Health-related Travel

Purpose

This policy provides direction on the payment or reimbursement of travel costs, including escort fees, if applicable, incurred by eligible clients to obtain certain treatment benefits.

Information regarding the payment or reimbursement of health-related travel expenses incurred by individuals when accessing rehabilitation and vocational assistance services is available.  See Rehabilitation Related Expenses - Other Than Training policy.

Policy

Eligibility for Travel

1. The Department is authorized to pay the costs of health-related travel for eligible clients who obtain certain treatment benefits (see paragraph 3) for a disability benefits entitled condition (referred to as A-line coverage).
2. The Department is also authorized to pay the costs of health-related travel for eligible clients who obtain certain treatment benefits (see paragraph 3) that are not for a disability benefits entitled condition (referred to as B-line coverage).  For these clients, the costs of health-related travel may be paid whether the services obtained are insured under a provincial health care system or not.
3. Health-related travel costs are paid to enable an eligible client to obtain:
   1. any medical, surgical or dental examination or treatment provided by an approved health professional;
   2. any surgical or prosthetic device or any aid approved by the Minister; or
   3. maintenance of the device or aid.

Requirement for Pre-authorization

4. Some travel expenses incurred by clients to receive treatment benefits require pre-authorization (e.g. travelling farther than the nearest appropriate treatment centre, escorts, overnight accommodations, air travel, train travel). 
5. If a client’s health condition or circumstances beyond the client’s control are such that obtaining pre-authorization is not possible, travel costs may be paid or reimbursed up to the limit deemed acceptable by the appropriate decision-maker, in accordance with this policy.

Reimbursable Travel Expenses for Treatment Benefits Received in Canada

6. Eligible clients may be reimbursed for travel expenses incurred in Canada to receive the treatment benefits noted in paragraph 3.  The client is responsible for obtaining, retaining (for a period of 12 months) and providing, when requested, proof of the appointment and incurred expenditures.  Such documents may be requested at any time during the 12-month period following submission of the travel claim.

NOTE:  Reimbursement of travel expenses incurred to acquire pharmaceuticals, preventive health care, or items that can be mailed, such as hearing aid batteries, etc., is not authorized under the Veterans Health Care Regulations.

