Comprehensive medical care services

Services will include:

• Physician Services
• Hospital Services
• Ambulance Services
• Addiction Counseling and Treatment
• Social Work Services
• Out-Patient Diagnostic Services
• Rehabilitation Care
• Home Care
• Assistive Devices and Adaptive Equipment
• Long Term Care Facilities
• Health Practitioner Benefits
• Bariatric Surgery
• Corneal Cross-Linking (CXL)

Physician Services

Physician services to include:

1. diagnosis and treatment of any illness or injury, to the full extent required;
2. counseling with regard to health promotion and preventive medicine;
3. surgery, to include bariatric surgery as described below;
4. administration of anesthesia;
5. obstetrical care, including pre- and post-natal care; and
6. administration of immunizations.

Hospital Services

This benefit provides reimbursement for reasonable and customary charges for hospital confinement in a general or specialized hospital, as required, including:

1. coverage for any service provided by a duly registered hospital in Canada including out-patient facilities and diagnostic fees normally charged to the provincial authority; and
2. semi-private hospital accommodation whenever available and compatible with the clinical condition. This applies to all CAF members irrespective of rank.

Ambulance Services

Emergency ground and air ambulance services, as the clinical situation and availability dictate. With prior approval, patient transfer by ground or air ambulance is included. Inappropriate ambulance use may result in cost recovery action.

Addiction Counseling and Treatment

Out-patient and residential addiction counseling and treatment programs when prescribed by an attending physician including:

1. assessment by a physician and/or a specialized counselor, as authorized by the HCC, at the request of the patient or of the military supervisor, to determine the presence of addiction/substance abuse concerns and to determine the required treatment, as well as any supportive counseling and/or detoxification that may be required prior to treatment. This may also involve family members and co-workers/supervisors;
2. formal in-patient treatment programs involving individual, group and family therapy/education sessions;
3. early intervention groups for counseling, for those not requiring the in-patient program;
4. follow-up sessions for a minimum of one year after treatment, on a weekly basis, with the referring physician and/or addiction counselor. Such sessions to be in a group setting with individual counseling, as necessary;
5. care delivered to family members must be in accordance with the instruction 5100-07 Member Focus Family Care

Social Work Services

1. assessment interviews including screening for isolated or unaccompanied postings, compassionate request assessments, intake assessments, psychosocial assessments;
2. counseling interviews including individual, marital, family or group therapy/counseling;
3. written reports on all assessment and counseling interviews;
4. stress management;
5. suicide prevention;
6. critical incident stress management programs;
7. life skills program;
8. family support services;
9. care delivered to family members must be in accordance with the instruction 5100-07 Member Focus Family Care

Out-Patient Diagnostic Services

Laboratory, Diagnostic Imaging and other diagnostic procedures when prescribed by an authorized health practitioner.

Rehabilitation Care

Care in rehabilitation centers or other rehabilitation programs, for members requiring extensive or specialized rehabilitation resulting from illness or injury.

Home Care

Home care services are eligible when the attending physician certifies they are required and the needs cannot be met on an out-patient basis. Appropriate home care services will be provided for eligible service members in their private residence, or in quarters, whether at their home base or elsewhere in Canada. Home care services may include:

1. physician services;
2. nursing services (including case management and mental health);
3. physiotherapy services;
4. occupational therapist;
5. speech pathologist;
6. social worker;
7. registered dietitian;
8. respiratory therapist;
9. psychologist;
10. personal support worker;
11. medical equipment and supplies. and
12. assistive device and adaptive equipment that would expedite return home after hospital/rehab center stay.

Assistive Devices and Adaptive Equipment

Items required for meeting in a timely manner the medical needs for functional independence of entitled CAF members. The Base Surgeon is given authority to prescribe immediate ADAE requirements and their installation to a maximum of $15 000 per item. This does not include permanent home modification which would be covered under CBI 211.

