Treatment Benefits – Programs of Choice (POC)

For a complete listing of what POC benefits and services may be covered and their respective requirements such as pre-authorizations, prescriptions, frequency and/or dollar limits, please visit the Benefit Grid.

POC 1 - AIDS FOR DAILY LIVING

Provides coverage for assistive devices and accessories that help people do everyday tasks and live independently. Repairs and maintenance are also covered.

Examples of devices or accessories covered include:

• Wheelchairs or walking aids (such as canes, walkers, ice grippers/rubber tips);
• bathroom aids (such as grab bars, raised toilet seats, bath boards, bathtub rails);
• self-help aids that assist with getting dressed, preparing food and living safely in your home.

POC 2 - AMBULANCE/MEDICAL TRAVEL SERVICES

Provides coverage for the use of ambulance services required for an emergency situation or a specified medical condition.

For non emergency use a prescription/pre-authorization are required before the service is provided.

For emergency situations an authorization is required before VAC covers the cost however not before the service is provided.

The program also includes coverage for travel expenses incurred to receive healthcare services or benefits.

POC 3 - AUDIO (HEARING) SERVICES

Provides coverage for equipment and accessories related to hearing impairment

Examples of benefits that are covered include:

• hearing aids
• telephone amplifiers, infrared devices
• hearing accessories
• dispensing and fitting fees for hearing aids

If the benefits covered by VAC do not meet your particular needs, your hearing health professional may submit a request to VAC to provide coverage for a different type of auditory aid. The hearing health professional must provide, in writing, the following information:

• the standard hearing benefit(s) already tried;
• the difficulty or lack of satisfaction experienced with the standard hearing benefit(s);
• the proposed replacement hearing aid; and,
• the rationale for the selection of the replacement hearing aid.

POC 4 - DENTAL SERVICES

Provides coverage for basic dental care and some pre-authorized comprehensive dental services. Services provided should be both generally accepted practices and the most cost-effective treatment essential to your good oral health.

VAC dental program covers up to 100% of the rates in the Provincial Dental / Denturist Association fee guide.

Examples of services that are covered:

• Annual basic treatments up to $1700 annually
  • Exams, polish and fluoride treatments every 9 months
  • Scaling (8 units per year)
  • Fillings and extractions
• Standard dentures once every 7 years

Examples of dental services that require pre-authorization from VAC: (Before any treatment is received a dental treatment plan is to be submitted to VAC for preauthorization.)

• Basic treatment exceeding $1700 annually
• Crowns
• Bridgework (x-rays required)
• Specialist treatment (referral required)
• Early replacement of dentures as determined by your dentist or denturist

Examples of services that are not covered

• Gum surgery
• Implants
• Equilibrated/custom/semi-precision dentures

POC 5 - HOSPITAL SERVICES

Provides coverage for treatment services in an acute care, chronic care or rehabilitative care hospital and muliti-disciplinary clinics registered with VAC. As these services are generally a provincial responsibility, costs for these services are normally covered by VAC only if they relate to a condition for which a client holds disability entitlement. Costs for private or semi-private rooms are not normally covered by VAC.

Examples of services that are covered:

• in-patient and out-patient services in an accredited provincial hospital or health facility.
• Blood collection services

POC 6 - MEDICAL SERVICES

Coverage for services of a licensed physician (including medical examinations or treatments or for reports requested by VAC). Typically, these services are for a condition related to your VAC disability benefit or your application for a disability benefit.

POC 7 - MEDICAL SUPPLIES

Provides coverage for medical and surgical equipment and supplies normally used by an individual in a non-hospital setting.

Medical supplies are those items that are essential to effectively monitor or treat an illness or injury, are primarily used to serve a medical purpose and generally, not useful to a person in the absence of an illness or injury.

Examples of benefits that are covered:

• Bandages / Dressings
• Bladder / Bowel Supplies
• Diabetic Supplies

POC 8 - NURSING SERVICES

Nursing Services have three distinct components: assessments, foot care and visits.

Examples of services that are covered:

• Medication administration and management
• Basic wound care
• Health teaching
• Basic and advanced foot care

Examples of services that are not covered:

• Acute care / specialized interventions
• Private nursing provided in a long-term care facility (nursing home) or a clinic / hospital facility
• Personal care

POC 9 - OXYGEN THERAPY

Provides coverage for oxygen and accessories as well as respiratory equipment and supplies.

Examples of benefits that are covered:

• Oxygen concentrators
• Oxygen compressors
• Oxygen gas
• CPAP and BiPAP machines

POC 10 - PRESCRIPTION DRUGS

Provides coverage for drug products and other pharmaceutical benefits to those who have demonstrated a medical need and have a prescription from a health professional authorized to write a prescription in that province. Your pharmacist can verify your eligibility for a benefit at the time that you present the prescription. Standard benefits and special authorization benefits are included in this program.

Standard benefits include many over-the-counter and prescription drugs that are considered by VAC to represent "common" therapies. These products are readily accessible for those who are eligible, have a prescription and present their VAC Health Care Identification card.

Special Authorization benefits include less common or higher cost therapies approved by VAC. A prescription is required and must be able to demonstrate a medical need that is most appropriately met with the requested therapy. You may be required to submit medical information prior to being approved for these benefits.

For a complete listing of what may be covered and respective requirements, please visit the VAC Drug Formulary search form.

POC 11 - PROSTHESES AND ORTHOSES

Provides coverage for prostheses, orthoses, and other related accessories. Necessary repairs and maintenance are also covered.

Examples of benefits covered:

• Arch supports
• Artificial limbs
• Leg/arm braces
• Modifications to ordinary footwear

POC 12 - RELATED HEALTH SERVICES

Provides coverage for the services provided by approved health professionals by VAC. In many cases, the service must be prescribed by a physician in order to be approved by VAC.

Examples of services covered include:

• occupational therapy,
• physiotherapy,
• massage therapy,
• chiropractic,
• acupuncture,
• speech language pathology and
• psychological counselling.

POC 13 - SPECIAL EQUIPMENT

Provides coverage for special equipment required for the care and treatment for eligible Veterans. These benefits must be prescribed by a VAC approved health professional and in many cases supported by the recommendation of another health professional. In addition, VAC may provide coverage for home adaptations or modifications (ie. wheelchair ramps, door widening) to accommodate the use of the special equipment in the home.

Examples of special equipment benefits covered:

• Wheelchairs
• Walkers
• Power mobility devices
• Transfer / Lift devices
• Hospital equipment
• Ergonomic equipment

POC 14 - VISION (EYE) CARE

Provides coverage for eye examinations, lenses, frames and accessories to correct sight impairments as well as low-vision aids.

Examples of benefits covered:

• Glasses
• Retinal imaging
• Regular eye exams
• Fees for low vision evaluation
• Magnifiers
• White Canes