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7.10 Eligibility for Health Care Programs - Civilian Pensioners.pdf

7.10 Eligibility for Health Care Programs - Civilian Pensioners.pdf

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Published by: Canadian_Veterans_Ad on Jan 06, 2013
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Eligibility for Health Care Programs - Civilian Pensioners
Issuing Authority:
Director General, Policy
Effective Date:
May 18, 2012This policy replaces the following VPPM 2 policy: 1.ii Civilian Pensioners.
Purpose
This policy provides direction on health care eligibility for those individuals who are recognized as CivilianPensioners under the
.
Policy
General
Under the
VHCR
, aCivilian Pensioneris defined as a person who isentitled to a pensionunder: Parts I to III or VI to X of the
, namely:Canadian salt water fishers;i.Auxiliary Services Personnel, including the Newfoundland Overseas Forestry Unit;ii.Corps of (Civilian) Canadian Fire Fighters;iii.Air raid precautions workers;iv.Members of the Voluntary Aid Detachment;v.Overseas welfare workers;vi.Civilian members of Ferry Command; or;vii.a.the
.b.1.
Treatment Benefits (Pensioned Condition)
Civilian Pensioners are eligible to receivetreatment benefitsin Canada or elsewhere in respect of apensioned condition.2.Civilian Pensioners who are hospitalized and assert that the hospitalization is related to their pensionedcondition, shall receive treatment benefits in respect of that hospitalization, in Canada or elsewhere, for theperiod during which there is uncertainty as to whether the primary condition in respect of which thetreatment benefits are required is the pensioned condition.3.
Treatment Benefits (Any Health Condition)
Civilian Pensioners are eligible to receive treatment benefits in Canada for any health condition, to theextent that the treatment benefits are not available to them as insured services under a provincial healthcare system, if:they aremediumorseriously disabled;a. they are eligible to receive Veterans Independence Program (VIP)home care,ambulatory health care, orintermediate carein response to a need arising from theirwar-related pensioned condition; b.they are in receipt of VIP services as ‘frail’ in accordance with the Frail Policy;c. they were authorized to continue receivingadult residential care (ARC)in acommunity facilityARC was provided as a VIP element until June 30, 1993. Those individuals who were already approvedfor ARC when it was terminated, effective July 1, 1993, were grandfathered; ord.they are in receipt of chronic carein a community facility, other than acontract bed, if the cost of  their care reduces their income below the applicable
income factor.e.4.
Supplementary Benefits
Civilian Pensioners are eligible to receivesupplementary benefitsif they are in receipt of the followingtreatment benefits authorized by the Department:any medical, surgical or dental examination or treatment provided by a health professional or,a.the provision or maintenance of any surgical or prosthetic device or aid, or any home adaptations toaccommodate the use of the device or aid.b.5.
Treatment Allowances
Civilian Pensioners are eligible to receive a “treatment allowance” in respect of a period of acute care for apensioned condition provided in a hospital or on an out-patient basis.6.
Miscellaneous Benefits
Civilian Pensioners are eligible to receive reimbursement associated with a medical examination, if themedical examination is requested by the Department or the Veterans Review and Appeal Board.7.Civilian Pensioners whose pensioned condition is blindness, or another disability that requires an escortwhen travelling, may have the cost of commercial transportation (other than by automobile) paid for anescort when on annual vacation or other authorized travel within Canada.8.Civilian Pensioners who are transferred from one health care facility to another for medical reasons areeligible to receive the costs of transportation incurred in Canada if they are eligible to receive any part of  9.
 
the cost of intermediate care under the VIP or chronic care under the Long Term Care program.When critically-ill Civilian Pensioners are in receipt of intermediate care or chronic care or in receipt of acutecare in a hospital and, in the attending physician’s opinion, a visit by a family member or other designatedperson would be beneficial to the health of the client; that family member or other designated person iseligible to receive the transportation costs incurred, in Canada, for the visit. (seeHealth RelatedTravelpolicy)10.
Veterans Independence Program
Civilian Pensioners are eligible to receive VIP services of home care, ambulatory health care, and homeadaptations, or intermediate care in a community facility, other than a contract bed, to the extent thatthose services or that care is not available to them as an insured service under a provincial health caresystem, if:they are resident in Canada; anda.an assessment indicates that their war-related pensioned condition impairs their ability to remainself-sufficient at theirprincipal residencewithout those services, and the provision of those serviceswill assist them to remain self-sufficient at their principal residence or that the provision of care isnecessary for health reasons.b.11.Civilian Pensioners are eligible to receive VIP services of home care, ambulatory health care, and homeadaptations, or intermediate care in a community facility, other than a contract bed, to the extent thatthose services or that care is not available to them as an insured service under a provincial health caresystem, if:they are resident in Canada;a.they aremediumorseriously disabled; and,b. an assessment indicates that the provision of those services will assist them to remain self-sufficientat their principal residence or that the provision of care is necessary for health reasons.c.12.Civilian Pensioners are eligible to receive VIP services of home care, ambulatory health care, and homeadaptations, or intermediate care in a community facility, other than a contract bed, to the extent thatthose services or that care is not available to them as an insured service under a provincial health caresystem, if:they are resident in Canada;a.they meet the criteria of ‘frail’; andb.an assessment indicates that the provision of those services will assist them to remain self-sufficientat their principal residence, or that the provision of care is necessary for health reasons.c.13.
Long Term Care
Civilian Pensioners are eligible for the following Long Term Care benefits if an assessment shows that thecare is an appropriate response to their health needs.14.Civilian Pensioners are eligible to receive the cost to them of chronic care, in respect of a war-relatedpensioned condition if the care is:received in Canada in a community facility, other than a contract bed; anda.received in a health care facility, outside Canada, that is of a standard equivalent to the care thatwould have been provided under a) provided that the cost of such care does not exceed the usualcost of chronic care in the jurisdiction in which the care is received.b.15.Civilian Pensioners are eligible to receive the cost to them of chronic care in Canada in a community facility,other than a contract bed, if:the chronic care is not available to them as an insured service under a provincial health care system;anda.they are medium or seriously disabled.b.16.Civilian Pensioners are eligible to receive chronic care in Canada in a community facility, other than acontract bed, if:the chronic care is not available to them as an insured service under a provincial health care system;anda.the cost of their care reduces their income below the applicable
(
)
income factor.These clients are required to pay the amount of their assessable income that exceeds the
WVA
income factor toward the cost of care. They are also required to pay up to the maximumaccommodation and meals rate.b.17.
References

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