Eligibility for Health Care Programs - Entitled to a Disability Award or Pain and Suffering Compensation for Special Duty Service

Purpose

This policy provides direction on health care eligibility under the Veterans Health Care Regulations for former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering compensation for special duty service.

Policy

Treatment Benefits (Disability Award or Pain and Suffering Compensation)

Treatment Benefits (Any Health Condition)

2. Former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering compensation for special duty service are eligible to receive treatment benefits in Canada for any health condition, if they are:
   1. eligible to receive Veterans Independence Program home care, ambulatory health care, or intermediate care in response to a need arising from a disability award or pain and suffering compensation related to their special duty service; or
   2. in receipt of Veterans Independence Program services as ‘frail’.
3. Individuals described in paragraph 2 may not be approved to receive treatment benefits, if such benefits are available to them under either a provincial health care system or, if applicable, are available to them as former members or reserve force members of the Canadian Armed Forces, or if the cost of the benefits are recoverable from a third party (see policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties policies).

Supplementary Benefits

4. Former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering compensation for special duty service are eligible to receive supplementary benefits, including the cost of travel and escort fees (see policy entitled Health-related Travel), 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 aid, or any home adaptations to accommodate the use of the device or aid.

Miscellaneous Benefits

5. Former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering compensation for special duty service whose disability is one that requires an escort may, when travelling in Canada, have the cost of commercial transportation (other than by automobile) paid for an escort when on annual vacation or other travel approved by Veterans Affairs Canada (see policy entitled Health-related Travel).
6. Former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering comepensation for special duty service and 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 intermediate care under the Veterans Independence Program or chronic care under the Long Term Care program.
7. When critically ill former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering compensation for special duty service receive intermediate care, chronic care, or acute care in a hospital 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 former member or reserve force member; 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. Former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering compensation for special duty service are eligible to receive Veterans Independence Program services of home care, ambulatory health care, and home adaptations, or intermediate care in a community bed, if:
   1. they are resident in Canada;
   2. an assessment indicates that the provision of those services will assist the them to remain self-sufficient at their principal residence or that the provision of care is necessary for health reasons; and
   3. they qualify under one of the following:
      1. an assessment indicates that the disability for which they are entitled to a disability award or pain and suffering compensation impairs their ability to remain self-sufficient at their principal residence; or
      2. they meet the criteria of a frail pensioner (see paragraphs 25 and 26 of the Eligibility of Pensioners (Veterans Independence Program) policy for more information).
9. Individuals described in paragraph 8 of this policy may only be approved to receive a contribution towards Veterans Independence Program services to the extent that such benefits are not available to them under either a provincial health care system or are not available to them as former members or reserve force members of the Canadian Armed Forces, or if the cost of such services or care is not recoverable from a third party (see policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties policies).

Long Term Care - Disability Award (Community Bed)

10. Former members or reserve force members of the Canadian Armed Forces who are entitled to a disability award or pain and suffering compensation for special duty service are eligible to receive the cost to them of chronic care in a community bed, (see policy entitled Treatment for a Disability Benefits Entitled Condition) when an assessment shows that the care is an appropriate response to their health needs and:
    1. the care is received in Canada; or
    2. the care is received outside Canada if:
       1. the care is received in a health care facility that is of a standard equivalent to the care that would have been provided in Canada; and
       2. the cost of such care does not exceed the usual cost of chronic care in the jurisdiction in which the care is received.

References

Spectrum of Care: Medical and Dental Benefits and Services

Veterans Well-being Act

Veterans Health Care Regulations

Health-related Travel policy

Requirement to Access Provincial Programs policy

Costs Recoverable From Third Parties policy

Treatment for a Disability Benefits Entitled Condition policy