CAF Member - Non-DoD Position
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Your Coverage & Access
What You DO Have Access To:
- CAF Spectrum of Care through civilian providers as primary coverage (with pre-authorization)
- CAFMLO medical guidance and oversight
- Full reimbursement for authorized medical services
- Full CAF medical administration support
- Claims processed through CF H Svcs Det Washington
- Medical advances available for major procedures
- Blue Cross emergency coverage worldwide
What You DON'T Have Access To:- Military Treatment Facilities (MTFs)
- TRICARE benefits
- On-base medical clinics
- Direct DoD healthcare coverage
- Military pharmacy services
- DEERS registration or military ID cards
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Accessing Healthcare - Step-by-Step Process
1. Identify your Healthcare Need
- Routine check-ups (PHAs, specialist follow-ups)
- Symptomatic care requiring medical attention
- Prescription medications
- Preventive care
2. Contact CAFMLO for Authorization- Include: Nature of medical need, type of provider required, urgency, current location
- For specialist care: You can find your own specialist utilizing the TRICARE Network Provider search tool for your region, while you do not have TRICARE, these providers do understand the military context more than others.
- Request cost estimate from provider and include in authorization request
- Response time: Within 1 business day
- If urgent and no response: Seek care and notify CAFMLO immediately
3. Recieve Written Authorization
CAFMLO will provide email authorization outlining:- What care/services are covered under CAF Spectrum of Care
- Specific scope and limits (e.g., "10 sessions of physiotherapy")
- Any restrictions or conditions
- Coverage limits (if applicable)
- Save this email - required for reimbursement
4. Seek care from the civilian provider
While you are there inform them that you are self-pay and that you need a copy of your medical records from the visit.- Inform provider you are "self-pay" and uninsured, this often reduces costs. If the provider requires certification that you can pay a letter can be provided by the CFMLO.
- Request copies of all medical reports and clinical notes
- Obtain a detailed invoices showing services provided
- Keep all receipts and proof of payment.
5. Submit Medical Records- Send all clinical notes to the Medical Records Clerk at CF H Svcs Det Washington
- The CFMLO will review the notes and ensure they are entered into CFHIS for continuity of care.
6. Submit Reimbursement Claim -
Claims & Reimbursement Process
- Pay out-of-pocket for authorized care
- Collect detailed receipts with provider information and diagnostic codes
- Submit claims to CDLS(W) with authorization email and receipts
- Processing time: Typically 2-4 weeks
Required Documentation:
- Original CAFMLO authorization email
- Detailed medical receipts
- Proof of payment
- Medical reports (if applicable)
- CF52 claim form
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Prescription Medications
1. Pre-Posting Preparation:
- Whenever possible, request 6 months of current medications when posted from your CFHS Pharmacy - If unable to bring sufficient supply, contact Medical Coordinator immediately: Kevin.Ramkishore@forces.gc.ca **
2. Process for Prescriptions:- Contact CFMLO, indicating prescriptions that are required to be filled. Please indicate any new prescriptions so that verification of coverage can be completed. CFMLO will send back authorization for prescription and duration, typically authorized for 1 year for chronic medications.
- Get a prescription from an authorized civilian provider
- Fill prescription at civilian pharmacy as "self-pay"
- Submit reimbursement claim with authorization
3. Over-the-Counter Medications:- Require specific CAFMLO approval before purchase
- Must be related to an authorized medical condition
- Will not be reimbursed without prior authorization
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Dental Care
- If it is a dental emergency (extreme pain, cannot eat, etc.) present to dental and notify the Medical Coordinator as soon as able.
- CF H Svcs Det Washington can approve routine cleaning and annual check-up.
- Any other dental work requires approval from the OUTCAN Dental Officer at CMP.DENTAL.OUTCAN@forces.gc.ca, once approved care is reimbursed through CF H Svcs Det Washington
- Keep dental records for submission to next Canadian dental unit
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Optometry Services
CAF members are generally only eligible to purchase eyewear every 2 years - any purchase made prior will not be reimbursable.
Procedure
- Log on to your Blue Cross Portal (www.medavie.bluecross.ca/myinfo) to determine when your last eyewear purchase was. You must purchase your new eyewear after 2 years has passed from the date listed in your portal.
- Contact the CFMLO for approval to purchase eyewear. Once approval is provided, you can purchase eyewear as per the approved amounts. Generally, there is no entitlement to purchase contact lenses.
- Submit claim (consisting of CFMLO approval, invoice, receipts and CF52 claim form) to the HS Med Admin inbox: CDLSW-MedicalAdmin-ELFCW-AdminMedical@forces.gc.ca.
Important
- Pers requesting any eyewear (i.e., regular glasses, sunglasses, BEW inserts, etc.) should read CF H Svcs Gp Instruction 4020-05 Optical Services first, and then follow up with the CFMLO.
