VETERANS AFFAIRS CANADA PAGE 1 PRINT DATE: SEPTEMBER 10, 2018 BENEFIT GRID
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1 ************************************************************************************************************************************************************************************************* * CUSTOMER...VAC/ACC * PROVINCE...PQ * POC...09 * LANGUAGE...E *************************************************************************************************************************************************************************************************
2 VETERANS AFFAIRS CANADA PAGE 1 BI-LEVEL POSITIVE AIRWAY PRESSURE (BI-PAP) IM,RP,ES,N RT FNS FNS 1/12 CM Y SEE NOTES 7 AND 12 BREATHING DEVICE - BI-LEVEL POSITIVE AIRWAY PRESSURE (BI-PAP) IM,RP,ES,N RT FNS FNS 4/4 CM Y SEE NOTE 7 BREATHING DEVICE - BI-PAP MASK MD,RT,NP DO,MAC DO,MAC 1/12CM SEE NOTES 1, 10 AND 13 CONTINUOUS POSITIVE PRESSURE BREATHING DEVICE IM,RP,ES,N RT FNS FNS 1/CY $ Y SEE NOTES 7 AND 12 (E.G. CPAP - CONTINUOUS POSITIVE AIRWAY PRESSURE) - CONTINUOUS POSITIVE PRESSURE BREATHING DEVICE IM,RP,ES,N RT FNS FNS 4/4 CM Y SEE NOTE 7 (E.G. CPAP - CONTINUOUS POSITIVE AIRWAY PRESSURE) - CPAP AND BI-PAP SUPPLIES - MINOR (E.G., TUBING, MD,RT,NP FNS,MAC FNS,MAC 12/12 CM SEE NOTES 1,10,11 AND 13 FILTERS, CANNULAS, ETC.) CPAP MASK MD,RT,NP DO,MAC DO,MAC 1/6CM SEE NOTES 1, 10 AND 13 HOME OXYGEN EQUIPMENT - LIQUID OXYGEN SYSTEM MD,NP RT FNS FNS Y HOME OXYGEN EQUIPMENT - LIQUID OXYGEN SYSTEM MD,NP RT FNS FNS 4/4 CM Y
3 VETERANS AFFAIRS CANADA PAGE 2 HOME OXYGEN EQUIPMENT - OXYGEN CONCENTRATOR MD,NP RT FNS FNS 1/5 CY Y HOME OXYGEN EQUIPMENT - OXYGEN CONCENTRATOR MD,NP RT FNS FNS 4/4 CM Y HOME OXYGEN EQUIPMENT - HOME FILL MODEL MD,NP RT FNS FNS 1/60 CM Y HOME OXYGEN EQUIPMENT - HOME FILL MODEL MD,NP RT FNS FNS 4/4 CM Y HOME OXYGEN EQUIPMENT - OXYGEN CYLINDER SYSTEM MD,NP RT FNS FNS 1/5 CY Y HOME OXYGEN EQUIPMENT - OXYGEN CYLINDER SYSTEM MD,NP RT FNS FNS 4/4 CM Y OXYGEN - OTHER ESSENTIAL OXYGEN BENEFITS MD,NP RT FNS FNS $ Y OXYGEN - OTHER ESSENTIAL OXYGEN BENEFITS MD,NP RT FNS FNS 4/4 CM Y OXYGEN REFILL - GAS FNS FNS Y SEE NOTE 6
