Eligibility for Health Care Programs - Overseas Service Veterans

Purpose

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

Policy

General

1. For the purpose of qualifying for treatment benefits and/or the Long Term Care program, an overseas service Veteran is defined in the Veterans Health Care Regulations as:
   1. a Veteran who, before April 1, 1946, served during World War II:
      1. in a theatre of actual war; or
      2. as a Merchant Navy Veteran.
2. For the purpose of qualifying for Veterans Independence Program services, an overseas service Veteran is defined in the Veterans Health Care Regulationsas:
   1. a veteran who served in a theatre of actual war during World War II, specifically from September 1, 1939, to May 8, 1945, in respect of service in connection with operations in the European and Mediterranean theatres of war; and from September 1, 1939, to August 15, 1945, in respect of service in connection with operations in the Pacific theatre of war; or
   2. a Merchant Navy Veteran of World War II.
3. The following individuals are also considered overseas service Veterans:
   1. a Veteran who was on service in a theatre of operations as a member of the Canadian Armed Forces, including the special force, during the Korean War;
   2. a Canadian Merchant Navy Veteran of the Korean War; or,
   3. effective January 1, 2010, an Allied Veteran as described in paragraphs 37(4)(c.1) and (d.1) or subsection 37(4.2) of the War Veterans Allowance Act, specifically:
      1. any former member of any of the forces that took part in the Korean War who was domiciled in Canada at the time when he or she joined that force or at any time while a member of that force, and served in a theatre of operations during the Korean War; or
      2. any former member of any of the forces that took part in the Korean War and who served during that war, who resided in Canada for a total period of at least 10 years beginning on or after July 27, 1953, who has been honourably discharged or has been permitted honourably to resign or retire from one of those forces and who served in a theatre of operations during that war.
4. Individuals eligible for treatment benefits, Veterans Independence Program services, including intermediate care, and/or long term care in accordance with this policy may only be authorized to receive such benefits, services or care to the extent that the benefits, services or care are not available under a provincial health care system, or if the cost of the benefits, services or care is not recoverable from a third party. Refer to the policies entitled Requirement to Access Provincial Programs and Costs Recoverable from Third Parties for additional information.
5. Paragraph 4 is not applicable to the provision of intermediate or chronic care provided in a contract bed, as described in paragraph 15.

Treatment Benefits - Any Health Condition

6. Overseas service Veterans are eligible to receive treatment benefits in Canada for any health condition, if:
   1. they are eligible to receive home care, ambulatory health care and/or home adaptation services under the Veterans Independence Program;
   2. they receive Veterans Independence Program services due to exceptional health needs;
   3. they receive  intermediate care or chronic care in a contract bed; or
   4. they receive financial support towards the cost of intermediate care or chronic care in a community bed.

Supplementary Benefits

7. Overseas service Veterans are eligible to receive supplementary benefits if they receive 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 any aid, or any home adaptations to accommodate the use of such a device or aid.

Miscellaneous Benefits

8. Overseas service Veterans are eligible to receive reimbursement associated with a medical examination, including the costs 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.)
9. Overseas service 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.
10. When a critically ill overseas service Veteran is in receipt of 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 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 policy).

Veterans Independence Program

11. Where overseas service Veterans are deemed eligible for intermediate care or chronic care in a contract bed but not in receipt of long term care or intermediate care, they are eligible to receive home care, ambulatory health care and home adaptations services under the Veterans Independence Program, if:
    1. they have applied to the Minister for admission to a contract bed, and are not admitted because there is no vacancy in a contract bed within a reasonable distance of the community in which they normally reside;
    2. they are resident in Canada; and
    3. an assessment indicates that the provision of those services will assist them to remain self-sufficient at their principal residence.
12. The preceding paragraph does not apply to those Allied Veterans who were granted access to benefits effective January 1, 2010, as these individuals are precluded from receiving long term care in a contract bed.
13. Overseas service Veterans are eligible to receive any of the Veterans Independence Program services, including intermediate care, if they:
    1. are resident in Canada; and meet all of the following criteria, in that they:
       1. require any of the Veterans Independence Program services, including intermediate care, as a result of exceptional health needs (see Veterans Independence Program - Benefits at Home Policy);
       2. have insufficient income to pay for the services or care (i.e. the cost of the required service or care reduces their income to an amount below the maximum War Veterans Allowance (WVA) income factor applicable to them); and
       3. an assessment indicates that the provision of the services will assist them to remain self-sufficient at their principal residence, or the provision of intermediate care is necessary for health reasons.
14. Overseas service Veterans described in paragraph 13 are required to pay the amount of their assessable income that exceeds the applicable War Veterans Allowance income factor toward the cost of the needed service or intermediate care. Those receiving intermediate care are also required to pay up to the maximum Accommodation and Meals Rate.

Long-Term Care Program – Contract Bed

15. Overseas service Veterans are eligible to receive intermediate care or chronic care in a contract bed, if an assessment shows that the care is an appropriate response to their health needs.

Long-Term Care Program – Community Bed

16. Overseas service Veterans are eligible to receive financial support toward the cost of intermediate care or chronic care in a community bed, to the extent that it is not available to them as an insured service under a provincial health care service, or if the cost of such care is not recoverable from a third party (see policy entitled Requirement to Access Provincial Programs for additional information), if they:
    1. have applied to the Minister for admission to a contract bed, and
    2. are not admitted because there is no vacancy in a contract bed within a reasonable distance of the community in which they normally reside.
17. The preceding paragraph does not apply to those Allied Veterans who were granted access to benefits effective January 1, 2010, as these individuals are precluded from receiving financial support toward the cost of long term care in a contract bed.
18. 18. Overseas service Veterans 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. an assessment shows that the care is an appropriate response to their health needs; and
    3. the cost of the care reduces their income below the applicable War Veterans Allowance income factor.
19. Overseas service Veterans who satisfy the criteria set out in paragraph 18 are required to pay:
    1. the amount of their assessable income that exceeds the War Veterans Allowance income factor toward the cost of care; and
    2. up to the maximum accommodation and meal rate (see policy entitled Accommodation and Meals Contribution).

References

War Veterans Allowance Act

Veterans Health Care Regulations

Requirement to Access Provincial Programs policy

Costs Recoverable from Third Parties policy

Health-related Travel policy

Costs Associated with Requested Medical Examinations policy

Accommodation and Meals Contribution policy