7. Transportation in a mode appropriate to the client's health condition and by the most convenient and economical means between the client's residence, or place of work when a client must travel to an appointment during normal working hours, and the nearest appropriate treatment centre may be reimbursed as follows:
   1. by private motor vehicle, at a rate that is two cents more than the kilometric rate available to employees of the Public Service of Canada for the use of privately-owned vehicles (refer to National Joint Council’s Appendix B), plus related toll/ferry charges and parking;
   2. by rental car, plus related toll/ferry charges and parking (the kilometric rate referenced in paragraph (a) above cannot be authorized for a rental car);
      1. NOTE 1:  If a client has access to a private motor vehicle, a rental car should not be authorized unless it is a more economical option (i.e. the total charge for the rental car is less than the amount that would be paid using the kilometric rate for a private motor vehicle).
      2. NOTE 2: When calculating the kilometric rate for a private motor vehicle, it is important that relevant facts and circumstances are taken into consideration to determine if the number of kilometres claimed is reasonable.  While distance calculation tools (i.e Google Maps, MapQuest, Maptuit, etc.) may provide guidance as to distance travelled, they are only guidelines, and variances may occur.  For example, the client may have travelled a longer distance due to road/weather conditions, construction detours, bridge closures, traffic accident, etc.  An older client may have chosen a secondary road rather than a busy main throughway.  If there is a reasonable explanation why the distance claimed by the client exceeds the distance suggested by the distance calculation tool, it should be resolved in favour of the client.
   3. by intra-city transportation, (i.e. travel within city limits by municipal/city bus, subway or streetcar) for charges considered reasonable up to and including the rate of $10.00, or the actual amount paid for charges greater than $10.00;
   4. by taxi, at the rate charged less a $5.00 surcharge payable by the client for each one-way trip.  The $5.00 surcharge may be waived if, in the opinion of the decision-maker, the client's mobility or cognition is severely impaired, or the deduction would seriously impede the client's ability to access treatment benefits.  In making this decision, the approval authority should err in favour of the client (benefit of doubt) whenever there are any potential concerns that subjecting the client to this surcharge may negatively impact the client’s ability to access needed treatment benefits.  Taxi travel is intended primarily for intra-city use (within city limits) and is not to be used for long distance travel when other acceptable modes of commercial transportation are available;
   5. by intercity transportation, (i.e. travel between cities) using the most economic public transportation available.  This includes bus, train, or any other form of public transportation, excluding taxis.  Where a train is used, rates are payable at coach class for rail trips of four continuous hours or less, and at higher rates (e.g. roomette) for longer trips or when pre-authorized because of the client's health condition; or
   6. by air, at economy rate or at excursion or discount rates when possible, except when the client's health condition warrants upgraded rates (i.e. business/executive or first-class air travel); all air travel should be pre-authorized by Veterans Affairs Canada (VAC) - in the absence of pre-authorization, airfare may be reimbursed if deemed appropriate by the approval authority. Shuttlebus or airport service should be used whenever feasible and practical.
8. Generally, eligible clients are expected to access services from the treatment centre closest to their residence.  However, the Department recognizes that in some situations this approach may not always meet the needs of the client.  Factors such as the availability of treatment, wait times for access to treatment, specialization of treatment, etc., should be considered when determining if an exception to the requirement of accessing care at the nearest appropriate treatment centre may be granted.  Examples include, but are not limited to, the following:
   1. if a client has an established relationship with a mental health provider which no longer meets the "nearest appropriate treatment centre" indication, it may be in the best interest of the client to continue to support access to the established provider so as not to jeopardize or negatively impact the client’s progress to date;
   2. if a health professional prescribes or recommends a treatment that is not readily available in the client’s community, or a delay in receiving a treatment constitutes a risk to the client’s health (see Services Outside Client’s Community).
9. Meal costs incurred by the client while travelling to receive treatment benefits, subject to paragraph 13, may be covered.  (Payment shall not exceed the appropriate meal allowances set out in the National Joint Council’s Appendix C and cannot be made for meals served free of charge on a commercial carrier, i.e. airplane, train).  Meals will be considered for reimbursement when there is evidence of travel being required over meal hours.
   1. For the purpose of this policy, meal allowances may be paid when travel, or travel and the appointment, occurs over the entire two hour period between 6:30 a.m. and 8:30 a.m. for breakfast; 11:30 a.m. and 1:30 p.m. for lunch; and 5:00 p.m. and 7:00 p.m. for supper.
   2. Meal allowances may be paid outside the hours indicated in paragraph 9 (a) if a reasonable explanation is provided (e.g. clients undergoing medical tests or obtaining treatment where fasting is required).
10. Overnight accommodation when required (e.g. overnight while awaiting treatment or during or after treatment) may be covered as follows:
    1. standard commercial overnight accommodation up to the maximum rate permitted for federal public servants, as outlined in the current Accommodation and Car Rental Directory (ACRD); or
    2. private accommodation at the rate outlined in the National Joint Council’s Appendix C.

       1. NOTE: The rates noted above shall only be exceeded in exceptional circumstances, when pre-authorized, if the client requires special accommodations due to a health condition.

11. A client who travels less than 350 kilometres (return trip) shall not be authorized overnight accommodation unless:

    1. the client lives a sufficient distance away from the treatment centre and the appointment is too early in the morning or too late in the day to return home safely;
    2. weather conditions prevent travel; or
    3. a health professional prescribes overnight accommodation for health reasons.
12. Parking costs incurred at the overnight accommodation, and/or at the treatment facility in conjunction     with the use of a private motor vehicle or rental vehicle may be covered.
13. Clients whose pre-approved need for health-related travel  lasts beyond 30 consecutive days will have their meal allowance reduced to 75% after the initial 30 days.
14. Incidental expenses are not covered.

Prepayment of Travel

15. Prepayment of travel costs for clients to receive treatment benefits is not normally approved.   Requests for prepayment of travel costs may be considered on an exceptional basis when a delay in receiving treatment would constitute a risk to the health of the client.  
16. Situations which may be considered exceptional would include those in which the client has:
    1. financial need;
    2. financial need combined with significant treatment duration and/or travel expenses;
    3. mental or physical incapacity that prevents the client from making their own travel arrangements and no support person (e.g. spouse, primary caregiver, Power of Attorney, etc.) to assist.

Former Canadian Forces Members

17. Former members of the Canadian Forces receiving treatment benefits at the request of the Department of National Defence (DND) by virtue of being hospitalized for a disability at the time of their discharge may, in addition to the reimbursable travel expenses, be reimbursed travel costs from the hospital to their place of residence if:
    1. these costs were payable by DND at the time of discharge; and
    2. DND agrees to reimburse the cost to VAC.
18. These travel costs are reimbursed in accordance with paragraph 7.