4 VETERANS AFFAIRS CANADA PAGE 3 OXYGEN REFILL - LIQUID FNS FNS Y SEE NOTE 6 OXYGEN STORAGE UNIT FNS FNS 1 PER $ LIFETIME OXYGEN SUPPLIES - MINOR - (EG, TUBING, MASKS, MD,RT,NP FNS,MAC FNS,MAC SEE NOTES 1,4,8,10 AND 13 FILTERS, CANNULAS, DISTILLED OR SALINE SOLUTION, ETC) PORTABLE OXYGEN UNITS - OXYGEN CONSERVER (E.G MD,NP RT FNS FNS $ Y OXYLITE) - PORTABLE OXYGEN UNITS - OXYGEN CONSERVER (E.G MD,NP RT FNS FNS 4/4 CM Y OXYLITE) - PORTABLE OXYGEN UNITS - PORTABLE CYLINDER MD,NP RT FNS FNS 1/5 CY Y PORTABLE OXYGEN UNITS - PORTABLE CYLINDER MD,NP RT FNS FNS 4/4 CM Y PROVINCIAL SALES TAX (PST) 0PST REPAIRS, MAINTENANCE AND SERVICE AGREEMENT FOR FNS,MAC FNS,MAC $300/CY Y RESPIRATORY EQUIPMENT
5 VETERANS AFFAIRS CANADA PAGE 4 SHIPPING AND DELIVERY CHARGES MAC,FNS MAC,FNS SEE NOTE 5 TAXES - GST/HST (GST/HST REGISTRATION NUMBER 0GST REQUIRED)
6 VETERANS AFFAIRS CANADA PAGE 5 - GENERAL NOTES - PRE-AUTHORIZATION NOT REQUIRED FOR REPLACEMENT ISSUE UNLESS OTHERWISE INDICATED. - IF THE BENEFIT GRID SPECIFIES A SPECIALIST, ONLY THAT SPECIALIST IS ACCEPTED. SHOULD "MD" BE INDICATED, THE SERVICE MAY BE PRESCRIBED/RECOMMENDED BY A GENERAL PRACTITIONER OR ANY MEDICAL SPECIALIST. - DISTILLED WATER/SALINE SOLUTION CAN ALSO BE PROVIDED IF THE GROUP AREA OF THE TAPS IDENTIFICATION CARD HAS AN "A" OR "B" POC COMMAS APPEARING IN THE "PRESCRIBER REQUIRED" AND "RECOMMENDER REQUIRED" COLUMNS INDICATE OR, EG. "MD", "RN" MEANS "MD" OR "RN". - SPECIAL NOTES - NOTE 1 - PRESCRIBER NOT REQUIRED FOR REPLACEMENT ISSUE. - NOTE 4 - THIS WILL BE APPROVED AT TIME OF APPROVAL OF EQUIPMENT AND THE AMOUNT APPROVED WILL BE FOR A ONE-YEAR SUPPLY. - NOTE 5 - FNSO WILL APPROVE SHIPPING AND DELIVERY AT THE TIME OF APPROVAL OF BENEFIT. - NOTE 6 - FNSO WILL APPROVE A ONE-YEAR SUPPLY AT THE TIME OF APPROVAL OF BENEFIT. NO ADDITIONAL REFILLS WILL BE PAID WITHOUT FNSO APPROVAL. - NOTE 7- IN CERTAIN CIRCUMSTANCES, GENERAL INTERNIST WITH SPECIALIZED KNOWLEDGE IN SLEEP MEDICINE MAYA BE ACCEPTED - NOTE 8 - THIS CODE IS NOT TO BE USED FOR CPAP AND BIPAP SUPPLIES - MINOR. - NOTE 10 - PRESCRIBER NOT REQUIRED FOR INITIAL ISSUANCE WHEN PRESCRIBER REQUIREMENT IS MET FOR PRIMARY EQUIPMENT. - NOTE 11 - THIS CODE IS NOT TO BE USED FOR CPAP AND BI-PAP MASKS. - NOTE 12 - MD OR NP PRESCRIBER IS ACCEPTED FOR REPLACEMENT ISSUE. - NOTE 13 - MAC MAY PRE-AUTHORIZE WHEN DNO HAS ALREADY PRE-AUTHORIZED THE PRIMARY EQUIPMENT. SUPPLIERS ARE ASKED TO CONTACT THE TAC TOLL FREE LINE (ENGLISH) / (FRENCH) OR BY FAX AT FOR AUTHORIZATION OF REPLACEMENT MASKS AND SUPPLIES.
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