Optometric Services Insurance Regulation

Optometric Services Insurance Regulation, M.R. 50/93 The Health Services Insurance Act , C.C.S.M. c. H35 Regulation 50/93 Registered March 19, 1993 bilingual version (HTML) Table of Contents Section 1 Definitions 2 Eye examination tests 2.1 Act applies to optometric services 3 Insured optometric services 4 Benefits 4.1 Northern fee differential 4.2 Rural fee differential 5 Payment conditional on receipt or account 6 Payment for a dependant 7 Coming into force Definitions 1 In this regulation, "benefit period" means the period of 24 months that begins on January 1, 1993 and includes each subsequent 24 month period; (« période de prestation ») "family registrant" means a person who has registered with the minister in his or her own name and on behalf of one or more of his or her resident dependants; (« chef de famille ») "northern Manitoba" means that part of Manitoba north of the 53rd parallel of latitude; (« Nord ») " rural Manitoba" means that part of Manitoba south of the 53rd parallel of latitude, excluding the City of Winnipeg. (« régions rurales ») M.R. 42/2010 ; 49/2026 Eye examination tests 2 In this regulation, "eye examination" includes the following tests when necessary: (a) case history, with occupational vision evaluation; (b) visual acuity testing — distance and near; (c) ophthalmoscopy and external eye health evaluation; (d) ocular motility testing: (versions, rotations, near point convergence and cover tests); (e) neurological integrity: (direct, consensual and accommodative pupillary reflexes); (f) refraction at far point (i) static retinoscopy, or (ii) subjective refraction, or both; (g) refraction at near point (i) dynamic retinoscopy, or (ii) subjective refraction, or both; (h) phorometric tests of accommodation, convergence and binocular co-ordination at far and near point; (i) ophthalmometry or keratometry; (j) confrontation of fields; (k) color vision screening; (l) depth perception; including a prescription which shall be issued to the insured person by the optometrist at the time of examination. Act applies to optometric services 2.1 For the purpose of section 71 of the Act, the Act applies to the optometric services described in section 3 when provided by a person lawfully entitled to provide them. M.R. 242/94 Insured optometric services 3 The following are insured optometric services: (a) for insured persons who are under 19 years of age or are 65 years of age or older, a complete eye examination, including refraction and other necessary tests when required, if another complete eye examination including refraction has not been provided to the insured person within the same benefit period. This service includes a written prescription which shall be issued to the insured person by the optometrist at the time of the examination; (b) for insured persons of any age, a complete eye examination, including refraction and other necessary tests when required, regardless of the period since a previous eye examination was provided, when the examination is required for a medical reason approved by the minister; (c) for insured persons of any age, a partial eye examination, regardless of the period since a previous partial eye examination was provided, when the examination is required for a medical reason approved by the minister; (d) for insured persons of any age, a full threshold visual field test, regardless of the period since a previous full threshold visual field test was provided, when the test is required for a medical reason approved by the minister and is performed using a Humphrey, Medmont, Octopus, Synemed or Dicon visual field analyzer; (e) for insured persons who are under 19 years of age or are 65 years of age or older, a tonometry examination, if another tonometry examination has not been provided to the insured person within the same benefit period; (f) for insured persons of any age, a tonometry examination, regardless of the period since a previous tonometry examination was provided, when the examination is required for a medical reason approved by the minister; (g) for insured persons who are under 19 years of age or are 65 years of age or older, a dilated fundus examination, if another dilated fundus examination has not been provided to the insured person within the same benefit period; (h) for insured persons of any age, a dilated fundus examination, regardless of the period since a previous dilated fundus examination was provided, when the examination is required for a medical reason approved by the minister. M.R. 242/94; 73/96; 42/2010 Benefits 4(1) Subject to sections 4.1 and 4.2, the amount of the benefit to be paid in respect of the cost of insured optometric services is as follows: (a) Tariff 8545 — complete eye examination, (i) from April 1, 2019 to March 31, 2020 Benefits for multiple services 4(2) For greater certainty, benefits for insured optometric services set out in clauses 3(d) to (h) are payable in addition to benefits for services set out in clauses 3(a) to (c), whether or not the services referred to in clauses 3(d) to (h) are provided in conjunction with services set out in clauses 3(a) to (c). M.R. 63/2003 ; 61/2006 ; 42/2010 ; 174/2015 ; 49/2026 Northern fee differential 4.1 The amount of the benefit to be paid in respect of the cost of insured optometric services provided on or after April 1, 2019 in northern Manitoba is the amount set out in section 4 plus an additional percentage of that amount determined as follows: (a) 10% from April 1, 2019 to March 31, 2025; (b) 15% from April 1, 2025 to March 31, 2026; (c) 20% on or after April 1, 2026. M.R. 42/2010 ; 49/2026 Rural fee differential 4.2 The amount of the benefit to be paid in respect of the cost of insured optometric services provided on or after November 1, 2025 in rural Manitoba is the amount set out in section 4 plus 5% of that amount. M.R. 49/2026 Payment conditional on receipt or account 5(1) It is a condition of payment for insured optometric services provided outside of Manitoba that within six months from the date upon which the services were provided the insured person submit to the minister an itemized receipt or account that shows the services provided and the fees paid or payable. 5(2) The minister may extend the time referred to in subsection (1) if in the minister's opinion there are extenuating circumstances that prevented the filing of the claim within the six month period. 5(3) Rather than making payment directly to an insured person for insured optometric services provided outside Manitoba, the minister may pay the person who provided the services if the insured person has not paid the fees for the services provided. Payment for a dependant 6 Where an insured person is a dependant who is entitled to payment under this regulation, payment may be made to the family registrant. Coming into force 7(1) This regulation, except section 4, comes into force on March 31, 1993. 7(2) Section 4 is deemed to have come into force on April 1, 1992.