Part VI - Medical and related expenses

FSD 38 - Preventive medical services expenses

Introduction

The employer wishes to ensure through preventive medical services that the general good health of employees and their dependants at posts outside Canada is maintained and that a tour of duty abroad will not have to be terminated because of the foreseeable or avoidable illness of an employee or dependant. Health Canada has been delegated authority to amend the appendix to this directive as and when required.

Directive 38

38.01  An employee and each dependant who:

(a)  is residing at a post listed in the appendix to this directive and indicated in the Foreign Affairs and International Trade's monthly Schedules to Foreign Service Directives and Meal Rates, or

(b)  is in full-time attendance at an educational institution away from the post and expenses are being paid pursuant to FSD 51 - Family reunion,

shall have the right, or may be required by the employer, to undergo chest x-ray examination, physical examination and laboratory or special examination or immunization as may be required, at the nearest place where suitable facilities exist as determined by Health Canada, and the results of such examinations shall be forwarded to Health Canada.

38.02  On assignment to Canada or to another post, an employee and/or a dependant residing at the post may, on request, be granted, or may, as a condition of future posting, be required by the employer to undergo a medical examination which shall include such specialist services, psychological assessments, x-rays or immunization as may be required.

Instructions

1.  The medical examinations referred to in Section 38.02 shall normally be provided where:

(a)  the employee and/or dependant completes a period of service at an unhealthy post; and/or

(b)  the employee has had a previous period of service at an unhealthy post, or has been otherwise exposed to unhealthy conditions at a post, and/or

(c)  a reasonable period of time has passed since the last medical examination of an employee or a dependant.

2.  The medical examinations referred to in Section 38.02 may be given in Canada or at another location approved by the deputy head while an employee is on leave or temporary duty.

38.03  The medical examinations referred to in Sections 38.01 and 38.02 and related hospitalization, if applicable, shall be administered in the manner prescribed by Health Canada, without charge to the employee, by a Canadian government facility, or by a private medical facility where the deputy head has authorized its use due to special circumstances or the absence of a Canadian government facility.

Instruction

The "prescribed manner" of medical examination specified in Section 38.03 shall be varied as appropriate in consideration of conditions at the post where the employee has served, or in consideration of the previous medical history of the employee or a dependant who is to be examined.

38.04  Where medical examinations are administered pursuant to Sections 38.01, 38.02, 38.06 and 38.07, the deputy head shall authorize:

(a)  payment of actual and reasonable medical expenses, and, where applicable,

(b)  payment of travelling expenses, as defined in FSD 2.01(aa), which means expenses for air transportation and local transportation to and from airports at the points of departure and destination and, when authorized in advance by the deputy head, for accommodation, meals and local transportation to and from the airport for a necessary stopover, where it is not possible or practicable to arrange an itinerary which will permit continuing travel to the approved destination.

38.05  An assessment as to fitness for duty prepared by Health Canada shall be submitted to the deputy head in respect of any medical examination administered pursuant to Sections 38.01 and 38.02. At the employee's request, the employer shall provide the employee with access to this assessment.

Instruction

The assessment as to fitness for duty prepared by Health Canada does not contain confidential medical information. Confidential medical information is available to an employee under the Privacy Act, or may be obtained informally by an employee from Health Canada.

38.06  Whenever a medical matter is at issue, the employee shall have the right to have a personal physician submit a written medical opinion to Health Canada. That department shall review such opinion and submit another assessment as to fitness for duty to the deputy head, taking into consideration the medical opinion of the employee's physician.

38.07

(a)  Where a variance in the written medical opinions submitted pursuant to Sections 38.05 and 38.06 is significant, Health Canada may request a third and independent written medical opinion, which shall be taken into consideration in resubmitting an assessment as to fitness for duty to the deputy head.

(b)  Where the deputy head is not satisfied with the assessment as to fitness for duty and a third and independent written medical opinion has not been obtained by Health Canada, the deputy head may request that a third and independent written medical opinion be submitted to Health Canada, which shall take such opinion into consideration in forming an assessment as to fitness for duty.

38.08

(a)  In making the decision concerning the assignment of an employee, the deputy head shall give consideration to the assessments as to fitness for duty submitted pursuant to Sections 38.05, 38.06 and 38.07.

(b)  Where, after taking into account any assessment as to fitness for duty provided, the deputy head determines that an employee cannot be posted, or cannot continue an assignment abroad, the employee shall be so informed.

38.09  The deputy head may approve payment of the expenses of a medical examination, laboratory tests and chest x-rays of each servant of an employee, (other than a casual servant) prior to employment and annually thereafter, provided:

(a)  the servant is one who is in frequent close contact with the employee or a dependant, and

(b)  such costs are not covered by local law.

38.10  The deputy head may approve payment of the necessary expenses of immunizing an employee, dependant and servant against communicable disease, provided:

(a)  the immunization is recommended by Health Canada, and

(b)  such costs are not covered by local law.

38.11  The deputy head may approve payment of the expenses incurred by an employee in securing preventive medicines, provided they have been prescribed by competent medical authority.

Instruction

The "competent medical authority" referred to in Section 38.11 may be a physician recognized by Health Canada, or other duly qualified medical practitioner acceptable to Health Canada.

38.12  Where it is necessary for a medical examination authorized under this directive to be conducted during normal working hours, the employee shall be considered to be on duty for the period required for such examination.

38.13  Where an employee is required to undergo a medical examination authorized under this directive, and it is not possible to conduct such examination during scheduled working hours, the deputy head may authorize compensation for any overtime as provided for in the applicable collective agreement for the period required for such examination.

38.14  Expenses incurred by the employee pursuant to Sections 38.01, 38.02, 38.06, 38.07, 38.09, 38.10 and 38.11 shall not be a charge against the employee's health and hospitalization insurance plan.

38.15  For the purposes of this directive, the posts listed in the appendix to this directive and as indicated in the Foreign Affairs and International Trade's monthly Schedules to Foreign Service Directives and Meal Rates are classed as unhealthy on the advice of Health Canada.

Instructions

1.  An unhealthy post is one where personnel are exposed to and may develop illnesses or diseases of a nature they would not develop or would be unlikely to develop in Canada.

2.  Several factors may exist alone or in combination which determine whether a post is unhealthy in the light of this definition. These include the diseases of the region, the climate, the altitude and the living and working conditions for Canada-based personnel and their dependants.

3.  Health includes mental health, and illness includes mental illness.

Appendix - Schedule of unhealthy posts

Abidjan, Ivory Coast
Accra, Ghana
Addis Ababa, Ethiopia
Algiers, Algeria
Amman, Jordan
Anguilla
Ankara, Turkey
Antigua
Arusha, Tanzania
Baghdad, Iraq
Bamako, Mali
Bangkok, Thailand
Beijing, P.R. China
Beirut, Lebanon
Belgrade, Serbia
Belize City, Belize
Birendranagar, Nepal
Bogota, Colombia
Bolgatanga, Ghana
Brasilia, Brazil
Bridgetown, Barbados
British Virgin Islands
Bucharest, Romania
Budapest, Hungary
Bujumbura, Burundi
Cairo, Egypt
Caracas, Venezuela
Chandaghar, India
Chonquing, China
Colombo, Sri Lanka
Conakry, Guinea 
Dakar, Senegal
Damascus, Syria
Dar-es-Salaam, Tanzania
Dhaka, Bangladesh
Diyarbakir, Turkey
Dominica 
Gaborone, Botswana
Gaza Strip, Israel
Georgetown, Guyana
Golan Heights, Israel
Grenada
Guatemala City, Guatemala
Harare, Zimbabwe
Havana, Cuba
Hong Kong
Hyderabad, India
Islamabad, Pakistan
Jakarta, Indonesia
Jerusalem, Israel
Kandy, Sri Lanka
Katmandu, Nepal
Khartoum, Sudan
Kigali, Rwanda
Kingston, Jamaica
Kinshasa, Zaire
Kuala Lumpur, Malaysia
Kupang, Indonesia
Kuwait
La Paz, Bolivia
Lagos, Nigeria
Libreville, Gabon
Lima, Peru
Luanda, Angola
Lusaka, Zambia
Managua, Nicaragua
Manila, Philippines
Maseru, Lesotho
Mbabane, Swaziland
Mexico City, Mexico
Montserrat
Moscow, Russia
Mumbai, India
Nahariya, Israel
Nairobi, Kenya
New Delhi, India
Niamey, Niger
Ouagadougou, Burkina-Faso
Port of Spain, Trinidad and Tobago
Port-au-Prince, Haiti
Prague, Czech Republic
Pucallpa, Peru
Puno, Peru
Quetta, Pakistan
Quito, Ecuador
Rabat, Morocco
Rangoon, Burma 
Riyadh, Saudi Arabia
San Jose, Costa Rica
San Salvador, El Salvador
Santiago, Chile
Sao Paulo, Brazil
Seoul, Korea
Shanghai, P.R. China
Singapore
St. Kitts and Nevis
St. Lucia
St. Vincent and the Grenadines
Taipei, Taiwan
Tarapoto, Peru
Tegucigalpa, Honduras
Tehran, Iran
Tel Aviv, Israel
Thies, Senegal
Tiberias, Israel
Tunis, Tunisia
Turks and Caicos Islands
Vila, Vanuatu
Warsaw, Poland
Wellington, India
Yaounde, Cameroon

