FSD 38 - Preventive Medical Services Expenses

Scope

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 Appendix A to this directive as and when required.

Please refer to the Instructions at the end of this Directive for additional information or greater clarification of certain sections.

Directive

38.1 Application

38.1.1 An employee and each dependant 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 if, the employee and/or dependant:

(a) is residing at a post listed in Appendix A 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.

38.1.2 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. (Note: Refer to Instructions)

38.2 Medical Examinations

38.2.1 The medical examinations referred to in subsections 38.1.1 and 38.1.2 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.  (Note: Refer to Instructions)

38.2.2 Where medical examinations are administered pursuant to subsections 38.1.1, 38.1.2, 38.3.1 and 38.3.2, the deputy head shall authorize:

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

(b) payment of travelling expenses.

38.2.3 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 subsections 38.1.1 and 38.1.2. At the employee's request, the employer shall provide the employee with access to this assessment. (Note: Refer to Instructions)

38.3 Independent Medical Opinion

38.3.1 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.

38.3.2 Where a variance in the written medical opinions submitted pursuant to subsections 38.2.3 and 38.3.1 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.

38.3.3 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.

38.3.4 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 subsections 38.2.3, 38.3.1, 38.3.2 and 38.3.3.

38.3.5 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.

38.4 Medical Expenses

38.4.1 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.

38.4.2 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.

38.4.3 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. (Note: Refer to Instructions)

38.5 Paid Leave and Overtime

38.5.1 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.

38.5.2 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.

38.6 Insurance Plan

38.6.1 Expenses incurred by the employee pursuant to Section 38.1 and subsections 38.3.1, 38.3.2, 38.3.3, 38.4.1, 38.4.2 and 38.4.3 shall not be a charge against the employee's health and hospitalization insurance plan.

38.7 Unhealthy Posts

(Note: Refer to Instructions)

38.7.1 For the purposes of this directive, the posts listed in Appendix A 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.

Instructions

Instructions for 38.1.2 – Application

1. The medical examinations referred to in subsection 38.1.2 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 subsection 38.1.2 may be given in Canada or at another location approved by the deputy head while an employee is on leave or temporary duty.

Instruction for 38.2.1 – Medical Examinations

The "prescribed manner" of medical examination specified in subsection 38.2.1 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.

Instruction for 38.2.3 – Medical Examinations

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.

Instruction for 38.4.3 – Medical Expenses

The "competent medical authority" referred to in subsection 38.4.3 may be a physician recognized by Health Canada, or other duly qualified medical practitioner acceptable to Health Canada.

Instructions for 38.7 – Unhealthy Posts

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 A - Schedule of Unhealthy Posts

Effective June 1, 2012

Abidjan, Ivory Coast
Abuja, Nigeria
Accra, Ghana
Addis Ababa, Ethiopia
Algiers, Algeria
Amman, Jordan
Ankara, Turkey
Astana, Kazakhstan
Baghdad, Iraq
Bamako, Mali
Bandar Seri Begawan, Brunei Darussalam
Bangkok, Thailand
Beijing, China
Beirut, Lebanon
Belgrade, Serbia
Bogotá, Colombia
Brasilia, Brazil
Bridgetown, Barbados
Bucharest, Romania
Buenos Aires, Argentina
Cairo, Egypt
Caracas, Venezuela
Chandigarh, India
Chennai, India
Chongqing, China
Colombo, Sri Lanka
Dakar, Senegal
Damascus, Syria
Dar es Salaam, Tanzania
Dhaka, Bangladesh
Georgetown, Guyana
Guadalajara, Mexico
Guangzhou, China
Guatemala, Guatemala
Hanoi, Vietnam
Harare, Zimbabwe
Havana, Cuba
Ho Chi Minh City, Vietnam
Hong Kong, China
Islamabad, Pakistan
Istanbul, Turkey
Jakarta, Indonesia
Johannesburg, South Africa
Juba, Sudan
Kabul, Afghanistan
Kampala, Uganda
Kandahar, Afghanistan
Kathmandu, Nepal
Khartoum, Sudan
Kigali, Rwanda
Kingston, Jamaica
Kinshasa, Democratic Republic of Congo
Kuala Lumpur, Malaysia
Kuwait City, Kuwait
Kyiv, Ukraine
La Paz, Bolivia
Lagos, Nigeria
Lima, Peru
Lusaka, Zambia
Managua, Nicaragua
Manila, Philippines
Maputo, Mozambique
Mexico City, Mexico
Monterrey, Mexico
Moscow, Russia
Mumbai, India
Nairobi, Kenya
New Delhi, India
Niamey, Niger
Ouagadougou, Burkina Faso
Port-au-Prince, Haiti
Port of Spain, Trinidad and Tobago
Pretoria, South Africa
Quetta, Pakistan
Quito, Ecuador
Rabat, Morocco
Ramallah, West Bank
Recife, Brazil
Rio de Janeiro, Brazil
Riyadh, Saudi Arabia
San José, Costa Rica
San Salvador, El Salvador
Santiago, Chile
Santo Domingo, Dominican Republic
São Paulo, Brazil
Seoul, South Korea
Shanghai, China
Taipei, Taiwan
Tartu, Estonia
Tegucigalpa, Honduras
Tehran, Iran
Tel Aviv, Israel
Tripoli, Libya
Tunis, Tunisia
Ulaanbaatar, Mongolia
Wellington, India
Yaoundé, Cameroon

Note:

1. 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.

2. Health Canada has the delegated authority to amend this Appendix as required.