Veterans Health Care Regulations (SOR/90-594)

Regulations are current to 2019-08-28 and last amended on 2019-04-01. Previous Versions

PART IVGeneral (continued)

Limitation on Reimbursements and Payments

  •  (1) Where a person incurs an expenditure to meet a health need, no reimbursement or payment shall be made under these Regulations to or in respect of the person except in accordance with this section.

  • (2) Subject to subsections (4) to (6), reimbursement or payment shall be made if the person was eligible to receive benefits, services or care under these Regulations for that health need at the time that the expenditure was incurred.

  • (3) Subject to subsections (4) to (6), reimbursement or payment shall be made if the person, within 90 days after incurring the expenditure, applies for a pension and

    • (a) the person is awarded the pension for the condition in respect of which the expenditure was incurred and would have been eligible to receive benefits, services or care in respect of that condition if the person had been entitled to the pension at the time the expenditure was incurred;

    • (b) the person is awarded the pension and as a result qualifies as a seriously disabled veteran or seriously disabled civilian; or

    • (c) the person is awarded the pension and, as a result, qualifies as a veteran pensioner or civilian pensioner, if 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%.

  • (4) A claim for reimbursement or payment must be made by or on behalf of the person within 18 months of the day on which the expenditure was incurred.

  • (5) Proof of the expenditure must be provided by the person or on the person’s behalf.

  • (6) Subject to subsection 34(1), no reimbursement or payment shall exceed the maximum amount payable under these Regulations at the time the expenditure was incurred.

  • (7) This section does not apply to a claim in respect of the services referred to in subparagraph 19(a)(iii) or (v). Payment shall be made for those services only in respect of periods during which a person is eligible to receive those services.

  • SOR/2001-157, s. 13
  • SOR/2001-326, s. 13
  • SOR/2003-362, s. 12
  • SOR/2005-39, s. 2
  • SOR/2006-50, s. 83
  • SOR/2012-221, s. 1
  • SOR/2017-161, s. 10

Payment Arrangements

 Where a client is eligible under these Regulations to receive a payment in respect of a benefit, service or care provided or paid for by a third party, the payment may be made

  • (a) directly to the client;

  • (b) to the third party on behalf of the client; or

  • (c) to the client and the third party jointly.

Notice of Decisions

 The Minister shall notify a client or the client’s representative of any decision relating to the award, increase, decrease, suspension or cancellation of any benefit under these Regulations concerning or affecting the client.

  • SOR/98-386, s. 17

Review of Decisions

  •  (1) A person who is dissatisfied with any decision made under these Regulations may, within 60 days after receiving notice of the decision or, where circumstances beyond the control of the person necessitate a longer period, within that longer period, apply in writing to the Minister for a review of that decision by an official of the Department of Veterans Affairs other than the official who made the original decision.

  • (2) Where a person is dissatisfied with the results of a review referred to in subsection (1), the person may, within 60 days after receiving notice of the decision on the review unless circumstances beyond the control of the applicant necessitate a longer period, apply in writing to the Minister for a final decision to be rendered by an official of the Department of Veterans Affairs other than the official who made the original decision or who reviewed it.

  • SOR/98-386, s. 18
  • SOR/2001-157, s. 14(E)
  • SOR/2009-225, s. 17

Reciprocal and Other Arrangements

 Benefits, services or care under these Regulations may be accorded to residents of a country other than Canada in accordance with

  • (a) a reciprocal or other arrangement made by the Minister with the government of that country, with such modifications as are necessary to comply with the terms of that arrangement; or

  • (b) special arrangements under which the benefits, services or care are provided at the expense of that country, with such modifications as are necessary to comply with the terms of those arrangements.

Transition Period

  •  (1) A client referred to in section 21, as it read immediately before the coming into force of this subsection, who was in receipt of adult residential care, intermediate care or chronic care in a departmental facility for any period of time that is within 30 days before the day on which the deed of transfer respecting the Hôpital Sainte-Anne-de-Bellevue is signed is not required to pay the cost of the accommodation and meals referred to in section 33.1, as it read immediately before the coming into force of this subsection, in that departmental facility for that period of time.

  • (2) For the purposes of subsection (1), departmental facility means the Hôpital Sainte-Anne-de-Bellevue.

  • SOR/2016-31, s. 12
 
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