Medical Coverage, Eligibility, Management and Access to Health Care

Coverage

Within the limits provided in this document, CAF members and other eligible persons will be:

  1. provided comprehensive coverage, whether serving in Canada or abroad, including:
    1. hospitalization and physician services;
    2. supplemental health benefits including drugs and health practitioner's benefits;
    3. occupational health services; and
    4. dental services.
  2. excluded from any deductible fees or co-payments for care and services provided by or authorized by the CAF, except where otherwise specified;
  3. provided emergency health services from the nearest appropriate military or civilian treatment facility; and
  4. responsible for all costs related to health care services not authorized, or for services from sources other than those designated and authorized by the senior Health Services authority. In addition, payment will not be made for treatments or therapies if they are deemed to be:
    1. controversial;
    2. not scientifically founded or proven;
    3. not medically beneficial; or
    4. provided solely for cosmetic purposes.

Limitation: Health Services Outside Canada. Eligible persons residing in Canada will not be entitled to routine health services outside Canada.

Note: Consideration will be given for cost recovery for the fees that result from missed appointments.

Eligibility

All Regular Force (Reg F) personnel are covered by the Spectrum of Care (SoC) from the time of enrolment to the effective date of release from the CAF. Reserve Force (Res F) personnel are covered only during specified periods of eligibility based on their duty status and the relatedness of their illness or injury to military service (QR&O 34.07).

From time-to-time, other persons may be authorized for specific services or for specified periods of time. Some examples are: visiting military forces, foreign military exchange personnel and their dependants, CAF recruit applicants and civilian food handlers.

Management

The SoC committee determines the services to which members are entitled. Entitlement to services is based upon the following five guiding principles:

  1. the benefit adheres to the scientific principle of evidence based medicine. This principle would eliminate any new medical procedures or remedies that have not been thoroughly and scientifically investigated (e.g. homeopathic remedies);
  2. the benefit is necessary for the purpose of maintaining health and mental well-being, preventing disease, diagnosing or treating an injury, illness or disability;
  3. the benefit is not for purely experimental, research or cosmetic purposes;
  4. the benefit is funded by a single province or federal agency. This principle is in keeping with Public Service Health Care Plan (PSHCP) criteria; and
  5. the benefit sustains or restores a serving member to an operationally effective and deployable member of the CAF.

The spectrum of care consists of six parts:

  1. Comprehensive Medical Care;
  2. Supplemental Health Care;
  3. Occupational Health Care;
  4. Preventive Medicine;
  5. Health Promotion; and
  6. Comprehensive Dental Care.

Accessing Health Care

Access to Health Care will, by necessity, be slightly different from base to base and dependent on: the base role, the size of the military population, the base location, the type and size of facilities available and the number and type of military and civilian Health Care personnel available. The local HCC and Dental Detachment Commander will be responsible to clearly publish any changes to the procedures and routines for accessing both regular and emergency health care.

Access to private medical clinic could be appropriate if there is either a clinical or operational requirement and the process is described in the Enhanced Access Health Care Services.