- The entitlement is for 2-years despite lost/broken eyewear OR change in prescription. Only eligible eyewear will be reimbursed (as per ref).
- You are entitle to a max reimbursement of $600 CAD - members will be out of pocket for expenses beyond their entitlement.
- Members with access to an MTF shall use MTF optical services for eye exams. Members requiring civilian resources for optometry exams need justification and authorization from the CFMLO (or Tricare) prior to using civilian optical services.
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Important Information to Know
1. CAF Spectrum of Care
- The CAF Spectrum of Care defines what medical and dental services, treatments, and items will be provided at public expense to CAF members who demonstrate clinical requirement. Coverage is not like traditional insurance - you receive specific authorization for specific care based on clinical need. Read more about CAF Medical and Dental Benefits Information.
- This care is "Authorization-Based Coverage" - You will be approved for specific treatments (e.g., "10 sessions of physiotherapy") - If additional care is required beyond your authorization, you must request additional approval
- Coverage is based on clinical necessity and evidence-based medicine
2. What's NOT Covered:- Care outside CAF Spectrum of Care (unless using spouse's insurance)
- Experimental or investigational treatments
- Care while on unauthorized leave
- Cosmetic procedures (unless medically necessary)
- Concierge medicine services (boutique or premium healthcare services)
3. Financial Considerations- Coverage limited to reasonable and customary rates
- CAFMLO will advise on any specific financial limits during authorization
- Some specialized treatments may require additional approval for costs
4. Advances- Healthcare in the US is expensive, as you receive estimates or are planning care we can issue advances for any combined amount over $400 to help reduce individual financial burden while awaiting claims and reimbursement.
- The process for requesting an advance is found here.
Medical Administration Guide
This outlines the processes for medical administration that is required by all CAF members posted OUTCAN to the United States regardless of position.
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Annual Medical Readiness Verification - An Overview
Non-Aircrew or Aircrew in non-flying/controlling positions
What is the Annual Medical Readiness Verification?
- This is a required process as part of your APRV and is being used to replace the old PHA system. This will enable more frequent and easier medical updates along with ensuring that appropriate medical care and screening is being done for CAF Members across the United States.
- It will involve the complete of a Annual Medical Readiness Verification (AMRV) form and a Personal Health Questionnaire (DND-4943) to be submitted along with your medical records that have not been submitted for that year.
- The process for this readiness verification is:
- Collect all U.S. medical records for submission.
- Complete the AMRV and DND 4943 forms, available in the form repository.
- Submit the medical records, questionnaire, and AMRV to medical records for review.
What happens after submission?
- CFMLO reviews all your medical records from the past year to:
- Assess your current health status
- Identify ongoing health issues needing additional care
- Determine preventive care needs
- Apply work limitations if needed (called MELs)
- Update your medical category if needed
- Contact the member to coplete the review
- Medical coordinator will sign off the medical section of the APRV once submitted.
Annual Aircrew Medical Submission
Active aircrew (those who are in flying or controlling positions) are usually familiar with timelines for Type 1 or Type 2 aircrew medicals, the details of which are outlined in AMA Directive 100-01 Medical Standards for CAF Aircrew. However, aircrew posted to the USA for greater than 2 years in non-flying/non-controlling positions can waive aircrew medicals and revert to a Non-Aircrew PHA (see above). All aircrew were required to have a valid Type 1 Aircrew Medical Exam prior to departure from Canada.
Aircrew who are actively flying or in controlling positions
While US Flight Med clinicians clear CAF members to fly/control according to US policies (usually through issuance of a DD2992 Medical Recommendation for Flying form), Aircrew PHAs must also be conducted in order to maintain a valid medical category, with particular attention to the Air Factor. This Air Factor can be maintained on the timeline of their DD2992 Medical Recommendation for Flying form. When scheduling your Aircrew medical, it is important to follow these steps:- Aircrew should request specific examinations based on the Period of Validity found in the table below; if there are questions on what is required, aircrew can reach out to the CAFMLO for clarification on specific exam requirements.
- Once you know what examinations are required, contact your clinic to schedule a complete medical (head-to-toe exam), vision testing (must have numbers, ie 20/20, indicating visual acuity), audiogram (must have frequencies and decibels), and any investigations the CAFMLO indicated you require.
- Aircrew are to complete the DND2452 and DND2552 medical questionnaires, available in the Forms Repository
- After all appointments are complete, send the clinical notes, DND 2452, and DND2552 to the Medical Records Clerk or CAFMLO (encrypted via email, via DoD Safe, or fax) in order to have your medical category updated.
The USAF may complete a DD 2992 form at this medical. Submissions consisting solely of DD 2992s are not sufficient. The CAFMLO does not require the 2992 form.
