Supplemental Health Care

In addition to the comprehensive coverage, supplemental health care benefits will include:

  1. CF Drug Benefits
  2. Vision Care Benefits
  3. Miscellaneous Expense Benefits

1. CF Drug Benefits

Medications Included on the Drug Benefit List

The CF provides a wide variety of both prescription and non-prescription drugs to its members. These medications are defined in the Drug Benefit List. The medications on this list must generally be proven to provide a therapeutic effect. Other products, such as selected medical devices or supplies may also be included as Drug Benefits if there is evidence available to support their therapeutic value.

Drugs benefits will include, but not be limited to:

  • drugs which normally require a prescription;
  • drugs which may not legally require a prescription, but which are only available at an accredited pharmacy, and have known therapeutic value;
  • replacement therapeutic nutrients provided that there is no other nutritional alternative to support the life of the member;
  • injectable drugs, including allergy serum and vaccines;
  • compounded prescriptions;
  • vitamins and minerals listed in the CF Drug Benefit List which are prescribed for the treatment of a chronic disease when the use of such products are proven to have therapeutic value; and
  • drug delivery devices, such as those used to deliver asthma medications, which are integral to the product.

Medications Not Included on the Drug Benefit List

Products which do not have a proven therapeutic value will not be included in the Drug Benefit List. Products which fall outside the CF SoC will also not be reimbursed. As well, not all medications in a given therapeutic category will necessarily be included. If several different drug entities are available with similar mechanisms of action and similar therapeutic effects, a smaller selection of these medications is included. This will ensure rationalization of re-supply during deployment.

The following items are not considered to be benefits, and will not be funded:

  • personal hygiene products (e.g. non-therapeutic soaps and shampoos, contact lens solutions, pumice stones, toothpaste and mouthwashes);
  • agents of debatable therapeutic value (e.g. multivitamin preparations for general consumption, drugs for weight loss, herbal products, and homeopathic preparations); and
  • drugs for purely cosmetic effects (e.g. drugs for male pattern baldness).

Restrictions to the Medications on the Drug Benefit List

Certain medications are only approved for use in specific conditions, generally because their therapeutic potential may be limited or their side effects are more significant: these medications require Special Authorization to confirm that criteria for use have been met, and to thereby ensure optimal drug therapy. As well, other medications which are not routinely provided may be considered for use when the CF Drug Benefit alternatives are not well tolerated or are ineffective. The use of these medications must be consistent with an evidence-based approach, and must be approved through the CF Drug Exception Centre (toll-free number 1-877-469-1003).

Updating of the Drug Benefit List

The Drug Benefit List is constantly being updated to reflect published literature and/or therapeutic guidelines. Such evidence is reviewed extensively by the Federal Pharmacy and Therapeutics (P&T) Committee, which includes independent physicians and pharmacists across Canada and representatives from various federal agencies. Based on such a review, this Committee makes recommendations as to whether medications should be added/removed from benefit lists. The CF P&T Committee then assesses this information, considering operational demands, and makes a decision regarding the status of the medications on the Drug Benefit List.

Accessing Medications

Prescriptions for medications should be filled at the local base pharmacy. If the base does not have a pharmacy, or if medication is required after-hours or in an emergency, the prescription may be filled at a community pharmacy. However, if a prescription is presented to a community pharmacy, a valid Blue Cross card will be required to process the prescription (if the community pharmacy will not honour the Blue Cross card, the prescription should be transferred to another pharmacy).

If the medication prescribed is an unrestricted benefit, the medication will be dispensed without complications. If the medication prescribed requires Special Authorization, the base pharmacist will attempt to determine if the criteria for use have been satisfied (if such a prescription is presented to a community pharmacy, the community pharmacist will contact the Blue Cross adjudication centre to determine if criteria for use have been met). If the Special Authorization criteria are not met, or if the drug prescribed is not on the Drug Benefit List, the CF Drug Exception Centre will contact the prescriber and/or pharmacist to discuss alternative treatment options or obtain further information to support the use of the non-benefit item.

The Role of the CF Drug Exception Centre

The CF Drug Exception Centre is responsible for adjudicating requests for medication which are either not included as benefits or which do not satisfy the criteria for Special Authorization use. This Centre collects relevant information and reviews each case on an individual basis to determine the most appropriate drug therapy available. This Centre also liaises with Blue Cross and base pharmacies to ensure that Special Authorization criteria and medication access will be consistent for CF members across Canada. Prescribers or patients who anticipate concerns regarding approval of prescriptions may discuss other drug options with their base pharmacist, or alternately may contact the Drug Exception Centre directly at 1-877-469-1003 (toll-free).

