ROYAL CANADIAN MOUNTED POLICE PAGE 1 PRINT DATE: SEPTEMBER 12, 2018 BENEFIT GRID
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1 ************************************************************************************************************************************************************************************************* * CUSTOMER...RCMP/GRC * PROVINCE...ON * POC...12 * LANGUAGE...E *************************************************************************************************************************************************************************************************
2 ROYAL CANADIAN MOUNTED POLICE PAGE 1 ACUPUNCTURE SERVICES MD $ /CY SEE NOTES 1 AND 2 ACUPUNCTURE TREATMENTS MD YES Y SEE NOTES 2,3,4 AND 14 CHIROPRACTIC SERVICES $ /CY SEE NOTES 1 AND 3 CHIROPRACTOR VISIT YES Y OCCUPATIONAL HEALTH CARE COUNSELLING SERVICES - NON PSYCHOLOGIST YES Y SEE NOTE 10 DESIGNATED CHIROPRACTOR ASSESSMENT YES Y SEE NOTE 9 EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT) PROVIDED MD YES Y SEE NOTE 7 BY A PHYSIOTHERAPIST EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT) PROVIDED MD YES Y SEE NOTE 7 BY A PODIATRIST FORM COMPLETION BY TREATING CHIROPRACTOR
3 ROYAL CANADIAN MOUNTED POLICE PAGE 2 MASSAGE THERAPIST - VISIT MD YES Y OCCUPATIONAL HEALTH CARE 1 VISIT = 1/2 HOUR MASSAGE THERAPY SERVICES MD $ /CY SEE NOTE 1 NATUROPATHY - CONSULTATION AND ASSESSMENT MD $ / CY NATUROPATHY - CONSULTATION AND ASSESSMENT MD YES Y OCCUPATIONAL HEALTH CARE OCCUPATIONAL THERAPIST - VISIT MD YES Y OCCUPATIONAL THERAPIST - VISIT MD YES Y OCCUPATIONAL HEALTH CARE OSTEOPATHY MD $ /CY SEE NOTE 6 OSTEOPATHY MD YES Y SEE NOTE 6 OCCUPATIONAL HEALTH CARE PHYSIOTHERAPIST MD YES Y OCCUPATIONAL HEATH CARE
4 ROYAL CANADIAN MOUNTED POLICE PAGE 3 PHYSIOTHERAPIST SERVICES $ /CY SEE NOTES 1, 3 AND 4 PODIATRIST / CHIROPODIST MD YES Y OCCUPATIONAL HEALTH CARE PODIATRIST/CHIROPODIST - VISIT MD $ /CY SEE NOTE 5 PSYCHOLOGIST - EMPLOYER MANDATED ASSESSMENT YES Y OCCUPATIONAL HEALTH CARE PSYCHOLOGIST ASSESSMENT - HIGH RISK/SPECIAL YES Y OCCUPATIONAL HEALTH CARE ASSIGNMENT GROUPS PSYCHOLOGIST FEES FOR REPORT/QUESTIONNAIRE YES Y PSYCHOLOGIST VISIT- COUPLE OR FAMILY COUNSELLING HOURS / 1 $55.00/ 15 MINUTES SEE NOTE 8 CY PSYCHOLOGIST VISIT- COUPLE OR FAMILY COUNSELLING YES $55.00 / 15 MINUTES Y OCCUPATIONAL HEALTH CARE 1 OCCURRENCE = 15 MINUTES PSYCHOLOGIST VISIT- PERSONAL OR GROUP COUNSELLING HOURS / 1 $55.00 / 15 MINUTES SEE NOTE 8 CY
5 ROYAL CANADIAN MOUNTED POLICE PAGE 4 PSYCHOLOGIST VISIT- PERSONAL OR GROUP COUNSELLING YES $55.00 / 15 MINUTES Y OCCUPATIONAL HEALTH CARE 1 OCCURRENCE = 15 MINUTES RELATED HEALTH SERVICES MD YES Y SEE NOTE 12 SPECIAL ENTITLEMENTS AUTHORIZED BY THE DG OR OHSB YES Y SEE NOTE 11 - OHC SPECIAL ENTITLEMENTS AUTHORIZED BY THE DG OR OHSB YES Y SEE NOTE 11 - SHC SPEECH LANGUAGE PATHOLOGIST MD YES Y OCCUPATIONAL HEALTH CARE SPEECH LANGUAGE PATHOLOGIST - VISIT MD $ /CY TAXES - GST/HST (GST/HST REGISTRATION NUMBER 0GST REQUIRED) TAXES - GST/HST (GST/HST REGISTRATION NUMBER 0TPS REQUIRED) VAC DISABILITY PENSION APPLICATION YES Y SEE NOTE 13 ASSESSMENT/REASSESSMENT
6 ROYAL CANADIAN MOUNTED POLICE PAGE 5 VIDEO GATE ANALYSIS PH,OS YES 1/12 CM Y OCCUPATIONAL HEALTH CARE WEIGHT MANAGEMENT PROVIDED BY A QUALIFIED MEDICAL YES Y OCCUPATIONAL HEALTH CARE PROFESSIONAL SEE NOTE 15
