7B.5. Vision Care for Adults

POLICY 

Authority OW Act: Sec. 8 and 74(4) & OW Directives: Dir. 7.2 

Adults may receive assistance with Vision Care under Discretionary Benefits. Coverage is provided for the purchase and repair of lenses and frames. 

An agreement exists between our Board and the Opticians in the area to provide eye care to those participants/recipients who qualify. 

• may be provided every three years; 
• exceptions can be made anytime there is a significant change in prescription; 
• may receive replacement lenses and/or frames as needed, should they become lost or damaged. Where abuse is suspected, the Case Manager will review the case and discuss further action with a supervisor; 
• the actual cost of lenses and dispensing fee will be covered where they are medically necessary. An estimate of the cost will be required, preferably two where reasonably possible. 
• the beneficiary may choose more expensive lenses (tints, photo gray, progressive bifocals, etc.) but they will be required to pay the additional cost for the lenses and any additional dispensing fee; 
• frames are provided up to a maximum amount; however, the beneficiary may choose more expensive frames and pay the difference; 
• where special frames or lenses are required, the amount may be paid with appropriate documentation from the prescribing ophthalmologist, optometrist or general practitioner; 
• the purchase of contact lenses may be approved if they are a medical necessity. A written rationale along with the prescription must be submitted for approval; 
• if tints or photo gray are a medical necessity, they may be authorized when medical verification is received.
   

PROCEDURE

1. Participant requests prior approval by submitting their prescription with estimate for eye glasses to Integrated Program Assistant. 

2. Integrated Program Assistant reviews need and documents the request and the cost in the Social Assistance Computer System Notes. 

3. Integrated Program Assistant will complete the vision care form.

1. It is on this form that the Integrated Program Assistant will list the item requested and why it is needed.
2. The Integrated Program Assistant will also copy this information into the Social Assistance Computer System notes.
3. The Integrated Program Assistant will forward the completed vision care form for approval to the Supervisor. The Supervisor will note in the Social Assistance Computer System the item was approved or denied.
4. Once approved the request will be forwarded to the Integrated Program Assistant.

4. The vision care form will be completed as per approval. Maximum amount for frames $75.

5. Participant presents original copy of authorization to optician upon purchase of the glasses. 

6. Optician invoices the Manitoulin-Sudbury DSB, attaching the authorization form. 

7. Upon receipt of the invoice the Integrated Program Assistant will: 

• Request the benefit / payment via the payment tab in the Social Assistance Computer System. The payment will be requested in the Vendor’s name. 
• Enter a notation in the Social Assistance Computer System that the cheque was issued to_____ and for______ in the amount of ________. 
• The Supervisor will release the cheque via daily pay list reviews.