Notwithstanding the provisions of section 107 of the Public Service Labour Relations Act, revisions to this Schedule shall not constitute a change in terms and conditions of employment for employees subject to the Foreign Service Directives. (revised April 1, 2006)

FSD 39 - Health care expenses

Introduction

This directive provides financial assistance to employees who incur health care expenses outside Canada which exceed those permissible under the Public Service Health Care Plan (PSHCP) and the Public Service Dental Care Plan (PSDCP), subject to certain conditions as specified in the directive.

Directive 39

39.01 For purposes of this directive, dependant means each dependant or dependent student as defined in FSD 2.01(j) or 2.01(k), respectively, who

(a) is residing with the employee at the post, or

(b) is in full-time attendance at an educational institution outside of Canada.

Instruction

It is essential that employees maintain comprehensive family coverage under the PSHCP for dependent students, normally resident in Canada, who visit the post for more than 40 days at one time.

39.02 Subject to the provisions of Section 39.05, where expenses have been incurred for health care, drugs or dental treatment in respect of an employee and/or a dependant which are in excess of eligible expenses under the Public Service Health Care Plan or the Public Service Dental Care Plan, the deputy head may authorize reimbursement to the employee of the amount in excess, provided:

(a) the employee pays the deductible share under the Public Service Health Care Plan or the Public Service Dental Care Plan or the share which would have been applicable for insurance under these plans; and

(b) the employee pays any co-insurance applicable under the Public Service Health Care Plan or the Public Service Dental Care Plan or the amount of co-insurance which would have been applicable for insurance under these plans; and

(c) the expenses involved have been incurred pursuant to consultation with a medical practitioner or dentist acceptable to Health Canada;

(d) the employee submits a claim under the Public Service Health Care Plan or the Public Service Dental Care Plan within the time constraints of the plan (usually 12 months) except that;

(e) where a claim is denied under the Public Service Dental Care Plan because it is for treatment which was previously claimed, and the required time has not elapsed before another claim may be made, the deputy head may authorize reimbursement in such amount as may be recommended by the Administrator of the Plan to reflect the amount which would otherwise have been payable under the PSDCP as an initial claim, plus any excess dental costs identified by the Administrator of the Plan and payable under this directive. This provision is designed to provide for those necessary additional costs resulting from initial incompetent/inadequate treatment, where the employee is no longer at the location where the original treatment took place or, in the opinion of Mission administration, cannot obtain redress from the original practitioner.

Instruction

Where an advance has been authorized under FSD 42 - Medical and/or dental expense advance, and a claim is rejected under the plan because of lateness, the employee shall be responsible for full repayment of the advance, which shall be subject to recovery pursuant to the relevant provisions of the Financial Administration Act.

39.03 The amount payable under Section 39.02 shall not exceed the amount over and above that which the employee is eligible to receive as a participant in any other plan of health insurance.

Instruction

Section 39.03 recognizes those situations where an employee incurs health care expenses outside Canada while still covered by a provincial health insurance plan following departure from Canada.

39.04 The health care referred to in this directive may include para-medical care and the services of medical and dental specialists, provided such services have been recommended pursuant to consultation with a medical practitioner or dentist acceptable to Health Canada.

Instructions

1. Each Post shall compile a roster of qualified local medical practitioners and dentists whom personnel at the post may consult. The roster should include medical internists, obstetricians, pediatricians and general practitioners and dental general practitioners and specialists.

2. Where costs for medical and hospital care, drugs and/or dental treatment are excessive, and the treatment can be deferred, an employee should explore the possibility of obtaining treatment at an alternative location. In such cases the employee should contact the deputy head who shall determine the cost effectiveness of obtaining treatment at an alternative location, including the cost of health care travel and related expenses under FSD 41 - Health care travel; the deputy head may thereafter authorize treatment at a location other than the employee's post.

