Optical Services

Effective:  September 1, 2017

The ministry covers routine eye examinations once every two years, through Pacific Blue Cross, for:

• adults aged 19 to 64 who are in receipt of income assistance, disability assistance or hardship assistance

• recipients of Medical Services Only (MSO) or Transitional Health Services (THS) if between ages 19 and 64

Routine eye examinations for children under 19 years of age and seniors continue to be covered by Medical Services Plan (MSP), as do medically necessary eye exams for everyone registered with MSP, regardless of age.

Payment for eye exams may not exceed the amounts shown in Rate Table: Health Supplements and Programs – Optical Services.

Effective:  November 3, 2014

Coverage of optical supplements is strictly limited to basic eyewear and repairs and pre-authorized eyewear and repairs.

Basic eyewear and repairs include any of the following items that are provided by an optometrist, ophthalmologist, or optician:

• for a child who has a new prescription, one pair of eye glasses per year consisting of single-vision or bifocal lenses and frames to the maximum rate payable by the ministry as set out in the current rate schedule
• for any other person who has a new prescription, one pair of eye glasses every three years consisting of single-vision or bifocal lenses and frames to the maximum rate payable by the ministry as set out in the current rate schedule
• for a child or other person:
  • new lenses at any time if an optometrist, ophthalmologist, or optician confirms a change in refractive status in either eye
  • a case for new eye glasses or lenses
  • necessary repairs to lenses or frames that come within this definition

Provision of glasses is limited to once in three years for adults and once a year for children with a valid prescription.

Pre-authorized eyewear and repairs include changeable coloured lenses or tints, special lenses or lens material, special or oversized frames, and contact lenses.  The Ministry’s optical program contractor, Pacific Blue Cross (PBC) only considers these special supplements when confirmed as medically essential by an optometrist or ophthalmologist.  Pre-authorized optical supplements also include replacement glasses without a significant change in prescription or outside the time limitations set by the ministry.

The ministry does not provide payment for any optical therapy or low-vision aids.

Effective:  February 25, 2013

To assess eligibility for optical supplements, follow these steps:

1. Ensure that Medical Services Plan (MSP) coverage has been applied for on behalf of the recipient [see Related Links – Medical Services Plan and Medical Coverage.]

2. For eye exams, refer recipients directly to any optometrist or ophthalmologist and advise them to provide a piece of BC government issued identification which displays the client’s Personal Health Number. 

   For eyewear and repairs, refer recipients with a prescription to any optical supplier.

The optometrist, ophthalmologist, or optical supplier contacts Pacific Blue Cross to confirm the recipient’s eligibility for products and services.

The optical supplier provides information to the recipient on the level of coverage available.  The recipient is responsible for any costs associated with eyewear, repairs, or eye exams in excess of the allowable rates.

Effective:  November 3, 2014

Unless the recipient has a new prescription, the ministry provides replacement glasses once every 3 years for adults and once every 12 months for children.  If a recipient loses or breaks their glasses before this timeframe is met, replacement glasses may be approved as follows:

1. Client must take their request and a piece of BC government issued identification which displays the client’s Personal Health Number to an optical supplier.

2. If the client is purchasing through the online supplier, the client will telephone the supplier and provide their basic information, Personal Health Number and prescription.  [see Contacts]

3. Optical supplier will call Pacific Blue Cross (PBC) for the necessary approvals.

Effective: February 3, 2019

For optical services that have been denied, the optometrist, ophthalmologist, or optical supplier will advise the client of the reasons for denial. Should the client not agree with the decision they have a right to request reconsideration. 

A request for reconsideration can be initiated by contacting the ministry. The worker will complete an Employment and Assistance Request for Reconsideration (HR0100) using the denial reasons provided by Pacific Blue Cross and forward to the client for submission to the Reconsideration Branch.

Effective:  November 3, 2014

Pacific Blue Cross is responsible for:

• determining eligibility for optical supplements at the request of optical suppliers
• administration and management of the provision of optical supplements
• pre-authorizing optical supplements