 

 

2. Vision Care Benefits

Eye Examinations are performed in accordance with CF Periodic Health Assessment requirement or as per occupational health standards and whenever clinically necessary. Eye Examinations are to be conducted by an ophthalmologist, optometrist or ophthalmic technician working under the authority of the Senior Medical Authority.

Entitled Personnel: All members of the Reg F and those entitled Res F members (in accordance with QR&O 34.07) are entitled to optical services as outlined in the CFHS Policy and Guidance: Optical Supply and Services: Entitlement to Frames and Lenses, Policy # 4020-05

Entitlement to Glasses: Two approved frames (in accordance with Standing Offer Agreement) with the proper prescription (single vision, regular bifocals, trifocals and/or progressive lenses in clear lenses) will be supplied as the initial issue to all entitled personnel to ensure and maintain operational and occupational efficiency. Frames and lenses are expected to last for a period of two years and will comply with CF dress standards. After the initial issue of two pairs of glasses, the entitlement for replacement is one new pair every two years.

Entitlement to Specialty Glasses: Specialized corrective glasses, such as sunglasses, safety glasses, ballistic eye wear and respirator glasses, will be in accordance with established scales of issue or other entitlement documents.

Entitlement to Contact Lenses: Contact lenses that are necessary for therapeutic purposes, as prescribed by a consultant ophthalmologist/optometrist or for other medical requirement, are funded with prior approval of Canadian Forces Health Services Center (CF H Svcs C) Senior Medical Authority. Contact lenses for Refractive Requirement or trade requirements are funded in accordance with current Policy and Guidance: Optical Supply and Services: Entitlement to Contact lenses, Policy # 4020-03.

Buying Up Option: CF members, who wish to upgrade their glasses from those provided by the Standing Offer Agreement (SOA) or Local Purchase Order (LPO), will pay any differences in cost between the price quoted in the SOA or LPO and that of the upgrade as long as the upgrades are not part of the Non-authorized Optical Frames and Lenses found in the CFHS Policy and Guidance: Optical Supply and Services: Entitlement to Contact lenses, Policy # 4020-03.

Optical Providers: CF H Svcs Group/D H Svcs Del is responsible for initiating the SOA request with input obtained from CF H Svcs Cs. Public Works and Government Services Canada prepares the document that includes a description of requirements for the provision of optical frames and lenses for a specific site. Entitled personnel will obtain all frames and lenses through providers named in the local SOA. If a member decides to obtain frames and/or lenses from a provider not named in the SOA, DND will not reimburse any of the costs.

 

 

3. Miscellaneous Expense Benefits

The item or service must be medically necessary for the treatment of disease or injury, and must be prescribed by a physician unless otherwise specified. Repairs or replacement of medical equipment will not be made at DND expense when it has been determined that the equipment has been misused. Eligible expenses are the reasonable and customary charges for the following items:

Hearing Aids, limited to $2,000 every 48-month period for each ear,

Orthopaedic Footwear (Military Pattern), including modification when authorized by the HCC, once every twelve months, expenses: for other than initial entitlement, the member will pay the price of the equivalent military footwear (unless the footwear is normally issued on a no cost replacement basis).

Orthopaedic Footwear (Civilian Pattern), including athletic footwear, may be modified at public expense when prescribed and approved in accordance with the regulations for military pattern orthopaedic footwear. Individuals may have a maximum of two pairs of shoes, one pair of athletic shoes and one pair of boots, modified per year. Eligible persons must however, purchase the footwear at their own expense. DND shall only pay for modifications.

Orthotics, limited to two pairs every twenty four months.

Trusses, Canes, Crutches, Splints, Casts, Cervical Collars and Off The Shelf Braces when prescribed by an authorized practitioner (see Dental Section for dental braces).

Custom Made Braces when prescribed by a medical specialist.

Elasticized Support Stockings. Stockings manufactured to individual patient specifications and elasticized apparel for burn victims.

Bandages and Surgical Dressings required for the treatment of an open wound or ulcer.

Orthopaedic Brassieres, limited to $100 every twelve months.

Wigs, when the patient is suffering from significant hair loss as the result of a disease or illness, limited to the maximum of $2000/lifetime.

Ostomy Supplies, Catheters and Drainage Bags when indicated and prescribed by the attending physician.