3. Employees shall be required to submit receipted accounts showing the differences between their actual expenses and those admissible under the PSHCP or the PSDCP, or their plan of health or hospitalization insurance.

4. In claiming for health care expenses which are in excess of eligible expenses under the PSHCP, the employee should include the detailed statement provided by the Administrator of the Plan. It should be noted that a claim may not be made for expenses which are not admissible under the PSHCP or which exceed specific dollar limits under the PSHCP as these are expenses which would be incurred by employees in Canada.

5. In claiming for excess hospital costs, an adjustment will be made where an employee has less than maximum coverage. For example, an employee incurs excess costs of $100.00 per day for semi-private hospital coverage and has Level I coverage which provides a benefit of $60.00 per day rather than Level III coverage which provides a benefit of $150.00 per day. The claim would be reduced by the difference between Level III and Level I coverage, that is, $90.00, and the employee would receive an adjusted amount of $100.00 minus $90.00, or $10.00.

6. Employees may claim for dental care expenses to the extent which would place them in the same position as employees in Ontario. Where eligible expenses under the Public Service Dental Care Plan which are incurred outside Canada are higher than in Ontario, employees may submit a claim for that portion of the cost which they are required to pay outside Canada and which would not be incurred in Ontario. For example, and assuming the deductible has been satisfied and reimbursement under the dental plan is at 50%, if in Ontario the eligible expense for a service is $400 (with the employee paying $200) and outside Canada the eligible expense is $600 for the same service (with the employee paying $300), then the cost to the employee is $100 more than it would be in Ontario. The employee could then claim $100 under this directive. This would place the employee outside Canada in the same position as the employee in Ontario.

7. Except as provided for under the Public Service Health Care Plan, dental care expenses are only eligible for reimbursement under this directive provided the employee, and eligible dependants, were covered, or were eligible to be covered, under the Public Service Dental Care Plan.

8. To assist employees in claiming dental expenses under this directive, the Administrator of the Plan will provide employees outside Canada who claim for dental expenses with the required information on excess dental costs as part of their claims procedure. A copy of the Explanation of Benefits from the Administrator of the Plan identifying the excess dental expenses should be attached to the claim for reimbursement which employees should submit to their departmental headquarters in the same way they would submit a claim for reimbursement of health care expenses under this directive.

9. Section 39.02(e) is designed for those situations where a claim for dental care has been refused by the Public Service Dental Care Plan because the employee is claiming for a specific procedure which was previously paid for under the Plan, under certain circumstances, and the required time has not elapsed before another claim may be made. When, in the opinion of the employee, the duplicate procedure was necessary because of incompetent/inadequate workmanship at a mission outside Canada, the employee should appeal the decision, and request referral to the Board of Management, on the basis of initial shoddy workmanship. While payment cannot be authorized under the Public Service Dental Care Plan, this will enable the Administrator of the Plan to investigate and determine whether a recommendation for payment is justified under this directive.

10. Where a claim for oral surgery has not been paid in full by the Public Service Dental Care Plan, a claim should be submitted to the Public Service Health Care Plan along with copies of the original claim made to the dental plan and the Explanation of Benefits from the Administrator of the Plan. If, following this settlement, there is still an unpaid balance, the employee should submit a claim under this directive, along with copies of the Explanation of Benefits from the Administrators of the Plans.

39.05 Where health care expenses are incurred on behalf of a dependant because of:

(a) an illness due to conditions at a location where the employee and/or a dependant is or has been residing and which is of a type, the incidence of which is greater than in Canada, or

(b) an injury resulting from an event at a location where an employee and/or dependant is or has been residing, and which would not normally occur in Canada, or which gives rise to circumstances not normally experienced in Canada,

the deputy head shall, in determining the amount of reimbursement under Section 39.02, include for payment:

(c) the deductible share attributable to the difference between single and family coverage under the Public Service Health Care Plan or the Public Service Dental Care Plan as applicable; and

(d) the actual amount of co-insurance for which the employee was responsible under the Public Service Health Care Plan or the Public Service Dental Care Plan.

Instruction

Section 39.05 does not apply to employees as they are covered by the Government Employees Compensation Act.

