Veterans Health Care Regulations

3 (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 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 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.