FSD 38 - Preventive medical services expenses
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.
38.01 An employee and each dependant who:
(a) is residing at a post listed in the appendix to this directive and published on the Department of Foreign Affairs and International Trade's website, 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.
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.
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(cc), 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.
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.
(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.
(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.
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 published on the Department of Foreign Affairs and International Trade's website are classed as unhealthy on the advice of Health Canada.
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
Addis Ababa, Ethiopia
Beijing, P.R. China
Belize City, Belize
British Virgin Islands
Colombo, Sri Lanka
Gaza Strip, Israel
Golan Heights, Israel
Guatemala City, Guatemala
Kandy, Sri Lanka
Kuala Lumpur, Malaysia
La Paz, Bolivia
Mexico City, Mexico
New Delhi, India
Port of Spain, Trinidad and Tobago
Prague, Czech Republic
Riyadh, Saudi Arabia
San Jose, Costa Rica
San Salvador, El Salvador
Sao Paulo, Brazil
Shanghai, P.R. China
St. Kitts and Nevis
St. Vincent and the Grenadines
Tel Aviv, Israel
Turks and Caicos Islands
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.