Short‑term Mental Health Coverage for Veterans

Summary#

These final regulations (SOR/2022-69) change the Veterans Health Care Regulations to create a new short-term mental health coverage program for certain veterans who apply for disability benefits. The rules were registered on March 28, 2022 and the new mental health coverage takes effect on April 1, 2022 (or on registration if the regulations are registered after that date).

What it does#

• Adds a new “Mental Health Benefits” section to the Veterans Health Care Regulations that lets eligible people get early coverage for mental health assessment and treatment while their disability claim is being decided.
• Defines eligible mental health conditions as anxiety disorders, depressive disorders, and trauma- and stressor-related disorders.
• Sets who can get the coverage:
  • Former members of the Canadian Forces and reserve members who are not covered for treatment by the Department of National Defence (DND).
  • Includes veterans who live outside Canada, if they apply for disability benefits for an eligible condition.
  • A person becomes eligible when they apply for disability benefits (or on April 1, 2022 if their application was already pending before that date).
• Describes what is covered:
  • Examinations and treatment by psychologists, counsellors, social workers or other professionals approved by the Minister.
  • Pharmaceuticals prescribed by an authorized prescriber (but not cannabis for medical purposes).
  • Coverage follows provincial fee rules in Canada or reimburses reasonable costs abroad up to an approved maximum.
  • Supplementary travel benefits and some other Treatment Benefits are not covered until a favourable disability decision is made.
• Explains how long coverage lasts:
  • Coverage continues while a decision on the disability application is pending.
  • If the final decision is unfavourable, coverage can continue for two years from the eligibility date in many cases.
  • If the decision is favourable, the person moves into the normal VAC Treatment Benefits program.
• Sets administrative details:
  • Medavie Blue Cross will issue benefit cards and handle payments.
  • Veterans Affairs Canada has a 21-calendar-day service standard to confirm eligibility and notify applicants.
• Makes a number of housekeeping and rate updates to other parts of the Regulations, including new dollar limits such as:
  • Home care: $11,842.40 per client per year (includes up to $1,652.41 for grounds maintenance).
  • Ambulatory health care: $1,377.02 per client per year.
  • Transportation: $1,652.41 per client per year.
  • Home adaptations: $6,775.43 per client per principal residence.
  • Intermediate care: $165.91 per client per day.
  • Veterans independence services: $3,198.80 per year maximum.
  • Chronic care in a community facility: $278.39 per client per day.
  • Maximum monthly accommodation and meal charge (for a specified period): $1,091.43 per month; personal comforts: $263.62 per month.

Who's affected#

• Veterans and former Canadian Forces members who apply for disability benefits for the listed mental health conditions.
• Still-serving reserve members who do not have DND treatment coverage.
• Veterans who live outside Canada (they are included if they apply).
• Families and caregivers who may see earlier access to counselling and medicine for an eligible veteran.
• Veterans Affairs Canada administers the program and will incur the program costs; Medavie Blue Cross will administer benefits.
• Provincial health plans and other insurers may act as first payers in cases where they already cover a service.

If any of the above descriptions are unclear for an individual case, the Regulations and VAC guidance determine the specifics.

Why it matters#

• The change gives eligible veterans quicker access to counselling and medications for common service-related mental health problems while they wait for a decision on their disability claim. That can reduce delays in care, prevent conditions from worsening, and lower out-of-pocket costs for veterans who otherwise would pay for treatment themselves.
• Uptake and cost estimates in the Government analysis: about 27,000 veterans are expected to use the new benefit over 10 years; estimated government costs are $40.7 million over 10 years, with a net present value of −$34.2 million (government costs exceed quantified monetized benefits). The analysis also notes important non-monetized benefits to veterans’ health and family well‑being.
• The coverage excludes some items commonly associated with VAC Treatment Benefits (notably cannabis for medical purposes and health-related travel) until entitlement is decided. This matters for veterans who rely on those services.
• The Regulations also update several dollar limits for other care programs (home care, intermediate care, etc.), which can affect what VAC will pay for those services.