About this Benefit
Getting a regular eye exam is necessary to maintain good eye health. If you wear prescription contacts or eye glasses it is important to update your prescription regularly and to get eye exams, which check the eyes and brain for diseases. First Nations Health Benefits has partnered with Pacific Blue Cross (PBC) to offer a comprehensive vision care plan to First Nations people in BC.
A Vision Care Benefit factsheet is available here. For detailed information of all products and services covered under your vision Benefits, visit the Fee Supplement here.
|
What My Plan Covers
Your plan covers certain vision care items and services under the following categories:
- prescription eyewear and repairs
- sight tests and eye exams
You can find detailed information about your vision
care benefits through your PBC Member Profile,
which you can access online or through the PBC app.”
How Do I Access Coverage?
When you make an appointment, the best way to access your coverage and avoid out-of-pocket costs is to discuss your exam, eyewear options, and billing details with your provider.
1. Ask your provider if they are registered with PBC. Providers who are registered can bill them directly. If you see a provider who is not registered you will need to pay out of pocket and request reimbursement. You can also search for a provider who is registered for direct billing using your PBC Member Profile.
2. Check if your vision care provider requires payment up front. Some providers ask their clients to pay for items and services before the appointment.
3. Talk to your vision care provider about which items and services are fully covered by your vision care plan. Before your eye exam, and before ordering your contact lenses or picking out your prescription glasses, make sure you have enough coverage to cover the cost. If the item or service costs more than your vision care benefit maximums, you will need to pay out of pocket for the remainder.
4. Health Benefits will cover glasses or contact lenses purchased online, however you will have to pay out of pocket and request reimbursement.
If you have any questions about your vision care plan, how to access coverage, or why a claim was denied, call Health Benefits at 1-855-550-5454.
What My Plan Does Not Cover
Some items and services are considered Exclusions. Exclusions cannot be covered as an exception and cannot be appealed. Vision care benefit Exclusions include, but are not limited to:
- prescription eyewear accessories or supplies (e.g., contact lens solution, glasses cases)
- industrial safety frames or lenses
- non-prescription items
- surgical procedures (e.g., laser eye surgery)
- procedures covered by MSP (e.g., cataract surgery)
Appeals
When a coverage request for a vision care item or service has been denied, you have the right to appeal the decision. Items and services that are Exclusions cannot be appealed. See the Appeals page for more information about the appeals process.
