Eligibility for Health Care Programs - Civilian

Purpose

This policy provides direction on health care eligibility under the Veterans Health Care Regulations for those individuals who are recognized as civilians.

Policy

General

1. There are five distinct civilian groups including civilian, civilian pensioner, income-qualified civilian, overseas service civilian, and income-qualified overseas service civilian, each with its own eligibility policy. For the purpose of this policy, a civilian is as defined in subsection 56(1) of the Civilian War-related Benefits Act.

Treatment Benefits - Any health condition

2. Civilians are eligible to receive treatment benefits in Canada for any health condition:
   1. to the extent that the treatment benefits are not available to them as an insured service under a provincial health care system, or if the cost of such benefits is not recoverable from a third party (see policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties for additional information); and
   2. if they are in receipt of financial support toward the cost of chronic care in a community bed.

Supplementary Benefits

3. Civilians are eligible to receive supplementary benefits if they are receiving the following treatment benefits authorized by Veterans Affairs Canada:
   1. any medical, surgical or dental examination or treatment provided by a health professional; or,
   2. the provision or maintenance of any surgical or prosthetic device or any aid, or any home adaptations to accommodate the use of such a device or aid.

Miscellaneous Benefits

4. Civilians are eligible to receive reimbursement of the costs associated with a medical examination, including the cost of travel incurred, if the medical examination is requested by Veterans Affairs Canada or the Veterans Review and Appeal Board. (Refer to the policies entitled Health-related Travel and Costs Associated with Requested Medical Examinations.)
5. Civilians who are transferred from one health care facility to another for medical reasons are eligible to receive the costs of transportation incurred in Canada, if they are eligible to receive any part of the cost of chronic care under the Long Term Care Program.
6. When a critically ill civilian is receiving chronic care and, in the attending physician’s opinion, a visit by a family member or other designated person would be beneficial to the health of the critically-ill civilian; that family member or other designated person is eligible to receive the transportation costs incurred, in Canada, for the visit. (See Health-related Travel policy.)

Long Term Care

7. Civilians are eligible to receive financial support toward the cost of chronic care in Canada in a community bed, provided:
   1. an assessment shows that the care is an appropriate response to their health needs;
   2. the chronic care is not available to them as an insured service under a provincial health care system, or if the cost of such care is not recoverable from a third party (see policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties); and
   3. they have insufficient income to enable them to pay for the chronic care (i.e. the cost of chronic care reduces their income below the applicable War Veterans Allowance income factor).
8. Eligible civilians in paragraph 7 of this policy are required to pay the amount of their assessable income that exceeds the applicable War Veterans Allowance income factor toward the cost of care. They are also required to pay up to the maximum accommodation and meals rate (see the policy entitled Accommodation and Meals Contribution for more information).

References

Veterans Health Care Regulations

Civilian War-related Benefits Act

Requirement to Access Provincial Programs policy

Costs Recoverable from Third Parties policy

Health-related Travel policy

Costs Associated with Requested Medical Examinations policy

Accommodation and Meals Contribution policy