Eligibility for Health Care Programs

Issuing Authority

Director General, Policy and Research

Effective Date

6 January 2016

Document ID

1010

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 Policy Allied Veteran Recognized Allied Veterans Health Care Benefits (General)Treatment Benefits (Pensioned Condition)Treatment Benefits (Any Health Condition)Supplementary Benefits Miscellaneous Benefits Veterans Independence Program Long Term Care Program - Contract Bed Long Term Care Program - Community Bed Long Term Care – Admission Prior to Confirmation of Eligibility References

Purpose

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

Note: A list of countries allied with Canada during World War II and the Korean War is available in the documents entitled Allied Veterans – World War II and Allied Veterans – Korean War respectively.

Policy

Allied Veteran

An Allied Veteran is defined as “… a former member of an Allied Force...”. Veterans Affairs Canada interprets the term “former member” to mean an individual who served in a formal military capacity as an enlisted member of the “armed forces” (i.e. army, navy or air force). Service as a former member of a resistance group cannot be recognized.
The provisions of the Veterans Health Care Regulationsrecognize various types of Allied Veterans depending on when and where the Veteran served, whether the Veteran was domiciled in Canada prior to or after serving in the Allied Force, and whether the Veteran is entitled to a disability pension. This recognition can be broken down into three categories: Allied Veterans with pre-war Canadian domicile, Allied Veterans with post-war Canadian domicile, and supplementary pensioners.

Pre-war Domicile

The term “pre-war domicile” is used to describe those World War II or Korean Allied Veterans who were domiciled in Canada at the time of joining the Allied Force or at any time while a member of that Force.

Post-war Domicile

The term “post-war domicile” is used to describe those World War II or Korean Allied Veterans who have been domiciled in Canada for a total period of at least 10 years beginning on or after August 15, 1945, for World War II Allied Veterans; and beginning on or after July 27, 1953, for Allied Veterans of the Korean War.

Domiciled in Canada

The term “domiciled in Canada” refers to that period of time during which a person made his/her home and ordinarily resided in any part of Canada. This can normally be confirmed using government-issued documents such as an Income Tax Return, a Canada Pension Plan Record of Contributions, etc.
A person’s domicile in Canada is deemed to be continuous if the person has not been absent from Canada for more than 183 days (consecutive or cumulative) between July 1 of one year and June 30 of the next year.
Residence in Newfoundland and Labrador prior to March 31, 1949, (i.e. the date Newfoundland joined Canada) is considered domicile in Canada.

Supplementary Pensioners

The term “supplementary pensioner” is used to describe those World War II Veterans of the United Kingdom, Commonwealth or other Allied Forces who satisfy Canadian pre-war domicile criteria and are entitled to a pension in respect of a disability incurred during wartime from either the government of the Allied country for which they served or from Canada.

Recognized Allied Veterans

Subject to paragraph 10, eligibility for health care benefits (i.e. treatment and supplementary benefits, Veterans Independence Program services and long-term care) is limited to those Allied Veterans who meet one of the following definitions:
Allied Veteran – Pre-War Domicile (World War II)
1. A former member of an Allied Force who was domiciled in Canada at the time when he or she joined the Allied Force or at any time while a member of that Force, and:
  1. served in a theatre of actual war during World War II;
  2. is in receipt of a pension or was, after death, declared to have been eligible for, or awarded, a pension for a disability under the Pension Act in respect of service during World War II; or
  3. has accepted a commuted pension in respect of a disability incurred during World War II.
Note: Allied Veterans described in paragraph 9(a) above are those who have been eligible for health care benefits since May 1, 1945. They may receive care in a contract bed.

Allied Veteran – Pre-War Domicile (Korean War)
1. A former member of any of the forces that took part in the Korean War who:
  1. was domiciled in Canada at the time when he or she joined the Allied Force or at any time while a member of that Force, and
  2. served in a theatre of operations during the Korean War.
Allied Veteran – Post-War Domicile (World War II)
1. A former member of an Allied Force who resided in Canada for a total period of at least 10 years; and has been honourably discharged, resigned or retired from the Allied Force; and:
  1. served in a theatre of actual war during World War II;
  2. is in receipt of a pension or was, after death, declared to have been eligible for, or awarded, a pension for a disability in respect of service during World War II; or
  3. has accepted a commuted pension in respect of a disability incurred during World War II.
Allied Veteran – Post-War Domicile (Korean War)
1. A former member of an Allied Force who resided in Canada for a total period of at least 10 years; and has been honourably discharged, resigned or retired from the Allied Force; and
  1. served in a theatre of operations during the Korean War.
Note: Allied Veterans described in paragraphs 9(b), 9(c) and 9(d) above are those who were recognized as eligible for health care benefits, effective January 1, 2010. They are not eligible for care in a contract bed, even if they satisfy the definition of an income-qualified Veteran or an overseas service Veteran.