7 ROYAL CANADIAN MOUNTED POLICE PAGE 6 - GENERAL NOTES - - COMMAS APPEARING IN THE "PRESCRIBER REQUIRED" COLUMNS INDICATE OR, (EG. "MD", "RN", MEANS "MD" OR "RN"). - - IF THE BENEFIT GRID SPECIFIES A SPECIALIST, ONLY THAT SPECIALIST IS ACCEPTED. SHOULD "MD" BE INDICATED, THE SERVICE MAY BE PRESCRIBED BY A GENERAL PRACTITIONER OR ANY MEDICAL SPECIALIST. - - REGISTERED ACUPUNCTURIST ARE ONLY AVAILABLE IN QUEBEC, BRITISH COLUMBIA, ALBERTA, ONTARIO, AND NEWFOUNDLAND AND LABRADOR. - SPECIAL NOTES: - NOTE A COMBINED MAXIMUM ALLOWANCE OF $4,800 PER CALENDAR YEAR FOR THE SERVICES OF AN ACUPUNCTURIST, CHIROPRACTOR, MASSAGE THERAPIST, AND PHYSIOTHERAPIST. - SPECIAL NOTE: - NOTE ACUPUNTURE SERVICES MAY BE PERFORMED BY A LICENSED PHYSIOTHERAPIST, A MEDICAL DOCTOR, A LICENSED NURSE, A LICENSED CHIROPRACTOR, OR AN ACUPUNCTURIST, WHERE THE PROFESSION IS PROVINCIALLY REGULATED AND THE PROVIDER IS REGISTERED WITH THE APPROPRIATE LICENSING BODY. - SPECIAL NOTE: - NOTE 003 -CHIROPRACTOR AND PHYSIOTHERAPY FEES FOR INITIAL ASSESSMENT, X-RAYS AND VISITS ARE INCLUDED IN COMBINED MAXIMUM ALLOWANCE OF $ SPECIAL NOTE: - NOTE PHYSIOTHERAPY SERVICES INCLUDE INITIAL ASSESSEMENT AND TREATMENT. - SPECIAL NOTE: - NOTE COSTS RELATED TO X-RAYS BY A PODIATRIST/CHIROPODIST ARE INCLUSIVE OF $1,200 CY ALLOWANCE AND ARE TO BE CHARGED TO SPECIAL NOTE: - NOTE 006 -REGISTERED OSTEOPATH THAT ARE ONLY AVAILABLE IN ONTARIO AND QUEBEC. ALL OTHER OSTEOPATH MUST BE AN OSTEOPATH DOCTOR (DO) AND REGISTERED WITH THE PROVINCIAL COLLEGE OF PHYSICIAN AND SURGEONS. - SPECIAL NOTE: - NOTE 007- OCCUPATIONAL HEALTH CARE - ESWT IS COVERED FOR PLANTAR FASCIITIS AND SHOULDER TENDONITIS WHEN PHYSIOTHERAPY AND CHIROPRACTIC TREATMENTS WERE TRIED AND SHOWN TO BE INEFFECTIVE. - SPECIAL NOTE: - NOTE PRE-AUTHORIZATION REQUIRED FOR ADDITIONAL 7 TO 12 HOURS. 1 OCCURRENCE = 15 MINUTES - SPECIAL NOTE: - NOTE ONLY FOR ASSESSMENTS PROVIDED BY DESIGNATED CHIROPRACTORS. OCCUPATIONAL HEALTH CARE - SPECIAL NOTE: - NOTE SERVICES MUST BE PRE-APPROVED BY RCMP DIVISIONAL PSYCHOLOGIST OR IN THE ABSENCE OF THE DIVISIONAL PSYCHOLOGIST, THE HSO. - SPECIAL NOTE: - NOTE FOR INTERNAL RCMP USE ONLY. -MANDATORY DESCRIPTION TO BE ENTERED BY THE OHSS OFFICE IN THE 'CLAIM MANAGEMENT- AUTHORIZATION COMMENTS' BOX WITHIN NPS. -PRE-AUTH AS PER CURRENT POLICY. - SPECIAL NOTE: - NOTE FOR INTERNAL RCMP USE ONLY. -MANDATORY DESCRIPTION TO BE ENTERED BY THE OHSS OFFICE IN THE 'CLAIM MANAGEMENT- AUTHORIZATION COMMENTS' BOX WITHIN NPS. -PRE-AUTH AS PER CURRENT POLICY. - OCCUPATIONAL HEALTH CARE. - SPECIAL NOTE: - NOTE PRE-AUTH AS PER CURRENT POLICY. FOR ACTIVE MEMBERS ONLY. - SPECIAL NOTE: - NOTE ON TREATMENTS PERFORMED BY PRACTITIONERS. OCCUPATIONAL HEALTH CARE - SPECIAL NOTE: - NOTE PROGRAM MUST INCLUDE DIET AND MUST BE ADMINISTERED BY A QUALIFIED MEDICAL PROFESSIONAL, E.G.: PHYSICIAN, NURSE,
8 ROYAL CANADIAN MOUNTED POLICE PAGE 7 PSYCHOLOGIST OR REGISTERED DIETICIAN.
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COMPLETION OF MEDICAL CERTIFICATE 2135 - OHC 249105 01-Feb-15 N CORRECTIVE LASER EYE SURGERY BY AN OPHTHALMOLOGIST (OHC) 299999 01-Jun-11 MD, O YES Y EMPLOYER MAND ASSESSMENT - EMOTIONAL HEALTH PROVIDED
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