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What You Must Report to CAFMLO
New Medical Diagnosis
- New chronic health diagnosis (i.e. hypertension, diabetes, high cholesterol)
- New physical health diagnosis (i.e. degenerative disc, chronic low back pain, major muscle or joint issue like ACL, hip arthritis)
- New mental health diagnosis (i.e. depression, anxiety, PTSD, substance use disorders)
- New long-term medication or medication change.
- Non self-limiting conditions (i.e not viral illnesses)
Injuries & Physical Issues
- Any injury taking more than 2 weeks to heal
- Any discussion about surgery (even future surgery)
- Service-related injuries (including PT injuries)
- Cannot perform any part of your job due to illness/injury
Medical Tests & Procedures
- Blood work and laboratory tests
- X-rays, CT scans, MRIs
- Colonoscopy or other screenings
- Any diagnostic imaging studies
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Medical Screening for Cross-Posting or Extension
There are three different screening scenarios for members that are OUTCAN USA. Each scenario has different requirements and steps, but all of them will engage the CF H Svcs HQ Det Washington team. Your orderly room will initiate the DND 4064 OUTCAN Posting Screening Checklist.
Initial steps that are required for all screenings:- Review and submit your Annual Medical Readiness Verification along with all US Health Records and a copy of your screening message.
- Complete an Annex B Form
- Complete the DND 4342 parts 1 and 2 for each dependant*
- *For cross-posting to Rest of World, Part 3 needs to be signed by their regular clinician.
- Send the AMRV, health records, Annex B form, and copy of screening message to Natalia Pela to create your screening file.
- Screening for an extension or cross-posting in same geographic location:
- CFMLO is the approving authority.
- SW Screen may be required based upon review by CFMLO.
- Phase 1 Part 8 form to be signed off by Med Records Clerk.
- Phase 2 to be signed off by CFMLO upon completion of screening.
- Screening for a cross-posting within the USA
- CFMLO is the approving authority.
- SW Screen will be required and scheduled by Med Records Clerk.
- Phase 1 Part 7 form to be signed off by CFHS Social Worker who completes the screening.
- Phase 1 Part 8 form to be signed off by Med Records Clerk.
- Phase 2 form to be signed off by CFMLO upon completion of screening.
- Screening for a cross-posting to a different country.
- All steps in the OUTCAN screening process are required, including Dental Screen (to be completed locally) and immunization screen (to be scheduled by Med Records Clerk).
- SW Screen will be required and scheduled by Med Records Clerk.
- DND 4342 Forms need to be completed and signed Part 3 by local clinician.
- CFMLO will be a reviewing clinician, D Med Pol is the final authority.
• • Note: all screenings require complete submission of US Medical Records for the member, along with either Aircrew Medical if actively flying or Annual Medical Readiness Verification submission. All forms are available in the Forms Repository. -
Medical Employment Limitations (MELs)
When MELs Are Applied
CAFMLO applies work limitations when you:- Have medical conditions affecting job performance
- Need accommodations or restrictions
- Require modified duties during recovery
MEL Process:
- CAFMLO Assessment - Reviews medical information submitted via clinical notes and discussion with the member. MELs provided by US Clinicians should be honored pending review by CFMLO.
- Limited Applied - Specific work restrictions documented and sent to the member along with uploaded into MonitorMass.
- Chain of Command Notified - Member notifies Chain of Command of MELs, if there are any questions for guidance Chain of Command can reach out to CFMLO.
- Regular Review - MELs reviewed and updated as needed
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Submitting Medical Records
Clinical notes generated from US medical providers, whether DoD or civilian, must be provided to the Medical Records Clerk for upload into CFHIS. There is a duty to report all medical care outside of Canadian Forces Health Services clinics.
Due to medical privacy laws here, the CF H Svcs HQ Det Washington team cannot request these records from the US; they need to be released by the member.
It is important to keep your medical file as up to date as possible to ensure that you are fit for your duties, to enable guidance on medical conditions, to enable potential future benefits reviews if service-related conditions arise, and to allow for effective transfer of care when posted back to Canada.
Clinical notes contain the actual assessment and diagnosis as provided by your clinician, not just the discharge instructions, medical employment limitations, or fitness to fly chits.- To submit your clinical notes, you can:
- Send an email to Med Records Clerk at Natalia.Pela@forces.gc.ca. This should ideally be encrypted but all unsecured medical information is secured immediately upon receipt.
- Have the records sent by Fax to 1-202-448-6438
- Arrange a DoD Safe link of your medical file for Medical Records at the MTF.
- Mail: CF H Svcs HQ Det Washington, 501 Pennsylvania Ave NW, Washington, DC 20001
- To submit your clinical notes, you can:
