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Home  Clients Veterans Services Veterans Independence Program A Guide to Access VAC Health Benefits and the Veterans Independence Program | |||||||
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A Guide to Access VAC Health Benefits and the Veterans Independence ProgramNational Client Contact CentreFor further information on Programs and Benefits, please contact Veterans Affairs Canada at the following toll free numbers.
General Information
Health BenefitsPrograms of Choice (POC)
Veterans Independence Program
Veterans Affairs Canada Health BenefitsIn recognition of the sacrifices made by Canadians in this nation's war and peacekeeping efforts, Veterans Affairs Canada (VAC) offers a wide range of services and benefits to qualified Veterans, still-serving Canadian Forces members, RCMP members, and certain civilians, as well as to their dependants or survivors. This guide provides information about the VAC benefits and services available through both the VAC Health Program and the Veterans Independence Program and explains how to obtain those benefits that you may be eligible to receive. It also offers an explanation on how to use your VAC Health Identification card. Health Benefits ProgramVeterans Affairs Canada offers health benefits including medical, surgical or dental examinations or treatment provided by health professionals; surgical or prosthetic devices or aids and their maintenance; home adaptations to accommodate the use of devices or aids; preventative health care; and prescribed drugs. In addition, clients may be eligible to receive supplementary benefits such as costs associated with travel to receive treatment, and travel costs for escorts, treatment allowances, and costs associated with medical examinations when requested by the Department. To obtain health benefits you must present your Health Identification card along with the necessary prescription to a provider of your choice who is a participant of the program. The provider will supply the benefit and send the bill for payment. Some benefits must be pre-authorized by VAC before they can be issued by the provider. Veterans Independence ProgramThe Veterans Independence Program (VIP) is a national home care program that assists clients to remain healthy and independant in their own homes or communities by offering a variety of services and programs, such as housekeeping or personal care, for clients who meet the eligibility requirements. VIP works in concert with other federal, provincial, or municipal programs. The services an eligible client may receive depend on their particular circumstances and health needs. To find out if you are eligible for VIP services, contact Veterans Affairs Canada. Staff in the District Office will work with you and your family to assess your needs, which VIP services will be provided, and the amount to be paid. Once an assessment has been completed, eligible Veterans may present their VAC Health Identification card along with the necessary authorization to a provider of choice who is participating in the program. All benefits must be pre-authorized by VAC before they can be issued by the provider. Other payment methods are available and will be discussed with you by your area counsellor. See Methods of Payment for VIP Confirmation of Benefit or ServiceOnce you have received a benefit or service, for both the Health Benefits and Veterans Independence Programs, you must sign a claim form, where applicable, to confirm that you have received a benefit or service. Your provider will tell you when your signature is required. It is important that you do not sign a claim form until the benefit or service has been received and you are satisfied with it. Frequency and Dollar LimitsThere are limits for VAC payment under both the Veterans Independence and Health Benefits Programs. In some circumstances, your request may be declined or reduced if it exceeds the frequency and/or dollar limits which have been established by VAC. Your service provider is aware of the frequency and dollar limits that apply to individual benefits and must verify your eligibility prior to giving a service or benefit. In the case of VIP, amounts that have been approved for each VIP service will be discussed with you in advance. Written confirmation of these amounts will be given to you at the time the services are approved. When You TravelIf you are planning to travel outside of your home province or leaving Canada, you should call the toll free telephone number on the front of your VAC Health Identification card or VAC's Foreign Countries Operations at 1-888-996-2242 (Canada & US) or (613) 996-2242 (Ottawa) for advice on how to obtain benefits while travelling. Your VAC Health Identification card is valid only in Canada. It cannot be used while you are outside of the country. Veterans Independence Program benefits are not paid for clients travelling or resident outside of Canada. Review ProcessIf you are refused a benefit to which you believe you are entitled, you will be notified in writing of your right to request a review of that decision. This request must be submitted in writing within 60 days from the date the decision is received. Requests for review are to be sent to the Regional Director General of the office nearest you unless otherwise directed in the decision letter. Please refer to the Regional and District Office Directory included with this booklet. Still-serving members of the Canadian Forces or the Royal Canadian Mounted Police who are VAC pensioners must seek all treatment from the Canadian Forces or RCMP organizations first. If clients are denied a benefit that they believe is attributable to their pensioned condition, they are able to appeal directly to VAC for health decisions related to their pensioned condition. This request must be submitted in writing within 60 days from the date the decision is received. Appeal requests are to be sent to the:
Director, Program Policy
Veterans Affairs Canada PO Box 7700 Charlottetown PE C1A 8M9 Your VAC Health Identification CardYou are the only person who is eligible to use your VAC Health Identification card. Your spouse and/or dependants are not covered to obtain either Health or Veterans Independence benefits or services. Client Name and Identification Number
Your VAC Health Identification card issued in your name is an efficient and effective method of identifying the benefits you are eligible to receive. Your client number begins with the letter "K". Whenever you call or write to VAC about your benefits, it is helpful if you quote this number. Client Info will show your contact number if you have questions or need to speak with someone about VAC benefits and services. Identifying Your Eligibility for Health BenefitsHealth benefits and services are offered through Programs of Choice (POC). On the reverse of your VAC Health Identification card you will find the names of all the Programs of Choice and their corresponding numbers. These POCs are described in detail on pages 15 - 24. In order to identify which programs you are eligible for, look on the front of your VAC Health Identification card. If you have an "A" or "B" (or both) denoted under the Program of Choice numbers, you are eligible for these programs. Group "A" and Group "B" - This section applies only to the Health Benefits Program Certain POCs (2 - Ambulance / Medical Travel Services, 5 - Hospital Services, 6 - Medical Services, 10 - Prescription Drugs) appear on all pensioners' VAC Health Identification cards (for "A" clients) regardless of the pensioned condition. For VAC to pay for any services covered by these POCs, i.e., prescription drugs, the services must be related to your pensioned condition. Prior authorization is required from VAC. When the letter "B" is shown under a Program of Choice (POC), all eligible benefits will be covered by VAC provided you have a clearly demonstrated health need and these benefits are not covered by a provincial or other private health plan. If you are a "B" client, your provider must first bill the appropriate provincial health program for the portion of the benefit that is covered by your province. If you have private health insurance, either you or your provider(s) must submit your claim for payment through this insurance. VAC is considered to be the payer as a last resort and would be able to cover remaining amounts for eligible benefits. When both "A" and "B" are shown, your eligibility for benefits will depend on several factors such as your pensioned condition and provincial and private health coverage. If neither "A" or "B" are shown under the specific POC, you are ineligible for the benefits under that program. Veterans Independence Program IndicatorIn addition to health benefits, you may be eligible to receive benefits and services through the Veterans Independence Program (VIP). If you have been assessed and determined to be eligible to receive benefits and services through the Veterans Independence Program, the letters VIP will appear directly below the word "Group" on the front of your card. Your Signature - In order to protect you and the use of your card, please sign your card. Card Design - Veterans Affairs Canada is pleased to offer your Health Identification card in your language of choice. The card is available in either French or English. If your card is not in the official language of your choice, please contact VAC to obtain a corrected version. VAC also offers a Health Identification card designed for clients who are visually impaired. If you wish to obtain this card, please call the toll free telephone number listed on the front of your current Health Identification card. Additional Information - If you require additional information regarding the use of your VAC Health Identification card or the health benefits available, you can call the toll-free telephone number on your card during regular business hours, 8:30 a.m. to 4:30 p.m. local time. Health BenefitsWho is EligibleTwo groups of clients are eligible for health benefits through Veterans Affairs Canada (VAC) - Group "A" clients and Group "B" clients. Group "A" clients may use their card to obtain approved benefits directly related to a disability pensioned condition. Included in this group are:
Group "B" clients may use their card to obtain approved benefits based on demonstrated health need where it is not covered either through provincial or private health coverage. Included in this group are:
Frequency and Dollar LimitsThere are limits for VAC payment under the Health Benefits Programs. In some circumstances, your request may be declined or reduced if it exceeds the frequency and/or dollar limits which have been established by VAC. Your service provider is aware of the frequency and dollar limits that apply to individual benefits and must verify your eligibility prior to giving a service or benefit. If you have exceptional health needs that require additional benefits or services, these can be requested by submitting a request to Veterans Affairs Canada District Office. If approved, you will be notified in writing and may present the authorization to your provider of choice. Health Benefits - Programs of Choice1. Aids for Daily LivingThis program provides devices and accessories, including necessary repairs, designed to assist the activities of your daily living. Examples of covered devices/accessories are:
For a complete listing of what may be covered, please visit our VAC Web site at www.vac-acc.gc.ca. 2. Ambulance / Medical Travel ServicesAmbulance - This program covers your use of ambulance services to or from a medical facility when it is required due to an emergency or medical condition. Some services require a prescription from your physician and/or authorization from VAC before payment can be made. In non-emergency cases, you should verify these requirements with your provider or VAC before the service is provided. Medical Travel Services - This program covers travel costs incurred in order to receive certain treatment benefits. These benefits include medical, surgical, or dental examinations or treatment by a health professional. Costs of travel incurred by escorts may be paid as well. Travel expenses incurred by clients to receive treatment benefits require pre-authorization from VAC before payment can be made. 3. Audio (Hearing) ServicesThis program offers benefits to compensate for hearing impairment. Your provider has a detailed list of available benefits. Examples of covered benefits are:
Provision of other models of programmable and digital aids will be considered by VAC on an exceptional basis if your hearing needs cannot be addressed by the standard benefit technology. Special authorization is required for non-standard hearing aids. Examples of special authorization benefits are:
4. dental servicesThis program offers basic dental care and pre-authorized comprehensive dental services. You are also entitled to receive dentures from your dentist, or in those provinces where they are licensed to practice, your denturist. The treatment must result in the most reasonable outcome for the client while not placing the client's overall health at risk. Procedures will not be approved where there are more conventional evidence based treatments which are both acceptable and costeffective alternatives. Examples of covered benefits are:
Examples of excluded benefits are:
Some forms of dental treatment require prior authorization from VAC. In other words, the provider must obtain VAC's approval of payment prior to commencement of treatment. Examples of treatment requiring prior authorization are:
For additional information regarding dental benefits, please contact the toll-free inquiries line at 1-866-522-2122 between the hours of 8:30 a.m. to 4:30 p.m. local time. 5. Hospital Services - Inpatient & Outpatient ServicesThis program offers benefits for treatment services provided in an acute care, chronic care, or rehabilitative care hospital. It includes both inpatient and outpatient services provided to a Veteran in an accredited provincial hospital or health facility. Costs for private or semi-private rooms are not normally covered by Veterans Affairs Canada. 6. Medical ServicesIn the case of a VAC disability pensioner, this program offers medical services provided by a licensed physician. The costs of medical examinations, treatment, or reports specifically requested by VAC are also covered by this program. For most VAC clients, physicians' services are the responsibility of the provincial health care programs and not normally paid under this program. 7. Medical SuppliesThis program offers medical and surgical equipment and supplies normally used by an individual in a non-hospital setting. Examples of covered medical and surgicalequipment:
8. Nursing ServicesThis program offers services provided by a registered nurse, or for basic foot hygiene by a registered nurse or a qualified licensed/certified nursing assistant. Examples of covered services:
Examples of excluded services:
9. Oxygen TherapyThis program offers oxygen and accessories, as well as the rental or purchase of other respiratory supplies and equipment. Examples of covered benefits are:
10. Prescription DrugsThis program provides drug products and other benefits dispensed by a pharmacist. Included under the VAC programs are: A. Standard Benefits which include many over-the-counter and prescription drugs, plus medical devices that are considered by VAC to represent "common" therapies. All products on this formulary are readily accessible to eligible clients who have a prescription. Prescriptions may be written by your 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.
Your pharmacist can verify your eligibility for a benefit at the time that you present the prescription from your physician or dentist. Your pharmacist is aware of the available benefits. Examples of covered benefits:
Pharmaceutical products which VAC does not generally cover:
For additional information regarding pharmacy benefits, please contact the toll-free inquiries line at 1-866-522-2122 between the hours of 8:30 a.m. to 4:30 p.m. local time. 11. Prosthetics and OrthoticsThis program provides necessary prosthetics or orthotics in addition to accessories and repairs for these benefits. Examples of covered benefits:
Examples of excluded benefits:
12. Related Health ServicesThis program offers alternative benefits and services from health professionals. These health professionals must be licensed by a licensing authority recognized by the province or territory in which these services are provided, or approved by VAC. Other therapies prescribed by health professionals in support of a treatment program may be recognized by VAC. Examples of covered services (requiring referral by physician):
Examples of covered services (directly obtained services):
Examples of excluded services:
13. Special EquipmentThis program provides special equipment required for the care and treatment of disabled VAC clients. These benefits must be prescribed by your doctor, and in many cases, they must also be supported by the recommendation of another health professional. The majority of benefits in this program require that authorization be obtained from VAC before the benefit can be provided. Examples of covered benefits:
Examples of excluded benefits:
14. Vision (Eye) CareThis program offers lenses, frames, and accessories to correct sight impairments, as well as lowvision aids available from the Canadian National Institute for the Blind. Examples of covered benefits:
Examples of excluded benefits:
Methods of Payment for Health BenefitsDirect Payment - Clients using a registered provider need not worry about up front payment for services. Registered providers will submit invoices directly to Atlantic Blue Cross Care to receive payment for authorized benefits. Reimbursement - For reimbursement of health benefit services, please submit your invoices/receipts to the VAC office location nearest you: Programs of Choice 4 & 10 - Dental Services & Prescription Drugs Veterans Affairs Canada Programs of Choice 3, 7 & 11 - Audio (Hearing) Services, Medical Supplies and Prosthetics & Orthotics Veterans Affairs Canada All other Programs of Choice: 1 - Aids for Daily Living, 2 - Ambulance / Medical Travel Services, 5 - Hospital Services - Inpatient & Outpatient, 6 - Medical Services, 8 - Nursing Services, 9 - Oxygen Therapy, 12 - Related Health Services, 13 - Special Equipment, 14 - Vision (Eye) Care. Please submit your invoices / receipts to the office location nearest you (please refer to addresses listed below). Veterans Affairs Canada Veterans Affairs Canada Veterans Affairs Canada Veterans Independence ProgramWho is EligibleThe following clients may be eligible for VIP services:
Determination of VIP ServicesDistrict Office Area Counsellors will visit you to carry out a comprehensive assessment to determine your health and social needs. Requests for VIP services are considered on the basis of your needs. VIP is not intended to duplicate or replace existing provincial or community services. When provincial or local services are not sufficient to meet your needs, VIP services may be approved to complement or "top up" the services provided by the province or local agency. Based on your health assessment, your area counsellor will work with you to determine the services to be provided and the amount to be paid. You will be provided with a letter outlining the VIP services and dollar amounts approved. If your circumstances or health needs change, please contact Veterans Affairs Canada to arrange for a review of the VIP services currently in place. VIP ElementsThe Veterans Independence Program is designed to assist with the costs of certain services provided at the clients' home such as: Grounds Maintenance - Grounds Maintenance include activities regularly required to maintain the grounds immediately surrounding the client's principal residence. Examples of covered services:
Examples of excluded services:
For a more comprehensive list of eligible grounds maintenance services, see Appendix A at the back of the booklet. Housekeeping - Housekeeping services are routine tasks or domestic chores required to support the client in remaining self-sufficient at their principal residence. Certain non-routine tasks or domestic chores may also be covered, with pre-authorization by VAC, if they are required as a result of the client's health and safety being at risk. Examples of covered services:
For a more comprehensive list of eligible housekeeping services, see Appendix A at the back of the booklet. Personal care - Personal care services are approved services provided by individuals other than those defined as Health Care Professionals (i.e., attendant as opposed to nurse). These services include assistance in the performance of the activities of daily living and supervision required by clients who cannot be left unattended. Examples of covered services:
Examples of excluded services:
To provide personal care services, personal care workers must have completed a recognized personal care training program consisting of a minimum of 120 hours of training and be bonded or have liability insurance. Home Adaptations - Home adaptations can be made to a client's principal residence. For example, bathrooms, kitchens, and doorways can be modified to provide access for basic everyday activities such as food preparation, personal hygiene, and sleep. Home adaptations do not include general renovations or repairs. Examples of covered services:
Examples of excluded services:
Nutrition Services - Access to nutrition services is aimed at ensuring that clients access nutritional food, whether it is delivered to the client's principal residence, offered in the community, or served at a local restaurant. Examples of covered services:
Examples of excluded services:
Health and Support Services Provided by Health Professionals - Health and support services are health assessments and diagnostic services, care, maintenance, and related personal care provided by health professionals and approved by VAC. These can be provided only when they are not insured services under a professional health care system or available to clients as residents of a province. Ambulatory Health Care - Ambulatory health care covers certain health and social services provided outside the home such as adult day care and travel costs to access these services. Intermediate Care Services - Intermediate Care Services may be provided when living at home is no longer practical and a greater level of nursing and personal assistance is needed. Social Transportation - Transportation service may be approved to allow clients to participate in social activities, in response to the client's basic social, recreational, or personal needs. These may include transportation to: church services, occasional visits to friends/relatives, community centres, banks, and grocery stores, when transportation is not otherwise available. Social Transportation cannot be provided where eligibility for VIP is based exclusively on pension relationship. Needs AssessmentShould your needs change, please contact Veterans Affairs Canada to arrange for a review of the VIP services presently in place. Methods of Payment for VIPDirect Payment - Clients using a registered VIP provider need not worry about out-of-pocket payment for services. Registered providers will submit invoices for payment for authorized benefits. Reimbursement - For reimbursement of services by non-registered providers please complete the claim form that you have been provided with and submit it with the invoice/receipts, if required, to: National Veterans Independence Program Normally, there is a 24 hour turn-around time for reimbursement, providing acceptable documentation has been received. Other ServicesEmployees of Veterans Affairs Canada work closely with provincial and local agencies to provide clients with the greatest possible range of services and benefits to meet their physical, social, and psychological needs. For more information on the Veterans Independence Program and how to apply, please contact Veterans Affairs Canada or visit our Website at www.vac-acc.gc.ca Questions and AnswersGeneralQ. I lost my VAC Health Identification card. What do I do? A. Please call VAC and a replacement card will be issued within 2-4 weeks. Q. I have moved. Do I have to notify VAC of my change of address? A. Yes. When you move you should notify VAC by phoning the client information number indicated on your card. Q. Can I use my VAC Health Identification card in another province? A. Yes, you may use your card anywhere in Canada. Q. I am travelling outside the country for a visit. Can I use my VAC Health Identification card while there? A. If you are a resident Canadian Veteran, please contact VAC Foreign Countries Operations for details on how to access health benefits while travelling outside of Canada. VAC Foreign Countries Operations 1-888-996-2242 (Canada & US) or (613) 996-2242 (Ottawa). Health BenefitsQ. What should I do if I do not know or can not find a registered provider? A. If you do not know any registered providers, call the toll free telephone number on your VAC Health Identification card. Q. What do I do if my provider will not accept my VAC Health Identification card? A. If your provider does not accept your card, you will be required to pay for the item then submit your receipts for reimbursement along with your prescription, to the appropriate Treatment Authorization Centre. (See addresses on pages 25 & 26). It is important that you call the client information number to verify that you are eligible for the benefit. Benefits are subject to frequency and dollar limits and most benefits are required to be prescribed by your physician based on a health need. Q. My health care provider is asking that I sign a consent form. Do I have to sign the form? A. On January 1st, 2004 the Personal Information Protection and Electronic Document Act (PIPEDA) was brought into law to protect the privacy of personal information. As a result of this legislation, your health care provider may ask that you sign a consent form to allow your provider to share information about you to VAC. VAC cannot advise you to sign or not sign the consent form. If you have questions or concerns and need more information about whether you should sign the consent form, you need to discuss your concerns with your health care provider. Q. Will VAC contribute towards the cost of alternate procedures/benefits? A. Please contact VAC for assistance by phoning the toll free telephone number