Eligibility for Health Care Programs - Detention Benefit Recipients

Purpose

This policy provides direction on health care eligibility under the Veterans Health Care Regulations (VHCR) for those individuals who have received a Detention Benefit.

Policy

General

1. A Detention Benefit is a payment for time spent in detention, which includes the period during which the former member or reserve force member was engaged in evading capture by, or in escaping from, any power (an enemy or an opposing force of Canada; a person or group that has as one if its purposes or activities the facilitating or carrying out of a terrorist activity; and any prescribed entity).
2. Individuals who have received a Detention Benefit under Part 3 of the Veterans Well-being Act are eligible for health care benefits under the Veterans Health Care Regulations, so long as they meet the eligibility criteria outlined in paragraph 3 of this policy.

Treatment Benefits (Any Health Condition)

3. Detention Benefit recipients are eligible to receive treatment benefits in Canada for any health conditions, if:
   1. the treatment benefits are not available to them as insured services 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. they are eligible to receive Veterans Independence Program services of home care, ambulatory health care or intermediate care in a community bed.

Supplementary Benefits

4. Detention Benefit recipients are eligible to receive supplementary benefits if they receive 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

5. Detention Benefit recipients 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.)
6. Detention Benefit recipients are eligible to receive the costs of transportation incurred in Canada when they are transferred from one health care facility to another for health reasons, if they are eligible to receive any part of the cost of intermediate care under the Veterans Independence Program (refer to the policy entitled Health-related Travel).
7. When critically ill detention benefit recipients are receiving intermediate care under the Veterans Independence 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 Detention Benefit recipient; 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.)

Veterans Independence Program

8. Detention Benefit recipients are eligible to receive Veterans Independence Program services of home care, ambulatory health care, and home adaptations, or intermediate care in a community bed, to the extent that the services or that care are not available as insured services under a provincial health care system, or if applicable, are not available to them as former members or reserve force members of the Canadian Armed Forces, 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 Partiesfor additional information), if:
   1. they are resident in Canada;
   2. they are totally disabled, whether by reason of military service or not; and
   3. an assessment indicates that the provision of these services will assist them to remain in their principal residence or that the provision of intermediate care is necessary for health reasons.

Long Term Care - Totally Disabled

9. Detention Benefit recipients are not eligible for chronic care under the Long Term Care program. Those Detention Benefit recipients approved for Veterans Independence Program intermediate care (type II health needs) whose health needs increase to chronic care (type III health needs) continue to be eligible to receive reimbursement for Veterans Independence Program intermediate care, as type III health care needs encompasses type II needs (see paragraph 9 of the Community Facilities (Veterans Independence Program - Intermediate Care and Long-term Care).
10. Detention Benefit recipients referred to in paragraph 9 of this policy are responsible for the cost of chronic care beyond the limit established for Veterans Independence Program intermediate care. If applicable, they are also required to pay up to the maximum accommodation and meal rate (see policy entitled Accommodation and Meals Contribution).

References

Veterans Well-being Act

Veterans Health Care Regulations

Health-related Travel

Requirement to Access Provincial Programs

Costs Recoverable from Third Parties

Accommodation and Meals Contribution