Eligibility for Health Care Programs - Medium Disabled (Veteran Pensioners and Civilian Pensioners)

/sites/default/files/pdf-e1016-161207121044.pdf

Issuing Authority

Director General, Policy and Research

Effective Date

January 06, 2016

Document ID

1016

Purpose

This policy provides direction on health care eligibility for those Veteran pensioners or civilian pensioners who are recognized as medium disabled under the Veterans Health Care Regulations.

Medium disabled is the term used to describe those Veteran pensioners or civilian pensioners whose extent of disability, in respect of the aggregate of all of their disability assessments under the Pension Act and the Veterans Well-being Act is equal to or greater than 48%, but less than 78%.
A portion of the disability assessment must be related to a disability incurred or aggravated while serving during World War II or the Korean War in order for the individual to be eligible for treatment benefits, the Veterans Independence Program and/or Long Term Care as medium disabled.
Effective November 6, 2003, the Veterans Health Care Regulations were amended to provide access to health care benefits to medium disabled Veteran pensioners and medium disabled civilian pensioners. As health care benefit access for these individuals is based on need, there is no requirement that the health need be related to a pensioned condition.

Veteran/civilian pensioners who satisfy the criteria to be recognized as medium disabled are eligible to receive treatment benefits in Canada for any health condition, to the extent that such benefits and services are not available to them under a provincial health care system, or if the cost of such benefits and services is not recoverable from a third party. See policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties for more information.

Veteran/civilian pensioners who satisfy the criteria to be recognized as medium disabled are eligible to receive supplementary benefits if they are in receipt of 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.

Veteran/civilian pensioners who satisfy the criteria to be recognized as medium disabled are eligible to receive the services of home care, ambulatory health care, and home adaptations, or intermediate care in a community bed, to the extent that such services or care are not available to them under a provincial health care system, 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 for more information), if:
1. they are resident in Canada; and
2. an assessment indicates that the provision of those services will assist them to remain self-sufficient at their principal residence, or that the provision of care is necessary for health reasons.

Veteran/civilian pensioners who satisfy the criteria to be recognized as medium disabled are eligible to receive the cost to them of chronic care received in Canada in a community bed, to the extent that the chronic care is not available to them 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 for more information.
Veteran/civilian pensioners, who are eligible for chronic care in paragraph 7 of this policy, are required to pay up to the maximum accommodation and meals rate (see policy entitled Accommodations and Meals Contribution for more information).