39.06 In reviewing claims for payment pursuant to Section 39.05, the deputy head shall seek and take into consideration the advice of Health Canada in order to confirm that the illness or injury is attributable to conditions at post.

39.07 Where an employee's medical, hospital or dental care insurance under the Public Service Health Care Plan is exhausted by expenses incurred as a result of an illness or injury described in Section 39.05, the deputy head shall authorize payment of the amounts that would have been paid under such plans until such time as the employee's normal coverage is re-established.

FSD 40 - Provincial health insurance premiums - dependants resident in Canada

Introduction

This directive provides financial assistance to employees who incur expenses for provincial health insurance premiums on behalf of a dependant(s) resident in Canada which exceed the cost of premiums for family coverage under the Public Service Health Care Plan that would otherwise have been payable had the dependant(s) accompanied the employee to the post.

Directive 40

40.01 Where an employee is required to pay provincial health insurance premiums on behalf of a dependant(s) resident in Canada which exceed the cost of premiums for family coverage under the Public Service Health Care Plan that would otherwise have been payable had the dependant(s) accompanied the employee to the post, the employee may claim an allowance for the excess amount, on presentation of receipts, for a separated dependant(s):

(a) for whom the employee is receiving family separation expenses under the provisions of FSD 16.09, or separation assistance for spouses or common-law partners under the provisions of FSD 17.04 or 17.05, or

(b) for whom the employee is being paid an education allowance(s) and/or shelter assistance under the provisions of FSD 34 - Education allowances, where such dependant(s) is/are attending an elementary, secondary or post-secondary educational institution in Canada,or

(c) who is under age 21 and who is receiving care or training in an institution in Canada by reason of a mental and/or physical infirmity or disability,

except that where a spouse or common-law partner chooses to remain in Canada for personal reasons, other than those specified for payment of family separation expenses or separation assistance for spouses or common-law partners, and is insured with other dependants, the cost of single coverage shall be attributed to only the balance of the premium actually paid shall be eligible for inclusion in the allowance.

Instructions

An employee may claim an allowance which represents the excess amount of the premium, as specified in Section 40.01 for costs incurred on or after October 1, 1997.

At the time the allowance is issued, the employee will be required to certify that the allowance will be used as specified and that any changes to the anticipated costs will be reported to Post Management. Allowances may be revised accordingly.

Employees will be required to submit such documentation as the employer may require to substantiate that the allowance was used for the purpose intended.

FSD 41 - Health care travel

Introduction

At a number of locations abroad, the standards of medical care and the extent of treatment facilities or specialist services are inadequate in comparison with those in Canada. Additionally, at several locations, while adequate health care/facilities exist, treatment costs are excessive. This directive is designed to ensure that an employee and/or dependant has access to necessary and suitable health care facilities and services on a cost-effective basis as determined by the deputy head.

The 1997 conversion of travel entitlements to non-accountable allowances has resulted in significant changes to administrative procedures. Allowances provided under FSD 41.04(b) are subject to the issue and verification procedures of FSD 70. Funds provided under the balance of FSD 41 are fully accountable.

Directive 41

41.01 In this directive, dependant means each dependant or dependent student, as defined in FSD 2.01(j) or 2.01(k) respectively, who:

(a) resides with the employee at the post, or

(b) is in full-time attendance at an educational institution outside of Canada.

41.02 The health care facilities or services referred to in this directive may include dental care, only for those posts listed in the Appendix to FSD 9 - Medical and dental examinations, and indicated in the Foreign Affairs and International Trade's monthly Schedules to Foreign Service Directives and Meal Rates, and reasonable para-medical care.

41.03

(a) Where the deputy head is satisfied that necessary and suitable health care facilities or services are not available locally, or local treatment costs exceed costs of travel, treatment and living expenses at the nearest suitable location, another suitable location, or Canada, the following may be approved:

Instructions

1. When approving payment of travelling and living expenses for accompanying dependent children on health care travel, the deputy head shall consider each case on its own merits taking into account such factors as the ages of the children accompanying the parent and the availability and cost of child-care services at the post.

2. The dollar amounts specified in Section 41.03(a)(v) shall be adjusted from time to time to reflect the dollar amounts authorized by the Travel Directive; any such change shall be indicated in the Foreign Affairs and International Trade's monthly Schedules to Foreign Service Directives and Meal Rates.

3. Receipts for dependant care costs under this section shall include the cost, dates of employment and the sitter's / company's name and telephone number, as well as the sitter's social insurance number (where applicable).