Grandfathered Allied Veteran – Post-War Domicile (World War II)
1. A former member who served during World War II as a member of any of His Majesty’s allies or powers associated with His Majesty, in respect of whom a determination was made on or before February 27, 1995, that:
  1. the person is or has been an income-qualified veteran, or
  2. the person had submitted a request that has been approved for one of the following benefits:
    1. Veterans Independence Program Services pursuant to section 18 of the Veterans Health Care Regulations (refer to the policy entitled Exceptional Health Needs);
    2. intermediate care or chronic care in a contract bed as an Overseas Service Veteran; or
    3. the cost of chronic care in a community facility by virtue of the fact that the Veteran had insufficient income to pay for that care (i.e. the cost of the needed chronic care reduces the Veteran’s assessable income to an amount below the maximum War Veterans Allowance income factor applicable to him/her that was in effect on the July 1 preceding the day on which they receive the care).
Note: Allied Veterans described in paragraph 9(e) above are those who were granted eligibility for benefits authorized by the Veterans Health Care Regulations on or before February 27, 1995.

Allied Veteran – Post-War Domicile (World War II) Access to intermediate or chronic care only
1. A former member of His Majesty’s forces, or of any of the forces of any of His Majesty’s allies or powers associated with His Majesty in World War II, who:
  1. served during the period commencing on September 1, 1939, and terminating on May 8, 1945, in respect of service in the European and Mediterranean theatres of war; and terminating on August 15, 1945, in respect of service in the Pacific theatre of war;
  2. has resided in Canada for a total period of at least 10 years post-war;
  3. was not domiciled in Canada at the time when he or she joined the Allied Force or at any time while a member of that force, and
    1. served in a theatre of actual war,
    2. receives a pension for an injury or disease incurred or aggravated during service, or
    3. has accepted a commuted pension in respect of a disability incurred during World War II.
Note: Allied Veterans described in paragraph 9(f) above are those who were recognized as eligible for intermediate or chronic care, effective November 6, 2003. They may receive care in a contract bed if they require specialized care that cannot adequately be provided in a community facility, other than in a contract bed.

Supplementary Pensioner – Pre-War Domicile (World War II – UK Forces)
1. A former member of the naval, army or air forces or the merchant navy of the United Kingdom who:
  1. was domiciled in Canada at any time during the four years immediately preceding the commencement of World War II, and
  2. served during World War II, and
  3. while serving:
    1. suffered disability or death in respect of which a pension has been awarded under the laws or regulations of the United Kingdom or,
    2. suffered disability or death in respect of which an application for a pension had been made and considered under the laws or regulations of the United Kingdom, but no pension has been awarded; and that would have been pensionable under the Pension Act, if the person had been a member of the Canadian Forces while so serving during World War II.
Supplementary Pensioner – Pre-War Domicile (World War II – Commonwealth and other Allied Forces)
1. A former member of the naval, army or air forces or the merchant navy of any of the Commonwealth countries, excluding Canada or the United Kingdom, or other countries allied with His Majesty who:
  1. was domiciled in Canada at the commencement of World War II, and
  2. served during World War II, and
  3. while serving:
    1. suffered disability or death in respect of which a pension has been awarded under the laws or regulations of the Commonwealth or other countries allied with His Majesty; or
    2. suffered disability or death in respect of which an application for a pension had been made and considered under the laws or regulations of any of the Commonwealth or other countries allied with His Majesty, but no pension has been awarded; and that would have been pensionable under the Pension Act, if the person had been a member of the Canadian Forces while so serving during World War II.

Health Care Benefits (General)

Health care benefits (i.e. treatment benefits, Veterans Independence Program services and/or long term care) provided to an eligible Allied Veteran, other than an Allied Veteran described in paragraphs 9(g) or 9(h), may only be authorized to the extent that such benefits, services or care are not available under a provincial health care system, or if the cost is not recoverable from a third party. Refer to the policy entitled Requirement to Access Provincial Programs for additional information.

Treatment Benefits (Pensioned Condition)

An Allied Veteran as described in paragraphs 9(g) or 9(h) is eligible to receive treatment benefits in respect of a pensioned condition as a Veteran Pensioner (refer to the policy entitled Eligibility for Health Care Benefits – Veteran Pensioner).

