Eligibility for Health Care Programs - Income Qualified Veteran

Purpose

This policy provides direction on health care program eligibility under the Veterans Health Care Regulations for those individuals who are recognized as Income-qualified Veterans.

Policy

General

1. Under the VHCR, an Income-qualified Veteran means a Veteran who is in receipt of an allowance under the War Veterans Allowance Act or in respect of whom a determination has been made that the Veteran would be eligible for such an allowance if the Veteran or their spouse/common-law partner were not in receipt of, or eligible to receive, payments under the Old Age Security Act or similar legislation of another country.

Treatment Benefits (Any Health Condition)

2. Income-qualified Veterans are eligible to receive treatment benefits in Canada for any health condition to the extent that the 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).

Supplementary Benefits

3. Income-qualified Veterans are eligible to receive supplementary benefits if they are in receipt of the following treatment benefits authorized by the Department:
   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

4. Income-qualified Veterans 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 Veterans are eligible to receive the cost of the premium or fee that is required for:
   1. insured health services of the province in which they are resident; or
   2. municipal or provincial benefits, services or care that are similar to the benefits, services or care described in the Veterans Health Care Regulations (see Premiums and Fees – Health Care).
6. Income-qualified Veterans 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; 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.
7. When a critically ill, income-qualified Veteran is in receipt of intermediate care or chronic care in a long term care facility or receives 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 Veteran; that family member or other designated person is eligible to receive the transportation costs incurred, in Canada, for the visit (see Health-related Travel).

Veterans Independence Program

8. Income-qualified Veterans are eligible to receive financial support toward the cost of any of the Veterans Independence Program services, including intermediate care, 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 services is not recoverable from a third party (see policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties), 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 intermediate care is necessary for health reasons.

Long Term Care Program - Contract Bed

9. Income-qualified Veterans are eligible to receive intermediate care or chronic care in a contract bed.

Long Term Care Program – Community Bed

10. Income-qualified Veterans are eligible to receive financial support toward the cost of chronic care in Canada in a community bed, if the care is not available to them as an insured service under a provincial health care system, or if the cost of such care is not recoverable from a third party (see policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties).
11. Income-qualified Veterans are required to pay up to the maximum accommodation and meal rate (see policy entitled Accommodation and Meals Contribution).

References

War Veterans Allowance Act

Veterans Health Care Regulations

Old Age Security Act

Requirement to Access Provincial Programs

Costs Recoverable from Third Parties

Costs Associated with Requested Medical Examinations

Premiums and Fees – Health Care

Health Related Travel

Accommodation and Meals Contribution