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Eligibility for Health Care Programs - Income Qualified Civilian

Issuing Authority: Director General, Policy and Research
Effective Date: December 23, 2015
Document ID: 1018

Care has been taken to ensure these policies accurately reflect the acts and regulations. Should any inconsistencies be found, the acts and regulations will prevail.

Purpose

This policy provides direction on health care eligibility under the Veterans Health Care Regulations for those individuals who are recognized as income-qualified 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.
  2. Under the Veterans Health Care Regulations, an income-qualified civilian means a civilian who is in receipt of an allowance under subsection 57(1) of the Civilian War-related Benefits Act or in respect of whom a determination has been made that the civilian would be eligible for such an allowance if the civilian or their spouse/common-law partner were not in receipt of, or eligible to receive, payments under the Old Age Security Act or similar legislation of another country.

Treatment Benefits - Any Health Condition

  1. Income-qualified civilians are eligible to receive treatment benefits in Canada if they are not available to them as insured services under a provincial health care system, or if the cost of such benefits and services is not recoverable from a third party (see policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties for additional information).

Supplementary Benefits

  1. Income-qualified civilians are eligible to receive supplementary benefits, including the cost of travel and escort fees (see policy entitled Health-related Travel), if they are in receipt of 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 aid, or any home adaptations to accommodate the use of the device or aid.

Miscellaneous Benefits

  1. Income-qualified civilians are eligible to receive reimbursement 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.)
  2. Income-qualified civilians are eligible to receive the cost of the premium or fee that is required to be paid in relation to:
    1. the insured health services of the province in which they are resident; or
    2. municipal or provincial benefits, services or care similar to the benefits, service or care described in the Veterans Health Care Regulations (see Premiums and Fees – Health Care).
  3. Income-qualified 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.
  4. When critically-ill, income-qualified civilians who are in receipt of chronic care under the Long Term Care program 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 income-qualified civilian; that family member or other designated person is eligible to receive the transportation costs incurred, in Canada, for the visit (see policy entitled Health-related Travel).

Long Term Care – Community Bed (Any Health Condition)

  1. Income-qualified civilians are eligible to receive financial support towards the cost of chronic care in Canada in a community bed, if:
    1. the care is not available to them as an insured service under a provincial health care system; and
    2. an assessment shows that the care is an appropriate response to their health needs.
  2. Income-qualified civilians referred to in paragraph 9 of this policy may be required to pay a monthly accommodation and meals contribution toward the cost of that care (see policy entitled Accommodation and Meals Contribution).

References

Veterans Health Care Regulations

Civilian War-related Benefits Act

Old Age Security Act

Requirement to Access Provincial Programs policy

Costs Recoverable from Third Parties policy

Premiums and Fees – Health Care policy

Health-related Travel policy

Accommodations and Meals Contribution policy

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