Treatment Benefits (Any Health Condition)

An Allied Veteran, as described in paragraphs 9(a) to (e) is eligible to receive treatment benefits in Canada for any health condition if they satisfy the definition of:
1. an income-qualified Veteran;
2. an overseas service Veteran and are receiving home care, ambulatory health care, or intermediate care in a community facility under the Veterans Independence Program; or
3. an overseas service Veteran and are receiving intermediate care or chronic care.
An Allied Veteran of World War II as described in paragraph 9(f) is eligible to receive treatment benefits in Canada for any health condition if, on or after November 6, 2003, they are:
1. receiving intermediate care or chronic care.
An Allied Veteran of World War II as described in paragraphs 9(g) or 9(h) is eligible to receive treatment benefits in Canada for any health condition as a Veteran Pensioner (refer to the policy entitled Eligibility for Health Care Benefits – Veteran Pensioner).

Supplementary Benefits

Allied Veterans as described in paragraphs 9(a) to (h) are eligible to receive supplementary benefits, if they are authorized to receive the following treatment benefits:
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 other aid, or any home adaptations to accommodate the use of such a device or aid.

Miscellaneous Benefits

Allied Veterans as described in paragraphs 9(a) to (h), are eligible to receive reimbursement associated with a medical examination (i.e. charges for examination and travel), if the medical examination is requested by Veterans Affairs Canada or the Veterans Review and Appeal Board in order to establish that they are entitled to any benefit, service or care authorized by the Veterans Health Care Regulations. (Refer to the policies entitled Health-related Travel and Costs Associated with Requested Medical Examinations.)
Allied Veterans as described in paragraphs 9(a) to (h) 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:
1. care in a contract bed (not applicable to those described in paragraphs 9(b), 9(c) or 9(d); or
2. any part of the cost of intermediate care under the Veterans Independence Program; or
3. any part of the cost of chronic care under the Long Term Care Program.
If an Allied Veteran described in paragraphs 9(a) to 9(h) is critically ill, a person designated by the Veteran is eligible to receive the costs of transportation incurred to visit the Allied Veteran in Canada, if:
1. the Veteran’s attending physician is of the opinion that a visit by the designated person would be beneficial to the Veteran’s health; and the Veteran:
  1. is in receipt of intermediate care; or
  2. is in receipt of chronic care; or
  3. satisfies the definition of an income-qualified Veteran or Veteran pensioner and is receiving acute care in a hospital.
Allied Veterans as described in paragraphs 9(a) to 9(e) who satisfy the definition of an income-qualified Veteran are eligible to receive the cost of the premium or fee that is required to access:
1. insured health services of the province in which they reside; or
2. municipal or provincial benefits, services or care similar to the benefits, service or care described in the Veterans Health Care Regulations.
  
  Note: Refer to the policy entitled Premiums and Fees – Health Care for additional information.

Veterans Independence Program

An Allied Veteran as described in paragraphs 9(a) to (e) is eligible to receive Veterans Independence Program services to the extent that the services are not available as insured services under a provincial health care system if they:
1. satisfy the definition of an income-qualified Veteran, and:
  1. are resident in Canada; and
  2. an assessment indicates that the provision of these services will assist them to remain self-sufficient at their principal residence, or the provision of that care is necessary for health reasons.
An Allied Veteran as described in paragraphs 9(a) to 9(e) is eligible to receive Veterans Independence Program services to the extent that the services are not available as insured services under a provincial health care system if they:
1. satisfy the definition of an overseas service Veteran, and
  1. are resident in Canada;
  2. have exceptional health needs;
  3. have insufficient income to enable them to pay for those services or that care (i.e. the cost of the required service or care reduces their income to an amount below the maximum War Veterans Allowance income factor applicable to them that was in effect on the July 1 preceding the day on which they receive the services or care). Refer to the Business Process entitled Determination and Collection of Accommodation and Meals for sample calculations; and,
  4. an assessment indicates that the provision of the Veterans Independence Program services will assist them to remain self-sufficient at their principal residence or the provision of intermediate care is necessary for health reasons.
Allied Veterans described in paragraph 21 are required to pay the amount of their assessable income that exceeds the maximum War Veterans Allowance income factor applicable to them toward the cost of the needed Veterans Independence Program service, including intermediate care. Those receiving intermediate care are also required to pay up to the maximum accommodation and meals rate.

