Eligibility for Health Care Programs - Prisoner of War

/sites/default/files/pdf-e1029-200212103221.pdf

Issuing Authority

Director General, Policy and Research

Effective Date

December 23, 2015

Document ID

1029

Purpose

This policy provides direction on health care eligibility for those individuals who are recognized as Prisoners of War under the Veterans Health Care Regulations.

The Veterans Health Care Regulations authorize the provision of specific health care benefits to Prisoners of War who are entitled to basic compensation under the Pension Act if they meet criteria for eligibility.

Prisoners of War are eligible to receive treatment benefits in Canada for any health condition, if:
1. the treatment benefits are not available to them as insured services under a provincial health care system or, if applicable, from the Canadian Armed Forces, or if the cost of such benefits 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); and
2. they are eligible to receive the Veterans Independence Program services of
  home care, ambulatory care, or intermediate care in a community bed.

Prisoners of War are eligible to receive supplementary benefits if they receive 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.

Prisoners of War are eligible to receive reimbursement associated with a medical examination (i.e. charges for examination and 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.)
Prisoners of War are eligible to receive the costs of transportation incurred in Canada when they are transferred from one health care facility to another for health reasons, if they are eligible to receive any part of the cost of intermediate care under the Veterans Independence Program.
When critically-ill, Prisoners of War who are receiving intermediate care under the Veterans Independence Program 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 Prisoner of War; that family member or other designated person is eligible to receive the costs of transportation incurred, in Canada, for the visit. (See Health-related Travel policy for additional information.)

Prisoners of War are eligible to receive Veterans Independence Program services of home care, ambulatory health care, and home adaptations, or intermediate care in a community bed, to the extent that these services or care are not available to them as an insured service under a provincial health care system or, if applicable, from the Canadian Armed Forces, or if the cost of such 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), if:
1. they are resident in Canada;
2. they are totally disabled, whether by reason of military service or not; and
3. an assessment indicates that the provision of those services will assist them to remain in their principal residence or that the provision of intermediate care is necessary for health reasons.

Prisoners of war are not eligible for chronic care under the Long Term Care program. Those prisoners of war approved for Veterans Independence Program intermediate care (type II health needs) whose health needs increase to chronic care (type III health needs) continue to be eligible to receive reimbursement for Veterans Independence Program intermediate care, as type III health care needs encompasses type II needs (see paragraph 9 of the Community Facilities (Veterans Independence Program - Intermediate Care and Long-term Care).
Prisoners of war referred to in paragraph 8 of this policy are responsible for the cost of chronic care beyond the limit established for Veterans Independence Program intermediate care. If applicable, they are also required to pay up to the maximum accommodation and meal rate (see policy entitled Accommodation and Meals Contribution).