Prosthesis and Implants: (see Dental Section for dental implants),

  1. breast prostheses following mastectomy, and replacement, but not within 24 months of the last purchase for the same side;
  2. temporary artificial limbs; and
  3. permanent artificial limbs and replacement thereof, but not within:
    1. 60 months from the last purchase of the same limb in the case of a member over 21 years of age, unless medically proven that growth or shrinkage of the surrounding tissue requires replacement of the existing prosthesis at an earlier date; or
    2. 12 months from the last purchase of the same limb in the case of a member 21 years of age or less.

Oxygen and its delivery devices.

Needles, Syringes, and Chemical Diagnostics Aids for the treatment of diabetes.

Insulin pumps and associated equipment, when prescribed by a specialist.

Blood Glucose Monitors when prescribed by a specialist.

Durable Equipment, manufactured specifically for medical use, which is required for therapeutic use in the patient's private residence and is recommended by the HCC, may be rented or purchased. Eligible durable equipment includes, but is not limited to, items such as wheelchairs, walkers, hospital beds, apnea monitors and alarm systems for anuretic patients. Reimbursement will be limited to the cost of non-motorized equipment unless medically proven that the patient requires motorized equipment.

Note: Any type of aid to daily living which is not a recognized form of medical treatment or any equipment that is not specifically designed for medical use is not an eligible benefit. Also refer to section on Assistive Device and Adaptive Equipment.

Infertility

  1. Investigation: Eligible persons are entitled to investigation of infertility; and
  2. Procedure: Eligible persons are entitled to the following procedures for infertility:
    1. artificial insemination: for a diagnosed medical condition only;
    2. in-vitro fertilization (IVF) funding will be provided only:
      1. if the infertility is the result of bilateral Fallopian tube obstruction;
      2. for a maximum of three cycles; and
      3. to serving members, not to civilian dependants, spouses or partners of serving members;
    3. medication as an adjunct to IVF when the bilateral tube obstruction criteria is met; and
    4. intra-cytoplasmic sperm injection (ICSI) will be provided:
      1. for male factor infertility;
      2. for a maximum of three cycles; and
      3. to serving members, not to civilian dependants, spouses or partners of serving members;
  3. Experimental or controversial new procedures not covered by provincial health care plans will not usually be funded by CF H Svcs. When in doubt, the HCC should contact D Med Pol - SSO Primary Care for advice.

Note: Investigation and procedures for infertility are not funded when the infertility is the result of voluntary sterilization.

Third Party Medical Services. Medical appraisals, certifications or testimonies required by a member or Third party including:

  1. proof of death;
  2. a medical-legal examination of a member injured on duty, or related litigation arising from events occurring while on duty;
  3. an examination required under a provincial mental patient's protection act;
  4. an examination required under a provincial public curatorship act; or
  5. an examination required under the Quebec Pension Plan or Canada Pension Plan

This would also include services which would be easily available to the majority of Canadians from their family physician for a nominal fee such as CF physician-completion of forms, e.g. visa applications, adoption medical fitness assessment, insurance medicals, driver medicals and sport diving medicals. No fees for the physician's time will be charged to the CF member for the provision of these services. However, where there are additional external costs associated with the provision of these services, such as charges for the use of outside-the-Clinic diagnostics, these costs will be the responsibility of the CF member seeking the service. The CF physician will nevertheless assist with ordering the required tests. In situations where the demand for CF medical services is high, third party medical services would be accorded a lower priority than:

  • The provision of medical care directly to patients; and
  • The provision of medical support to CF training and/or operations

Civil aviation medical examinations are not a benefit except when they are done by CF flight surgeons for a CF pilot and as part of a CF-required assessment of the pilot's fitness to fly CF aircraft. Psychological assessments required as part of custody disputes or any other examination, appraisal, testimony, or certification required by a member or a third party involved in any criminal litigation that arises from events occurring during off-duty periods, or for any litigation instigated privately by a member are not an eligible benefits.

Laser Treatment of Dermatologic conditions. The following treatments are included:

  1. laser treatment of tattoos resulting from sexual abuse, prisoner of war experience and traumatic tattoos (imbedded particulate);
  2. laser treatment for scars which interfere with function or with operational military equipment;
  3. laser treatment for to add significant and unsightly vascular and pigmented facial lesion of the face and neck (upon recommendation of a dermatologist);
  4. laser treatment for Rosacea (upon recommendation of a dermatologist), and
  5. laser treatment for acne scarring: (upon recommendation of a dermatologist and mental health provider).