Eligibility for Health Care Programs - Overseas Service Civilians

Purpose

This policy provides direction on health care eligibility in accordance with the Veterans Health Care Regulations for those individuals who are recognized as overseas service civilians.

Policy

General

1. There are five distinct civilian groups including civilian, civilian pensioner, income-qualified civilian, overseas service civilian, and income-qualified overseas service civilian, each with its own eligibility policy. An overseas service civilian is defined under the Civilian War-related Benefits Act as:
   1. a person who served in a theatre of actual war during World War II as a member of the Corps of (Civilian) Canadian Fire Fighters for Service in the United Kingdom. (These individuals served in the United Kingdom assisting the National Fire Service combat fires caused by enemy air raids and bombing.);
   2. a person who:
      1. served in a theatre of actual war during World War II as an overseas welfare worker. (These individuals served under the auspices of the Canadian Red Cross Society or the St. John Ambulance Brigade of Canada as welfare workers, nursing aids, ambulance or transport drivers, members of the Overseas Headquarters Staff, or in any other capacity; or were selected by the Canadian Red Cross Society and served with the Scottish Ministry of Health as orthopaedic nurses or surgeons.); or,
      2. served outside Canada during the Korean War in a capacity similar to paragraph i) above;
   3. a person who served in a theatre of actual war during World War II as a civilian member of Ferry Command (These individuals were employed by the Air Ministry of the United Kingdom, and served as air crew with Number 45 Wing of the Royal Air Force Transport Command, Number 45 Group of the Royal Air Force Ferry Command or the Atlantic Ferrying Organization); or
   4. a person who served in a theatre of actual war during World War II as a member of the Newfoundland Overseas Forestry Unit. (These individuals were engaged in cutting pit props for coal production in the United Kingdom, an activity considered vital to the war economy.)

Treatment Benefits - Any Health Condition

2. Overseas service civilians are eligible to receive treatment benefits in Canada for any health condition, if the benefits and services are not available to them as insured services 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 Partiesfor additional information), and they are in receipt of:
   1. or eligibility has been established for, services and/or care under the Veterans Independence Program, specifically home care, ambulatory health care, or intermediate care; or
   2. any Veterans Independence Program services due to having exceptional health needs (see policy entitled Exceptional Health Needs (Veterans Independence Program) for more information); or
   3. chronic care in a community bed.

Supplementary Benefits

3. Overseas service civilians are eligible to receive supplementary benefits, including the cost of travel and escort fees (see policy entitled Health-related Travel), 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.

Miscellaneous Benefits

4. Overseas service civilians are eligible to receive reimbursement of the cost 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 (see policies entitled Health-related Travel and Costs Associated with Required Medical Examinations).
5. Overseas service civilians who are transferred from one health care facilityto another for medical reasons are eligible to receive the costs of transportation incurred in Canada, if they are:
   1. eligible to receive any part of the cost of intermediate care under the Veterans Independence Program; or
   2. eligible to receive any part of the cost of chronic care under the Long Term Care Program.
6. When a critically-ill overseas service civilian receives intermediate care or chronic care 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 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. Overseas service civilians who have exceptional health needs (see policy entitled Exceptional Health Needs (Veterans Independence Program) for more information) and who require Veterans Independence Program services and/or care are eligible to receive financial support toward the cost of all Veterans Independence Program services, or intermediate care in a community bed, to the extent that the services or care are not available to them as insured services 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), provided they meet the following requirements:
   1. they are resident in Canada;
   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; and
   3. they have insufficient income to enable them to pay for those services or that care.
8. Overseas service civilians eligible for financial support toward the cost of Veterans Independence Program services and/or care under exceptional health needs are required to pay the amount of their assessable income that exceeds the War Veterans Allowance income factor (see War Veterans Allowance Act for more information) toward the cost of their Veterans Independence Program services. Those receiving intermediate care are also required to pay up to the maximum accommodation and meal rate (see policy entitled Accommodation and Meals Contribution).
9. Those individuals who qualify as income-qualified overseas service civilians are eligible to receive all Veterans Independence Program services or care to the extent that the services or care are not available to them as an insured service under a provincial health care system (see policy entitled Requirement to Access Provincial Programs), or if it is not recoverable from a third party (see policy entitled 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 that care is necessary for any health reason. Please consult the policy entitled Eligibility for Health Care Programs – Income-qualified Overseas Service Civilian for more information. 

Long-term Care - Community Bed

10. Overseas service civilians are eligible to receive financial support toward the cost of chronic care in Canada in a community bed, if:
    1. the chronic care is not available to them as an insured service under a provincial health care system;
    2. the cost of their care reduces their income below the applicable War Veterans Allowance income factor; and
    3. an assessment shows that the care is an appropriate response to their health needs.
11. Overseas service civilians referred to in paragraph 10 of this policy are required to pay the amount of their assessable income that exceeds the War Veterans Allowance income factor (see War Veterans Allowance Act for more information) toward the cost of care. They are also required to pay up to the maximum accommodation and meal rate (see policy entitled Accommodation and Meals Contribution).

References

Civilian War-related Benefits Act

Veterans Health Care Regulations

Health-related Travel policy

Costs Associated with Required Medical Examinations policy

Requirement to Access Provincial Programs policy

Costs Recoverable from Third Parties policy

Exceptional Health Needs (Veterans Independence Program) policy

Eligibility for Health Care Programs – Income-qualified Overseas Service Civilian policy

War Veterans Allowance Act

Accommodation and Meals Contribution policy