4. The provisions for dependant care under this directive also apply to joint custody situations where the dependant qualifies as a dependant under the provisions of FSD 2 - Interpretation. Depending on the terms of the joint custody agreement, dependant care assistance shall not normally be provided where the child's other parent resides in the same location as the child who requires dependant care.

(b) For the purposes of this section, travelling expenses(frais de déplacement) means expenses for air transportation and local transportation to and from airports at the points of departure and destination and, when authorized in advance by the deputy head, for accommodation, meals and local transportation to and from the airport for a necessary stopover, where it is not possible or practicable to arrange an itinerary which will permit continuing travel to the approved destination.

(c) For the purposes of this section, living expenses (frais de subsistance) means:

(d) Unless the deputy head otherwise directs, travel leave shall only be granted during normal working hours where it is not feasible for the employee to travel during non-working hours.

Instructions

1. The need for an escort to remain with the person being treated will vary with the circumstances. For example, if the person being treated is a small child, it may be necessary or desirable for an escorting parent to remain with the child throughout the treatment period. On the other hand, if it is not necessary for the escort to remain with the person being treated, it may be more cost-effective to have the escort make a second trip to the treatment centre at the conclusion of the treatment period, rather than to pay living expenses throughout the treatment period.

2. The deputy head shall determine the suitability of health care facilities by reference to the advice of a roster doctor, an official of Health Canada or other qualified medical practitioner. An assessment of the suitability of treatment centres should also take into account cultural, social and political factors.

Guidelines

1. Telephone calls are to be supported by receipts or an appropriate statutory declaration that the costs have been incurred. Where direct dialing facilities are not available, the deputy head shall determine the appropriate cost limitation.

2. More than one telephone call may be claimed per week, as long as the total cost for the period of health care travel does not exceed the total cost for one ten-minute call per week for the total period of health care travel.

41.04 In cases of accouchement, where payment of actual and reasonable travelling expenses has been authorized under Section 41.03 for an employee and/or a dependant who travels to the nearest suitable place; or where the deputy head determines it is cost-effective and the employee so requests, to Canada or another suitable place where accouchement may take place, the deputy head may also approve:

(a) the payment of actual and reasonable living expenses both before and after the time of delivery where:

(b) an allowance for travelling expenses and living expenses for a period not to exceed five days, in accordance with Section 41.03, to enable the spouse or common-law partner to be present at the birth of the child.

Instructions

1. While the standard for air travel is economy class (including APEX, charters and other reduced fares), there may be situations which, in the opinion of the deputy head, justify a higher standard of travel. The lowest available airfare appropriate to a particular circumstance andor itinerary shall be authorized. Particularly where health care travel can be anticipated and travel arrangements made in advance, discount and reduced fares shall be selected, where these rates are available. Significant savings can be realized if flights are booked as far in advance as possible. In non-urgent situations, it is the responsibility of the employee to make every effort to schedule medical appointments and/or treatment in order to take advantage of advance bookings.

2. Additional leave in connection with travel under Section 41.04(b) should be claimed under FSD 48 - Other leave, and not under this directive.

3. Provisions for the issue and verification of travel allowances under FSD 41.04(b) are found in FSD 70 - Reporting requirements and verification of allowances.

41.05 When health care travel is authorized under this directive, a medical report from the attending physician, acceptable to Health Canada, must be sent to

Medical Officer in Charge
Workplace Health and Public Safety Program
Healthy Environments and Consumer Safety Branch (3712M)
Health Canada
171 Slater Street
Ottawa, ON K1A 0K9

FSD 42 - Medical and/or dental expense advance

Introduction

At locations outside Canada, doctors, dentists and hospitals may not be prepared to wait for payment from medical, dental or hospitalization insurance plans. Accordingly, where the employee can demonstrate eligibility for future reimbursement for health care or dental expenses, either from the Public Service Health Care Plan or the Public Service Dental Care Plan or pursuant to the Foreign Service Directives, the employer will make an advance to the employee for the purpose of paying medical or dental expenses.

The intent of this directive is to provide financial support for larger expenses, rather than for routine medical and dental expenditures.

