Alberta.ca » AISH Policy Manual


AISH Program Policy

Published Date: March 01, 2014
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Benefits

Health Benefits

Optical Services

AUTHORITY

Assured Income for the Severely Handicapped Act, section 3
Assured Income for the Severely Handicapped General Regulation, section 7

INTENT

To provide basic coverage for optical products and services to eligible clients, cohabiting partners and dependent children to ensure their optical health and well-being.

POLICY

AISH provides optical services through the AISH Health Benefits Card. Optical goods and services are provided by opticians and optometrists within Alberta. These services are provided according to agreements between AISH, and the Alberta Opticians Association and the Alberta Association of Optometrists. Pre-authorization from Alberta Blue Cross (ABC) is required for all optical services.

Basic optical coverage includes routine eye examinations, eyeglasses and in certain circumstances, contact lenses. Optical service providers should confirm the basic optical services available with the Health Benefits Card with ABC.

Eye Examinations

AISH provides payment for one routine eye examination every 24 months, performed by an optometrist, for clients, their cohabiting partners and their dependent children who are 18 or 19 years of age, attending high school and residing with the AISH client.

Alberta Health and Wellness covers medically necessary eye examinations for adults, and performed by an optometrist, for Albertans aged 19 to 64 if they have diabetes, cataracts, glaucoma, retinal disease, are taking Hydroxy Chloroquine Sulfate (Plaquenil), require a foreign object to be removed from their eye or have been referred by a physician or nurse practitioner. However, this exam may not include a refraction exam (vision test).

Alberta Health and Wellness covers eye examinations for dependent children under 18 years of age.

Eyeglasses

AISH provides payment for eyeglasses. Eye conditions must vary at least 0.5 diopters from normal before initial eyeglasses are issued.

  • AISH provides one pair of replacement eyeglasses, if needed, after 24 months for clients, cohabiting partners and dependent children who are 18 or 19 years of age, attending high school and residing with the AISH client.
  • AISH provides one pair of replacement eyeglasses, if needed, after 12 months for dependent children who are under 18 years of age.

Lenses only may be replaced more often if the change in refractive error is significant, at least plus or minus 0.5 diopters.

AISH allows one pair of eyeglasses for distance and one pair of eyeglasses for reading when substantiated by a prescription and documentation that a bifocal cannot be worn.

The optical agreements contain fixed prices for frames and single, bifocal, and trifocal eyeglasses. If more expensive or additional options are chosen and the cost exceeds the amounts outlined in the applicable agreement, the client must pay the difference.

The optical agreements provide for a one-year limited manufacturer’s warranty on frames against breakage. The one-year warranty runs from the date of service and covers against manufacturer’s defects.

If glasses are lost or damaged, or if optical goods or services are not covered by the Health Benefits Card, a request for an Additional Health Benefit may be made.

Contact Lenses

AISH provides contact lenses for clients, cohabiting partners and dependent children, with the same frequency as eyeglasses, when prescribed by an optometrist or ophthalmologist if any of the following medical conditions exist:

  • Aphakia;
  • Cornea irregularities;
  • Astigmatism that is inadequately corrected by eyeglasses; or
  • Refractive errors in excess of plus or minus 7.00 diopters in any meridian.

Clients, cohabiting partners or dependent children who have contact lenses may also receive one back-up pair of eyeglasses, as contact lenses cannot normally be worn on a continuous basis. Back-up eyeglasses are subject to the same rules as other eyeglasses.

Clients, cohabiting partners or dependent children are responsible for the costs related to contact lens solutions.

Travel outside of Alberta

Optical coverage is not provided outside of Alberta, and any costs incurred while traveling or vacationing outside of Alberta are not covered. Prior to leaving the province, the client should contact their AISH worker to discuss available options.

If optical services are denied, the client may request a review through AISH.