Long Term Care Facilities

1. Nursing Home. Nursing home services when an eligible person requires 24-hour medical supervision, as well as nursing and personal care; and
2. Chronic Care. Care in chronic care facilities for eligible persons who have long-term illnesses or disabilities which cannot be treated at home.

Health Practitioner Benefits

Out-Patient services of the following practitioners when prescribed by the attending physician, within the limits as follows:

1. physiotherapist (20 appointments);
2. speech language pathologist (10 appointments);
3. psychologist (10 appointments);
4. chiropractor (10 appointments);
5. osteopath (10 appointments);
6. registered dietitian (5 appointments);
7. acupuncture, when in conjunction with pain management or when used as an adjunct to treatment of substance dependence (10 appointments);
8. podiatrist or chiropodist (5 appointments); and
9. occupational therapist (10 appointments).

Note: Physicians can authorize attendance as indicated, per condition, after which physician follow up of each case is required to ensure that care is progressing and to determine whether further care is required. Patient care, rather than monetary limits per se, will be the determining factor.

Bariatric Surgery

Bariatric surgery is an effective procedure for the treatment of a bona fide medical condition: morbid obesity. This surgery is recognized as a legitimate surgery and included as an entitled service within the majority of provincial health care plans and as such, is included in the SoC.

Corneal Cross-Linking (CXL)

Canadian Armed Forces members are eligible to receive corneal cross-linking (CXL) as a treatment for keratoconus, subject to approval by the Senior Staff Officer Primary Care (SSO Primary Care) within the Directorate of Medical Policy (D Med Pol). The process for seeking SSO Primary Care approval is as follows:

1. Patient Evaluation – The member must have a diagnosis of keratoconus from an ophthalmologist who also considers the member a candidate for CXL. Before proceeding to request SSO Primary Care approval for the CXL procedure on one or both eyes (through the Base or Wing Surgeon, B/W Surg), the member’s primary care clinician must obtain a surgical opinion from an ophthalmologist who performs CXL procedures;
2. Sending for SSO Primary Care Approval – SSO Primary Care approval is sought in accordance with the procedures detailed in CFHS Instruction 5000-03, Requesting Items or Services as Canadian Armed Forces Spectrum of Care Exceptions;
3. SSO Primary Care Approval – The SSO Primary Care will then assess whether CFHS will pay for the CXL procedure, using the following criteria. The decision will be documented in the Canadian Forces Health Information System (CFHIS) and communicated to the B/W Surg IAW CFHS Instruction 5000-03:
   1. Ensuring that the CXL procedure has not been carried out on the same eye in the past. CFHS will only pay once per lifetime per eye;
   2. Assessing the consultant ophthalmologist(s)’ reports carried out as part of the patient’s evaluation;
   3. Determining that the diagnosis of keratoconus has been established; and
   4. Verifying that, if the CXL procedure proposed is to be done in conjunction with a refractive laser eye surgery procedure, the member will be paying for the latter procedure, which is outside of the Spectrum of Care;
4. Payment for CXL Procedure – If the SSO Primary Care approves the CXL procedure for the member, the following payment guidelines are to be adhered to. All fees will be paid to the CXL service provider through the CFHS third-party payment processor (currently Blue Cross), not by direct reimbursement to the CAF member. Any proposed exceptions to these guidelines must be pre-approved by the SSO Primary Care:
   1. Total fees, including the ophthalmologist’s consulting fee and  the technical/procedure fee, should not normally be greater than $1,800 per eye, and
   2. Fees paid above will cover:
      1. pre- and post-procedure ophthalmologist assessments,
      2. pre- and post-procedure corneal pachymetry,
      3. corneal de-epithelization,
      4. all isotonic riboflavin drops,
      5. any other drops required,
      6. the technician’s time, and
      7. the use of the UV-A light or any other energy source required for the procedure; and
5. Payment for Follow-Up – Patient follow-up visits on subsequent days are billed by the ophthalmologist separately through the CFHS third-party payment processor in accordance with the usual fee schedule for ophthalmologist services.