Eligibility for Health Care Programs - Income Qualified Overseas Service Civilian

Purpose

This policy provides direction on health care eligibility for those individuals who are recognized as Income-qualified Overseas Service Civilians under the Veterans Health Care Regulations (VHCR).

Policy

General

1. Under the VHCR, an Income-qualified Overseas Service Civilian means an overseas service civilian who is an income-qualified civilian.

Treatment Benefits (Any Health Condition)

2. Income-qualified Overseas Service Civilians are eligible to receive treatment benefits in Canada, if the treatment benefits are not available to them as insured services under a provincial health care system.

Supplementary Benefits

3. Income-qualified overseas service civilians 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 aid, or any     home adaptations to accommodate the use of such a device or aid.

Miscellaneous Benefits

4. Income-qualified overseas service civilians are eligible to receive reimbursement associated with a medical examination, including the cost of travel, 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.)
5. Income-qualified overseas service 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 (refer to the policy entitled Health-related Travel), if:
   1. they are eligible to receive any part of the cost of intermediate care under the Veterans Independence Program; or
   2. they are eligible to receive any part of the cost of chronic care under the Long Term Care Program.
   3. When critically ill, income-qualified overseas service civilians who receive intermediate care or chronic care in a long term care facility or receive 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 income-qualified overseas service civilian; 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).
6. When critically ill, income-qualified overseas service civilians who receive intermediate care or chronic care in a long term care facility or receive 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 income-qualified overseas service civilian; 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

7. Income-qualified overseas service civilians (who are 65 years of age or more) are eligible to receive financial support toward the cost of all Veterans Independence Program services to the extent that the services 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 Requirement to Access Provincial Programs and Costs Recoverable from Third Parties policies), if:
   1. they 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.

Long Term Care Program – Any Health Condition

8. Income-qualified overseas service civilians are eligible to receive financial support toward 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, 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); and
   2. an assessment shows that the care is an appropriate response to their health needs.

References

Veterans Health Care Regulations

Costs Associated with Requested Medical Examinations policy

Requirement to Access Provincial Programs policy

Health-related Travel policy

Premiums and Fees – Health Care policy