Long Term Care Program - Contract Bed

Allied Veterans described in paragraphs 9(a) or 9(e) are eligible to receive intermediate care or chronic care in a contract bed when an assessment shows that the care is appropriate to meet their health needs and they are either:
1. an income-qualified Veteran, or
2. an overseas service Veteran.
Allied Veterans described in paragraphs 9(g) or 9(h) are eligible to receive intermediate care or chronic care in a contract bed when an assessment shows that the care is appropriate to meet their health needs and they fall under the eligibility group of:
1. a Veteran pensioner, or
2. an income-qualified Veteran, or
3. an overseas service Veteran.
Allied Veterans described in paragraph 9(f) are eligible to receive financial support toward the cost of intermediate care or chronic care in a contract bed, when:
1. an assessment indicates that they require specialized care that cannot adequately be provided in a community bed; and
2. they are admitted from home or from a community bed, on or after November 6, 2003.
An income-qualified Veteran or an overseas service Veteran who is an Allied Veteran as described in paragraphs 9(b), 9(c) or 9(d) is not eligible to receive care in a contract bed.

Long Term Care Program - Community Bed

Allied Veterans described in paragraphs 9(a) or 9(e) are eligible to receive the cost of chronic care in a community facility in Canada, when an assessment shows that the care is appropriate to meet their health needs and they are:
1. an income-qualified Veteran.
Allied Veterans described in paragraphs 9(a), 9(e), 9(g), or 9(h) are eligible to receive financial support toward the cost of intermediate care or chronic care in a community facility, if:
1. they are an overseas service Veteran; and
2. they have applied to the Minister for admission to a contract bed; and
3. they are not admitted to the contract bed because there is no vacancy within a reasonable distance of the community in which they normally reside.
  Note: Refer to the policy entitled Overseas Service Veterans Who Apply for a Contract Bed for additional information.
Allied Veterans described in paragraph 9(f) are eligible to receive financial support toward the cost of intermediate care or chronic care in a community facility, when:
1. an assessment shows that the care is appropriate to meet their health needs; and
2. they are admitted for the first time to a community facility, on or after November 6, 2003.
Lack of bed availability in an approved health care facility does not constitute a basis for consideration for placement in a contract bed for those Allied Veterans described in paragraph 9(f). If the Allied Veteran meets the eligibility requirements for long term care in a community facility, but no bed is immediately available, the Veteran should be referred to community resources, until a bed in a community facility becomes available. An Allied Veteran cannot be placed in a contract bed, unless a specialized level of care is required, and the specialized care cannot adequately be provided in a community facility, other than in a contract bed.
Allied Veterans described in paragraphs 9(b), 9(c), or 9(d) are eligible to receive financial support toward the cost of chronic care in a community facility, to the extent that such care is not available as an insured service under a provincial health care system when an assessment shows that the care is appropriate to meet their health needs and they are:
1. an income-qualified Veteran.
Allied Veterans described in paragraphs 9(b), 9(c), or 9(d) are eligible to receive chronic care in a community facility, if they are:
1. an overseas service veteran, and
  1. an assessment shows that the chronic care is appropriate to meet their health needs; and
  2. they have insufficient income to enable them to pay for the chronic care (i.e. the cost of the needed chronic care reduces their assessable income to an amount below the maximum War Veterans Allowance income factor applicable to them that was in effect on the July 1 preceding the day on which they receive the care). Refer to the Business Process entitled Determination and Collection of Accommodation and Meals for sample calculations.
Allied Veterans described in paragraph 31 are required to pay the amount of their assessable income that exceeds the maximum War Veterans Allowance income factor applicable to them toward the cost of the needed chronic care. They are also required to pay up to the maximum accommodation and meals rate (see policy entitled Accommodations and Meals Contribution for more information).
Some Allied Veterans of World War II may have more than one gateway to access Long Term Care. In such cases, eligibility under paragraph 29 should be considered first.

Long Term Care – Admission Prior to Confirmation of Eligibility

If an Allied Veteran requires immediate admission to a facility and cannot wait for eligibility to be confirmed, the Allied Veteran or, if applicable, a provincial program must pay the long term care costs incurred during the time that entitlement is being adjudicated.
If the application is subsequently approved, Veterans Affairs Canada may reimburse the Allied Veteran or, if applicable, provincial program for eligible costs, less accommodation and meals.
If the application is subsequently declined, the Allied Veteran or, if applicable, a provincial program will continue to be responsible for the cost of the long term care, including applicable accommodation and meals charges.