Clients on Vacation

19. Clients who become ill while vacationing in Canada follow the policy outlined in paragraph 7.  While on vacation, the client’s place of residence is determined to be where the client is staying when the client becomes ill and requires treatment.  Travel is then paid from that location to the nearest appropriate treatment centre.  Clients vacationing abroad are subject to the provisions set out in the Out of Canada Clients and Veterans of Other Countries policy.

Requirement for Receipts

20. Clients are required to obtain and retain proof of incurred expenditures for the items listed below where the charge is greater than $10. (VAC may request that clients submit this proof at any time during the 12 months following claim submission.)
    1. intra-city commercial transportation charges;
    2. toll and ferry charges;
    3. non-meter parking charges;
    4. taxi charges;
    5. train travel;
    6. air fare; and
    7. commercial overnight accommodation.

Lost Receipts

21. When a client claims expenses described in paragraph 20, but has lost a receipt, the client must provide a statutory declaration for the amount of the claim that cannot be supported by a receipt.

Reimbursable Travel Expenses for Treatment Benefits Received Outside Canada

22. The conditions established in paragraph 7 for travel in Canada, also apply for the costs of travel incurred to receive treatment benefits outside of Canada, with the exception of rates established in the National Joint Council’s Appendix B and/or in the Hotel Directory (i.e. Appendix C and Hotel Directory rates do not apply to travel outside Canada).  The policy, Out of Canada Clients and Veterans of Other Countries, provides specific direction on reimbursement (by Foreign Country Operations) of travel expenses incurred for treatment benefits received outside Canada.

Medical Examinations Requested by the Department or the Veterans Review and Appeal Board

23. Persons requested to undergo a medical examination at the request of the Minister or the Veterans Review and Appeal Board are eligible to receive:
    1. reimbursement of the cost for the examination; and
    2. reimbursement of the travel costs incurred to receive the examination
24. Reimbursement shall be paid in accordance with this policy and the Costs Associated with Requested Medical Examinations policy.

Escorts

25. An escort is a person who accompanies a client, when medically necessary, to enable the client to obtain:
    1. any medical, surgical or dental examination or treatment provided by an approved health professional;
    2. surgical or prosthetic device or any aid approved by the Minister; or
    3. maintenance of the device or aid.
26. Services of an escort should be pre-authorized, and be medically necessary.  The attending health professional must indicate in writing that the client requires an escort when travelling for health reasons. Approval of an escort may also be based on the client’s inability to represent himself or herself adequately during a medical appointment, or to adequately comprehend or follow medical instructions.
27. In most cases, a prescription from the client's health professional is required for an escort to be approved.  However, the delegated decision-maker can determine what is reasonable based on the merits of each case.  With the availability of other information (consultation with a VAC health professional, recent nursing or other types of assessments, disability entitlements, etc.) the decision-maker can make a determination whether the need for the services of an escort is reasonable.
28. When an escort is required, the escort must accompany the client:
    1. from the client’s residence to their medical appointment; and
    2. for the duration of the client’s medical appointment; and
    3. from the medical appointment back to the client’s residence.

The escort is expected to remain with the client at their health professional’s office.

29. Where a client requires the services of a health professional as an escort while travelling for medical reasons, other than by ambulance, the delegated decision-maker may recommend payment of the costs of transportation, and the normal per diem for that health professional if:
    1. the services of a health professional are requested by the attending physician; and
    2. the need for the escort is for medical reasons.

Eligibility for Escorts

30. If a client is hospitalized, the Department will pay the lesser of:
    1. the transportation costs of the escort to return to the place of residence, and then return to the facility to escort the client back home, if necessary; or
    2. the costs of accommodations and meals and local transportation between the escort’s place of residence and the hospital while awaiting the client’s discharge from the facility.
31. Escort fees are not payable during periods of hospitalization.

Travel Expenses for Escorts

32. Travel expenses are payable in Canada for all authorized escorts.  For travel outside Canada or from Canada to another country, travel expenses may be paid for escorts of pensioners who are travelling to receive treatment of their pensioned conditions, or for conditions for which entitlement to a disability award or pain and suffering has been granted.
33. Eligible travel expenses for escorts include transportation, meals, and accommodations at the rates indicated in the National Joint Council’s Appendix Band/or Appendix C.