indicated on your card. Q. Can I still use my own physician or dentist for the treatment I need? A. Yes. You are free to use the physician or dentist/denturist of your choice for all benefits which you are eligible to receive. If you use a physician or dentist outside your region, you should contact Veterans Affairs Canada before obtaining the services. Q. Can I use my card to obtain prescribed medications, benefits, or services for my spouse and/or children? A. No. Your card is to be used for benefits and services prescribed or approved for you only. Dependants are not eligible for health benefits provided by VAC. Q. I believe that I should be eligible for benefits that are not on my card. What should I do? A. Call the toll free telephone number on your card, making reference to your client number, and explain your situation. Please be specific about what service or benefit you believe you should receive and why. Q. I have been refused a benefit from Veterans Affairs Canada to which I feel I should be entitled. What can I do? A. You have the right to request a review of the decision. Please see page 40 for details. Q. Will Veterans Affairs Canada pay for special treatment by a physician or hospital not covered by our provincial health plan? A. Normally your physician will direct you to receive necessary treatment through the provincial health care system. There may be some circumstances where VAC would pay for non-insured services. However, in order to determine this, your physician will have to submit a report to VAC. Contact Veterans Affairs Canada before treatment begins. Q. My dentures do not fit. How do I obtain a new pair? A. Visit a licensed dentist or denturist of your choice to determine if replacement dentures are necessary. Please note: If your original dentures were paid for by VAC within the last seven years, you will require authorization from VAC before a replacement denture can be provided. Q. My dentist says I need a bridge. Will VAC pay for it? A. Some dental benefits, including bridges, require prior authorization from VAC. If your dentist believes that you need a bridge, then your dentist should submit a treatment plan to VAC for consideration and authorization. Q. I need new eyeglasses. Do I get the form from my VAC District Office? A. No. You can use your VAC Health Identification card to obtain your glasses from a licensed provider in your area. Q. My provider says that VAC will only pay a certain amount for frames for my eyeglasses. May I pay the difference for a more expensive pair? A. Yes, you may pay the difference, but VAC will not reimburse you for the difference. Q. What happens if I do not use my VAC Health Identification card to obtain a benefit covered by VAC? A. If at any time you pay for a health benefit or service yourself, please keep your receipt(s) and call the toll free telephone number for direction on how to obtain reimbursement. Veterans Independence ProgramQ. I have been refused a service or my contribution amount has not been renewed. What can I do? A. You have the right to request a review of the decision. Please contact Veterans Affairs Canada. Q. My provider does not accept my card. What can I do? A. Call the toll free telephone number to verify that you are eligible for the benefit. If you are eligible, you will be given information about other providers in your area, or you can pay for the services yourself, obtain a receipt, and claim reimbursement by submitting a claim form and your receipt to: National Veterans Independence Program Q. What happens if I don't use my VIP card to obtain a service under the Health Benefits Program? A. If at any time you pay for a service yourself, please keep your receipts and call the toll free telephone number for direction on how to obtain reimbursement. Q. How do I know whether my provider is registered? A. Contact Veterans Affairs Canada for a list of registered providers within your area. Q. Can I use the services of a non-registered provider? How do I get reimbursed? When can I expect reimbursement? A. Yes, you can use the services of a non-registered provider for all VIP services except for personal care. There are some exceptional situations for personal care - contact Veterans Affairs Canada for more information. Services provided by non-registered providers can only be paid by reimbursement (except for clients on advance payment). For reimbursement, complete the claim form that you had been provided with and submit it along with receipts to: National Veterans Independence Program Normally, there is a 24 hour turn-around-time for reimbursement, providing acceptable documentation has been received by the National Veterans Independence Program Reimbursement Centre. Appendix A - Detailed list of eligible and ineligible services for Housekeeping and Grounds Maintenance Services:Routine Housekeeping - covered services:
For any housekeeping services not on the above list, contact Veterans Affairs Canada for prior authorization. Housekeeping- Non RoutineIn exceptional circumstances Non-Routine Housekeeping may be approved by your local VAC District Office. Examples include:
All non-routine housekeeping elements must be pre-approved by Veterans Affairs Canada. Ground Maintenance - covered services:
For any grounds maintenance services not on the above list, contact Veterans Affairs Canada for pre-authorization. Examples of Grounds Maintenance NOT Covered:
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