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Veterans Health Care Regulations (SOR/90-594)

Regulations are current to 2021-06-28 and last amended on 2019-04-01. Previous Versions

PART IHealth Care Benefits

Treatment Benefits

  •  (1) The following clients are eligible to receive treatment benefits in Canada or elsewhere in respect of a pensioned condition:

    • (a) a veteran pensioner;

    • (b) a civilian pensioner;

    • (c) a Red Cross pensioner; and

    • (d) a flying accident pensioner.

  • (2) A Newfoundland Special Award pensioner is eligible to receive treatment benefits in Canada or elsewhere in respect of the disability for which they receive the award.

  • (3) The following clients are eligible to receive treatment benefits in Canada or elsewhere in respect of a pensioned condition or a disability for which they are entitled to a disability award or entitled to pain and suffering compensation to the extent that those benefits are not available to them as a member or former member of the Canadian Forces:

    • (a) a special duty service pensioner;

    • (b) a military service pensioner; and

    • (c) a former member or a reserve force member.

  • (4) The following clients are eligible to receive treatment benefits in Canada, for any health condition, to the extent that those benefits are not available to them as a member or former member of the Canadian Forces nor available as an insured service under a provincial health care system:

    • (a) a veteran pensioner or a civilian pensioner if the extent of their disability in respect of the aggregate of all of their disability assessments under the Pension Act and the Veterans Well-being Act is equal to or greater than 48%;

    • (b) a client referred to in subsection (1) or (2) who is seriously disabled; and

    • (c) a special duty service pensioner or a former member or reserve force member who is entitled to a disability award or pain and suffering compensation in respect of special duty service, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e).

  • (5) The following clients are eligible to receive treatment benefits in Canada, for any health condition, to the extent that those benefits are not available as an insured service under a provincial health care system:

    • (a) an income-qualified veteran;

    • (b) an income-qualified civilian;

    • (c) a client who is in receipt of adult residential care, intermediate care or chronic care in a contract bed;

    • (d) a client who is in receipt of the cost to them of intermediate care or chronic care under section 21.1 or 21.2;

    • (e) a Canada service veteran who is in receipt of chronic care in a community facility under subsection 22(2); and

    • (f) a client who is in receipt of chronic care in a community facility under section 22.1.

  • (6) The following clients are eligible to receive treatment benefits in Canada, for any health condition, to the extent that those benefits are not available as an insured service under a provincial health care system:

    • (a) if they are eligible under section 15, 17 or 17.1 to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e) or are in receipt of those services under section 18:

      • (i) a veteran pensioner,

      • (ii) an overseas service veteran,

      • (iii) a dual service veteran, and

      • (iv) an overseas service civilian; and

    • (b) if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e):

      • (i) a civilian pensioner,

      • (ii) a prisoner of war who is entitled to basic compensation under subsection 71.2(1) of the Pension Act,

      • (iii) a Canada service veteran, and

      • (iv) a former member or a reserve force member who has received a detention benefit under Part 3 of the Veterans Well-being Act.

  • (7) If a client is hospitalized and they assert that hospitalization is required in respect of their pensioned condition, treatment benefits in respect of that hospitalization, in Canada or elsewhere, are deemed to be required in respect of the pensioned condition, for the period during which there is uncertainty as to whether the primary condition in respect of which the treatment benefits are required is the client’s pensioned condition.

  • SOR/91-438, s. 2
  • SOR/92-406, s. 2
  • SOR/98-386, s. 2
  • SOR/2001-157, s. 2
  • SOR/2001-326, s. 2
  • SOR/2003-362, ss. 2, 13
  • SOR/2006-50, s. 74
  • SOR/2012-42, s. 1
  • SOR/2012-289, s. 2
  • SOR/2016-31, s. 2
  • SOR/2017-161, s. 10
  • SOR/2018-177, s. 22
  • SOR/2018-177, s. 23

 Treatment benefits consist of the following:

  • (a) any medical, surgical or dental examination or treatment provided by a health professional;

  • (b) the provision of any surgical or prosthetic device or any aid approved by the Minister, the maintenance of the device or aid and any home adaptation that is necessary to accommodate or facilitate its use;

  • (c) preventive health care approved by the Minister; and

  • (d) pharmaceuticals prescribed by a physician, dentist or other person authorized to prescribe pharmaceuticals under the laws in force in the province or the country where the pharmaceuticals are provided.

  • SOR/2001-157, s. 3
  •  (1) Where treatment benefits are provided in Canada, the rate at which the treatment benefits and any administrative costs related thereto are payable is

    • (a) where the treatment benefits are fully insured health services of the province in which they are provided, the rate established by the province for those services and costs;

    • (b) where the treatment benefits are not fully insured health services of the province in which they are provided and, in respect of that province, an association of health professionals has adopted a fee schedule for treatment benefits and costs, the rate that is approved by the Minister and that is based on that fee schedule; and

    • (c) in any other case, the rate normally paid for those treatment benefits and costs in the community in which the treatment benefits are provided.

  • (2) Where treatment benefits are provided in a country other than Canada, the rate at which the treatment benefits and any administrative costs related thereto are payable is

    • (a) the rate established for former members of the armed forces of that country for those treatment benefits and costs; or

    • (b) where no rate referred to in paragraph (a) is established, the lesser of the rate that would be payable to the client under subsection (1) if the client were resident in Ottawa, Ontario and the actual rate paid by the client for the treatment benefits and costs.

Supplementary Benefits

 A client who receives treatment benefits referred to in paragraph 4(a) or (b) under section 3, and a client referred to in subsection 3(2.1) or (2.11), paragraphs 3(2.2)(b) or (2.21)(b) or any of subsections 3(4) to (10) who receives those benefits as an insured service under a provincial health care system, are eligible to receive supplementary benefits as follows :

  • (a) the costs of travel incurred by the client who travels to receive those treatment benefits;

  • (b) where the client’s health needs are such that the client needs to be accompanied by an escort on travel referred to in paragraph (a), the costs of travel incurred by that escort; and

  • (c) the remuneration of an escort referred to in paragraph (b), where that escort is not the spouse or common-law partner or a dependant of the client or any other member of the client’s household.

  • (d) [Repealed, SOR/95-440, s. 2]

  • SOR/95-440, s. 2
  • SOR/98-386, s. 3
  • SOR/2001-326, s. 14
  • SOR/2003-362, s. 3
  • SOR/2012-42, s. 2
 
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