Exclusions and limitations to health services
Medical services excluded from entitlement
Unless specifically required by the CAF, eligible persons will not be entitled to coverage for the following items:
- most services provided for purely cosmetic purposes or dictated by other than a medical requirement. Some of the excluded services are:
- removal of wrinkles;
- excision or dermabrasion of tattoos and scars, except as a result of injury or surgery;
- capillary graft to correct hereditary alopecia (hair loss);
- electrolysis, except for pathological hirsutism or folliculitis;
- correction of a congenital deformity, except if it causes significant physical symptoms;
- excision of excess adipose tissue;
- any type of laser eye therapy: orthokeratology, radial keratotomy, or photo refractive keratotomy; and
- breast implants (except after a mastectomy).
- reversal of tubal ligation or vasectomy;
- massage therapy (except for still serving VAC pensioned members who were already medically assessed and found eligible for the treatment in 2013 according to the direction given in CFHS Instruction 5010-13 "Delivery of Pension-Related Health Benefits"); and
- homeopathic and unproven herbal remedies.
Dental Services Excluded from Entitlement
Unless specifically required by the CAF, eligible personnel will not be entitled to coverage for the following items:
- dental examinations required by a third party;
- any service provided for purely cosmetic purposes, unless required to restore that caused by accident or service-related traumatic injury; and
- treatments or therapies viewed by medical/dental authorities as controversial or not scientifically validated.
Limitations on the type, level and frequency of services are applied by the senior dental authority based on selection criteria and guidelines developed by the Director Dental Services on behalf of the Director General Health Services. These limitations are designed to ensure that a comprehensive range of appropriate dental services are provided to entitled personnel based on professionally assessed need. For entitled CAF members, major restorative, prosthodontic, orthodontics and surgical services are usually limited to members with:
- three or more years of completed service; and
- sufficient time remaining in their current terms of service to complete the procedures and the required follow-up.
Major orthodontic services are limited to the treatment of a functional disability related to malocclusion.
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