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);
- hair removal by laser or electrolysis;
- 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 local senior dental authority based on selection criteria and prioritization guidelines developed by the Director Dental Services on behalf of the Chief Dental Officer and 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 eligible CAF personnel, major dental care services (major restorative, major prosthodontic, orthodontics and surgeries linked to orthodontic or major prosthodontic treatment plans) are usually limited to service-related injury necessitating rehabilitation, or dysfunctional occlusion or a dental disability related to a malocclusion that necessitates intervention.
The provision of major dental care services warrants additional considerations and caution should be exercised before:
- initiating major dental care services for personnel who have not completed their occupation’s Basic Level Qualification Course due to the inherent training demands and the impending posting upon course completion; and
- initiating major dental care for personnel who are expected to be posted before treatment completion.
When possible, consideration may be given to offer major dental care services in a phased approach when mitigating issues around geographic postings and availability during occupational training.
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