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) veteran pensioners;

• (b) civilian pensioners;

• (c) [Repealed, SOR/2001-326, s. 2]

• (d) Red Cross pensioners; and

• (e) flying accident pensioners.

• (f) [Repealed, SOR/2001-326, s. 2]

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

(2.1) Clients referred to in subsections (1) and (2) who are seriously disabled are eligible to receive treatment benefits in Canada for any health condition, to the extent that the treatment benefits are not available to them as members or former members of the Canadian Forces or as insured services under a provincial health care system.

(2.11) A veteran pensioner or a civilian pensioner is eligible to receive treatment benefits in Canada for any health condition, to the extent that the treatment benefits are neither available to them as members or former members of the Canadian Forces nor available as insured services under a provincial health care system, if the extent of their disability in respect of the aggregate of all of their disability assessments under the Pension Act and the Canadian Forces Members and Veterans Re-establishment and Compensation Act, is equal to or greater than 48%.

(2.2) Special duty service pensioners are eligible to receive treatment benefits

• (a) in Canada or elsewhere in respect of a pensioned condition to the extent that the treatment benefits are not available to them as members or former members of the Canadian Forces; and

• (b) in Canada to the extent that the treatment benefits are not available to them as members or former members of the Canadian Forces or as insured services under a provincial health care system, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e).

(2.21) A member or former member who is entitled to a disability award in respect of special duty service is eligible to receive treatment benefits

• (a) in Canada or elsewhere in respect of a disability for which they are entitled to a disability award, to the extent that the treatment benefits are not available to them as a member or former member of the Canadian Forces; and

• (b) in Canada, in respect of any health condition, to the extent that the treatment benefits are neither 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, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e).

(2.3) Military service pensioners who are no longer members of the Canadian Forces, or who are members of the Canadian Forces as members of the reserve force, are eligible to receive treatment benefits in Canada or elsewhere in respect of a pensioned condition to the extent that the treatment benefits are not available to them as members or former members of the Canadian Forces.

(2.4) A member or former member who is no longer a member of the Canadian Forces, or who is a member of the Canadian Forces as a member of the reserve force, is eligible to receive treatment benefits, in Canada or elsewhere, in respect of the injury or disease for which they are entitled to a disability award, to the extent that the treatment benefits are not available to them as a member or former member of the Canadian Forces.

(3) Where a client is hospitalized and the client asserts that hospitalization is required in respect of the client’s 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.

(4) Income-qualified veterans and income-qualified civilians are eligible to receive treatment benefits in Canada to the extent that the treatment benefits are not available to them as insured services under a provincial health care system.

(5) Civilian pensioners, prisoners of war who are entitled to basic compensation under subsection 71.2(1) of the Pension Act, Canada service veterans and a member or veteran who has received a detention benefit under Part 3 of the Canadian Forces Members and Veterans Re-establishment and Compensation Act are also eligible to receive treatment benefits in Canada, to the extent that the treatment benefits are not available to them as insured services under a provincial health care system, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e).

(6) Veteran pensioners, overseas service veterans, dual service veterans and overseas service civilians are eligible to receive treatment benefits in Canada, to the extent that the treatment benefits are not available to them as insured services under a provincial health care system, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e) or are in receipt of any of those services under section 18.

(7) Clients who are in receipt of adult residential care, intermediate care or chronic care in a departmental facility or contract bed are eligible to receive treatment benefits in Canada to the extent that the treatment benefits are not available to them as insured services under a provincial health care system.

(8) Canada service veterans who are in receipt of chronic care in a community facility under subsection 22(2) are eligible to receive treatment benefits in Canada to the extent that the treatment benefits are not available to them as insured services under a provincial health care system.

(9) Clients who are in receipt of chronic care in a community facility under section 22.1 are eligible to receive treatment benefits in Canada to the extent that the treatment benefits are not available to them as insured services under a provincial health care system.

(10) Clients who are in receipt of the cost to them of intermediate care or chronic care under section 21.1 or 21.2 are eligible to receive treatment benefits in Canada to the extent that the treatment benefits are not available to them as insured services under a provincial health care system.