reflective Coating: Multi-layer anti-glare treatment may be authorized on lenses with a refractive index equal to or greater than 1.60 diopters AND the client must be eligible for high index lenses.
Scratch Resistant Coating: Scratch resistant coating may be authorized for polycarbonate, high index plastic lenses (please refer to "Type of lenses" for eligibility criteria) and for children's glasses.
Tints: Tinted lenses must have an average transmission over the visible spectrum of 40 percent, as long as the tinted lenses provide total UV protection. Tints may be authorized for the following conditions:
- albinism
- aniridia
- certain chronic conditions of the anterior segment of the eye causing photophobia
Ultraviolet Protection Filter: Ultraviolet protection is the incorporation of a filter which blocks UV rays up to 400mm, without changing lens transmission over the visible spectrum. These filters may be authorized for the following conditions:
- aphakia (without intra ocular lens)
- cataracts
- retinal degeneration or dystrophy
- prolonged usage of some drugs that cause photosensitivity
- Tints and Coatings
- Anti-reflective treatment
- Tints
- Scratch resistant coating for plastic lens, left where applicable
- Scratch resistant coating for plastic lens, right where applicable
- Ultraviolet protection filter
- Replacement Guidelines
- Une fois pendant toute la durée de vie de la lentille ophtalmique
- Frames (Exceptions)
- Flex frames (only for those who are neurologically compromised)
- Frames and unifocal lenses (second set) for those who cannot wear bifocals
- Oversize frames (56mm)
- Replacement Guidelines
- Evaluated on a case by case basis
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