CANADIAN ARMED FORCES PAGE 1 PRINT DATE: NOVEMBER 20, 2018 BENEFIT GRID
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1 ************************************************************************************************************************************************************************************************* * CUSTOMER...CAF/FAC * PROVINCE...PQ * POC...14 * LANGUAGE...E *************************************************************************************************************************************************************************************************
2 CANADIAN ARMED FORCES PAGE HIGH INDEX LENSES; SPHERE FROM TO YES 1/24CM $ Y HLTH SVCS NOTE: REFER TO SPHERICAL EQUIVALENT OR SPHERE TO WRITTEN IN MINUS (-) CYLINDER 1.67 HIGH INDEX LENSES; SPHERE FROM TO YES 1/24 CM $ Y HLTH SVCS NOTE: REFER TO SPHERICAL EQUIVALENT OR SPHERE TO WRITTEN IN MINUS (-) CYLINDER HIGH INDEX LENSES; SPHERE OVER YES 1/24CM $ Y HLTH SVCS NOTE: REFER TO SPHERICAL EQUIVALENT OR SPHERE OVER WRITTEN IN MINUS (-) CYLINDER. COMPUTER LENSES YES 1/24 CM $ Y CONTACT LENS - SOFT DAILY WEAR (LEFT AND/OR YES 12/CY Y 1 PAIR OF DAILY WEAR OR 12 RIGHT) PAIRS PER YEAR CONTACT LENS - SOFT TORIC - DAILY WEAR (LEFT YES 1/24 CM AND/OR RIGHT) CR-39 SINGLE OR BIFOCAL VISION WITH SPHERE OF YES 1 PAIR/24 CM $ Y HLTH SVCS NOTE: REFER TO OR LESS SPHERICAL EQUIVALENT OR SPHERE OF OR LESS WRITTEN IN MINUS (-) CYLINDER. CXL SURGERY - LEFT YES 1 PER $1, Y LIFETIME CXL SURGERY - RIGHT YES 1 PER $ Y LIFETIME
3 CANADIAN ARMED FORCES PAGE 2 DISPOSABLE CONTACT LENSES YES 12/CY Y EXAM BENEFIT - CONTACT LENS - SPHERICAL OR TORIC YES Y (INCLUDING FITTINGFEES) EXAM BENEFIT - CONTACT LENS - TORIC (INCLUDING YES Y FITTING FEES - OTHERTHAN OPTICIAN) EXAM BENEFIT - CONTACT LENS RGP (INCLUDING YES Y FITTING FEES 0THER THAN OPTICIAN) EXAMS - MAJOR OPTOMETRIC EXAM YES Y THE COST OF THIS SERVICE EXAMS - MINOR OPTOMETRIC EXAM YES Y THE COST OF THIS SERVICE EXAMS - OPTOMETRIC EXAM PERFORMED BY AN YES Y THE COST OF THIS SERVICE OPTHALMOLOGIST EYE EXAM - HEIDELBERG RETINAL TOMOGRAPHY YES Y THE COST OF THIS SERVICE EYE EXAM - OCULAR COHERENCE TOMOGRAPHY YES Y THE COST OF THIS SERVICE
4 CANADIAN ARMED FORCES PAGE 3 EYE EXAM - PACHYMETRY YES 1/24 CM Y THE COST OF THIS SERVICE FEES (VISION) - ANGIOGRAPHY YES Y FEES (VISION) - EXTERNAL PHOTOS YES Y HLTH SVCS NOTE: REFER TO FEES (VISION) - FUNDUS PHOTO YES Y FEES (VISION) - TONOMETRY YES Y FEES (VISION) - VISUAL FIELDS YES Y FRAMES - REGULAR YES 1/24 CM Y FRAMES - SAFETY FRAMES WITH SIDE SHIELD YES 1/24 CM Y HIGH INDEX PROGRESSIVE LENS WITH ANTI-SCRATCH AND YES 2/24 CM Y ANTI-REFLECTIVE COATING
5 CANADIAN ARMED FORCES PAGE 4 IOL MASTER YES Y LENS BENEFIT - (CORRECTIVE) BALLISTIC EYEWEAR YES 2/24 CM Y LENS BENEFIT - (SINGLE VISION) YES 2/24 CM Y LENS BENEFIT - BIFOCAL BALLISTIC EYEWEAR - LEFT YES 1/24 CM OR RIGHT LENS BENEFIT - BIFOCALS (LEFT AND/OR RIGHT) YES 2/24 CM Y LENS BENEFIT - CONTACT LENS - RGP YES 2/24 CM Y LENS BENEFIT - HIGH INDEX BIFOCALS YES 2/24 CM Y LENS BENEFIT - HIGH INDEX INCLUDING ANTI-SCRATCH YES 2/24 CM Y & ANTI-REFLECTIVECOATING LENS BENEFIT - LENS FOR GAS MASK GLASSES YES 2/24 CM Y
6 CANADIAN ARMED FORCES PAGE 5 LENS BENEFIT - TINTING (CORRECTIVE LENSES) YES 2/24 CM Y LENSES ONLY YES 1/24CM $ Y HLTH SVCS NOTE: REFER TO MONTHLY DISPOSABLE SPHERICAL LENSES YES 4 BOXES/12 Y CM MONTHLY DISPOSABLE TORIC LENSES YES 4 BOXES/12 Y CM OFF-THE-SHELF READERS O,OP,OT YES 2/24 CM $ Y PAIR OF SAFETY FRAME WITH SAFETY LENSES YES 1/24CM $ Y HLTH SVCS NOTE: REFER TO PAIR OF SUNGLASSES YES 1/24CM $ Y HLTH SVCS NOTE: REFER TO POST CATARACT SURGERY - INTRAOCULAR LENS TWO PER $ LIFETIME PROGRESSIVE LENS WITH ANTI-SCRATCH AND YES 2/24 CM Y ANTI-REFLECTIVE COATINGS
7 CANADIAN ARMED FORCES PAGE 6 PROGRESSIVE LENSES WITH SPHERE OF OR LESS YES 1/24CM $ Y HLTH SVCS NOTE: REFER TO SPHERICAL EQUIVALENT OR SPHERE OF OR LESS WRITTEN IN MINUS (-) CYLINDER. PROVINCIAL SALES TAX (PST) 0PST REPAIRS AND MAINTENANCE TO VISION (EYE) CARE YES Y BENEFITS TAXES - GST/HST (GST/HST REGISTRATION NUMBER 0GST REQUIRED) TAXES - GST/HST (GST/HST REGISTRATION NUMBER 0TPS REQUIRED)
8 CANADIAN ARMED FORCES PAGE 7 - SPECIAL NOTE
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