Directive 42

42.01 Where an employee incurs expenses for health and/or dental care and is eligible for reimbursement either from the Public Service Health Care Plan or the Public Service Dental Care Plan or pursuant to the Foreign Service Directives, the deputy head may authorize an advance to the extent of such expenses. Such advances shall be authorized only:

(a) where the advance is not less than $200; and

(b) where, subject to Sections 42.03 and 42.04, the employee agrees to repay the advance within 6 months; and

(c) where the employee submits an estimate of costs from the doctor, dentist or hospital representing 90% of the advance requested, when the amount of the advance exceeds $500; and

(d) on condition that the employee undertakes in writing on the Medical and/or Dental Expense Advance form to endorse and remit to the Receiver General for Canada any cheque issued by the underwriters or by the employer under the provisions of another foreign service directive in reimbursement for the medical or dental expenses for which the advance was authorized; and

(e) in the case of an advance for dental expenses for dependants not covered by the Public Service Dental Care Plan (PSDCP), employees may be asked to provide proof of coverage.

Instructions

1. Provisions related to the financing of advances made under Section 42.01 are contained in the Appendix to FSD 10 - Posting loan.

2. In order to protect employees from exchange rate fluctuations, advances may be calculated and reimbursed in Canadian dollars or in some other currency, where this is the currency used in all of the following: (revised April 1, 2004)

(a) the estimate of costs from the health care provider submitted by the employee in support of the medical/dental expense advance; (revised April 1, 2004)

(b) the payment for services for which the advance was approved; and (revised April 1, 2004)

(c) the reimbursement of the employee's claim of insurance. (revised April 1, 2004)

3. The deputy head has delegated authority to the Head of Mission to approve and monitor all medical/dental advances for employees at their Mission(s) of responsibility. It is the HOM's responsibility to ensure the legality and suitability of the currency in which the advance is requested, where this is not Canadian dollars. In the case of an advance to the HOM, authority must be sought from the FSD Policy and Administration Division, DFAIT. (revised April 1, 2004)

42.02 Except as provided in Section 42.04, where, for any reason, any cheque issued by a plan administrator or by the employer under the provisions of another foreign service directive in reimbursement for the medical or dental expenses for which the advance was authorized is not endorsed and remitted to the Receiver General for Canada by the employee, such advance shall be repaid upon receipt of such settlement.

42.03 Except as provided in Section 42.04:

(a) where an employee who has received settlement from a plan administrator or from the employer, fails to repay any outstanding portion of the advance within 60 days of the date(s) on which the settlement cheque(s) were issued, such outstanding portion of the advance shall be subject to recovery pursuant to the relevant provisions of the Financial Administration Act.

(b) where an advance has been authorized under this directive, the employee shall ensure that a claim under the Public Service Health Care Plan or the Public Service Dental Care Plan is submitted as soon as possible, notwithstanding the time requirements that the plans have in place for accepting claims; in the event that a claim is rejected under the plan because of lateness, the employee may not claim under Directive 39 of these directives and shall be responsible for full repayment of the advance, which shall be subject to recovery pursuant to the relevant provisions of the Financial Administration Act.

Guidelines:

1. Currently, under the PSHCP, employees must file claims with the PSHCP Administrator (currently World Access) no later than six months following the end of the calendar year in which the expense was incurred.

2. In the case of the PSDCP, claims must be submitted to the PSDCP Administrator (currently Great West Life) within 15 months of the date of service.

42.04 An extension of the repayment period may be granted where the deputy head is satisfied that exceptional circumstances beyond the reasonable control of the employee prevent an employee from repaying the advance granted pursuant to Section 42.01 within the required period.

Guidelines

1. An employee shall not be eligible for an advance for medical expenses incurred following relocation to Canada when the hospital, doctor or other health care facility is prepared to await settlement from the employee's provincial or other medical insurance plan.

2. The period during which an employee is eligible to receive an advance for medical expenses incurred following relocation to Canada shall terminate on the date on which the employee's provincial medical insurance plan number is reinstated.

3. A medical advance should not be necessary where an employee returns to Canada during an assignment for health/medical care, as health care facilities may bill the claims administrator directly. To arrange this, the employee should contact World Access at 1-800-363-1835. If it can be demonstrated that the health care providers will not accept direct billing to the PSHCP Administrator, a suitable advance shall be issued.

4. Ontario and some other provinces permit immediate reinstatement to the provincial plan for foreign service personnel returning to Canada.

Forms

TB 330-18 - Medical and/or Dental Expense Advance

TB 330-19 - Medical and/or Dental Expense Advance Request for Extension