Daily Escort Fees

34. Escort fees are payable only to a person who is not the spouse or common-law partner, a dependant of the client, or any member of the client's household.
35. Only one escort fee may be paid per half day period, even if the escort accompanies more than one client during that period.
36. The daily escort fee is determined by dividing the monthly pension payable to a Class 1 pensioner with a spouse or common-law partner by 30.  The escort fee may be pro-rated to a half - day rate, depending on the circumstances of the travel.
37. The daily escort fee is modified, as required, in accordance with changes to the pensions payable under the Pension Act.
38. Escort fees outside Canada are paid at the rate set for escorts for former members of its Forces by the government of the country where the client is residing.  Where no such rate is set, the rate available to Canadian residents is payable.
39. Subject to paragraph 6, payment or reimbursement of escort fees must be supported by a receipt. When fees paid are less than the established rate, reimbursement will be for the actual costs.

Miscellaneous Costs of Transportation - Transfers Between Health Care Facilities

40. The clients noted below are eligible for the cost of transportation incurred in Canada as a result of a transfer between health care facilities if, in the opinion of the appropriate decision-maker, the transfer is for medical reasons acceptable to the Department:
    1. clients eligible for Intermediate Care under the Veterans Independence Program (VIP);
    2. clients receiving adult residential care in community facilities, as outlined in the policy on Adult Residential Care in Community Facilities, and
    3. clients eligible for long-term care under the Long Term Care Program.
41. Clients transferred from a health care facility outside Canada to one in Canada are eligible only for the transportation costs incurred in Canada, i.e. from the nearest point of entry in Canada to the health care facility in Canada.
42. Only the transportation cost to transfer between health care facilities in Canada may be paid. Meals, accommodation and escort expenses and fees are not included in this provision.
43. Transportation must be appropriate to the client's health condition and by the most convenient and economical means as outlined in paragraph 7. For non-emergency transfers, ambulance service must be prescribed and pre-authorized in accordance with the Ambulance Services policy.

Next-of-Kin Visits

44. Subject to paragraph 10, clients in health care facilities may have the travel costs in Canada paid for a family member or other person designated by the client to visit the client if:
    1. the client is critically ill (usually where a client is at the risk of death); and
    2. the visit is pre-authorized by the Department.
45. Although the next-of-kin transportation provision would normally apply only once for a critically ill client, the Department may authorize additional visits when deemed appropriate (critically ill client who recovers and then becomes critically ill again).
46. Only the transportation cost in Canada may be paid; meals, accommodation and escort expenses and fees are not included in this provision.
47. For visits of next-of-kin from outside Canada, transportation costs may be paid only from the Canadian point of entry nearest the health care facility in which the client is resident.
48. Transportation must be by the most convenient and economical means in accordance with paragraph 7.

Veteran Pensioner, Civilian Pensioner, or Special Duty Area Pensioner on Authorized Travel

49. A Veteran Pensioner, a Civilian Pensioner, or a Special Duty Area Pensioner entitled to a pension under the Pension Act or a former member or reserve force member entitled to a disability award or pain and suffering compensation for special duty service on annual vacation or other authorized travel within Canada may have the commercial transportation costs of an escort paid if the condition is blindness or a disability that requires an escort when travelling.
50. This travel must be pre-authorized by the Department.
51. Costs are limited to commercial transportation costs for air, train or bus travel only.  Meals and accommodations as required are the responsibility of the escort.  Travel by private automobile is not covered.

Payment Time Limits

52. Unless otherwise provided for within the Veterans Health Care Regulations, claims for health-related travel must be submitted by or on behalf of a client within 18 months of the day on which the expense was incurred to obtain the treatment benefit.  (See Payment Time Limits for Benefits, Services or Care policy.)

Unfavourable Decisions

53. A client who is dissatisfied with any decision rendered with respect to health-related travel may ask to have the decision reviewed in accordance with the Review of Health Care Decisions policy.

References

Pension Act

Veterans Health Care Regulations

Ambulance Services

Costs Associated with Requested Medical Examinations

Out of Canada Clients and Veterans of Other Countries

Adult Residential Care in Community Facilities

Services Outside Client’s Community

Payment Time Limits

Review of Health Care Decisions

National Joint Council Kilometric Rates (Appendix B)

National Joint Council Allowances (Appendix C)

Hotel Directory for Government Employees

Designated Travel Card

Escort Rates