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 requiring health care for an acute medical condition or emergency medical condition or for accouchement have access to suitable health care facilities or services on a cost-effective basis as determined by the deputy head.
Issue and verification procedures are found in FSD 70 – Allowances and Reporting Requirements.
Note: These definitions only apply to this directive.
Acute medical condition (condition médicale aiguë) means an illness/injury with a rapid and abrupt onset requiring prompt treatment. It is in contrast to a chronic medical condition.
Chronic medical condition (condition médicale chronique) means a medical condition of long duration which may require on-going medical treatment. It is in contrast to an acute medical condition.
Dependant (personne à charge) means each dependant or dependent student, as defined in FSD 2 - Definitions respectively, who resides with the employee at the post, or is in full-time attendance at an educational institution outside of Canada.
Elective medical treatment/procedure (traitement/intervention médical facultatif) is defined as an investigation or treatment of a medical condition that is of a non-emergency nature and for which the normal provision of care can be planned with no expected detriment to the overall health or well-being of the employee and/or dependants.
Emergency medical condition (condition médicale urgente) means a medical condition where the lack of provision of immediate health care is expected to have an impact on the health or well-being of the employee and/or dependants.
Routine medical examination (examen médical de routine) means a medical examination undertaken at pre-established intervals and not related to a change in the health status of the employee and/or dependants or a new or evolving medical condition not of an emergency/urgent nature which can be evaluated at a Canadian or equivalent medical centre during planned travel from the post. Examples include an annual physical examination or follow-up examination for a medical condition including a chronic medical condition, performed by any type of health care service provider.
41.1.1 This directive applies to the employee and/or dependant(s) as defined in this directive who require health care travel, when the deputy head determines health care is necessary for an acute medical condition, for an emergency medical condition or for accouchement; and
- suitable health care facilities or services are not available locally; or
- local treatment costs are excessive.
41.1.2 This directive is not intended to facilitate routine medical examinations, appointments or treatments, including treatments for chronic medical conditions, or elective medical treatment/procedures. Employees and/or dependants are responsible for scheduling appointments during planned travel away from the post if they do not have access to suitable medical facilities or services locally.
41.1.3 The health care facilities or services referred to in this directive may include dental care, only for those posts listed in Appendix A of FSD 9 - Medical and Dental Examinations, and reasonable para-medical care.
41.1.4 In determining whether health care travel is necessary subject to subsection 41.1.1, the deputy head shall seek the advice of a roster doctor, the medical service provider as defined in FSD 2 – Definitions, or other qualified medical practitioner, as required.
41.1.5 In assessing the suitability of health care facilities or services, the deputy head must take into account comparability with the standards of health care and the extent of treatment facilities or specialist services in Canada, the professional competency of medical practitioners, the quality of the post-operative care, cultural, social and political factors, as well as cost-effectiveness.
41.1.6 Subject to subsections 41.1.4 and 41.1.5, where the deputy head approves health care travel, the deputy head shall authorize travel to the nearest suitable location, another suitable location, or Canada, subject to the specific circumstances of the case and cost-effectiveness, and shall approve expenses as outlined in this directive for:
- an employee or dependant requiring health care travel; and
- a young child who is obliged to accompany the parent requiring health care travel; and
- a person to escort where the need is certified by a qualified medical practitioner.
41.1.7 Subject to paragraph 41.1.6(b), when determining if expenses for accompanying dependent children should be authorized, the deputy head shall consider each case on its own merits taking into account such factors as the ages of the children and the availability and cost of child care services at the post.
41.1.8 Where the need is certified by a qualified medical practitioner and, where the employee or a dependant is receiving inpatient treatment and it is either desirable or more economical to have the person who escorted remain at the treatment centre for the duration of the treatment period, admissible expenses in accordance with section 41.2 shall be authorized.
41.1.9 Travelling expenses may be paid for the person who escorted to make a second trip to and from the treatment centre at the conclusion of the treatment period, where it is not necessary for the escort to remain with the person being treated.
41.2 Admissible Expenses
41.2.1 Subject to subsection 41.1.6, the deputy head shall authorize:
- actual and reasonable travelling expenses as defined in FSD 2 - Definitions, including the lowest available airfare appropriate to a particular circumstance and/or itinerary, between the location of the employee or a dependant requiring health care, and the city where the treatment centre is located as determined by the deputy head;
- accommodation in accordance with the NJC Travel Directive, at the location of the treatment centre;
- actual and reasonable expenses based on receipts for meals when in commercial accommodation only, at the location of the treatment centre. However, meals may not be claimed when in private accommodation;
- one daily incidental expense allowance per family unit in accordance with the NJC Travel Directive at the location of the treatment centre; and
- the cost of telephone calls in accordance with the NJC Travel Directive between the location of the person on health care travel and the family members at the employee’s post for the person receiving health care and for the person escorted who is not a family member. However, telephone calls may not be claimed where an incidental expense allowance is paid for travel within Canada or the continental U.S.A.
41.3 Dependant Care
41.3.1 The deputy head shall authorize payment of dependant care expenses in accordance with the provisions of the NJC Travel Directive.
41.3.2 Where expenses for dependant care are incurred at a post, the maximum amount may be exceeded on the recommendation of the appropriate foreign service interdepartmental coordinating committee.
41.4 Travel Leave
41.4.1 Unless the deputy head otherwise directs, travel leave for the employee shall only be granted during normal working hours where it is not feasible for the employee to travel during non-working hours.
41.5.1 In cases of accouchement and subject to subsection 41.1.6, the deputy head shall also approve the payment of expenses as specified in section 41.2, both before and after the time of delivery where:
- the common carrier approved by the deputy head to provide the most suitable and appropriate means of transportation places restrictions on the travel of the expectant mother or newborn infant; and/or
- the visa or other re-entry regulations delay the return to the post; and/or
- there is a medical requirement acceptable to the medical service provider.
41.6 Health Care Travel Allowance to Attend the Birth of a Child
41.6.1 Subject to section 41.5, the deputy head shall approve a Health Care Travel Allowance for the spouse or common-law partner to be present at the birth of the child, for a period not to exceed five (5) days. Subject to FSD 70 – Allowances and Reporting Requirements, the allowance shall include:
- travelling expenses in accordance with paragraph 41.2.1(a);
- accommodation in accordance with paragraph 41.2.1(b), if required; and
- daily meal allowance in accordance with the NJC Travel Directive. The NJC Travel Directive incidental expense allowance is not payable.
41.7 Medical Report
41.7.1 When health care travel is authorized under this directive, a medical report from the attending physician acceptable to the medical service provider must be sent to the medical service provider as determined by the deputy head.
41.7.2 Where Health Canada is the medical service provider, medical reports shall be sent to:
Public Service Occupational Health Program, NCR Clinic
Specialized Health Services Directorate
Corporate Services Branch
171 Slater Street, 12th Floor, P.L. 3712M
Ottawa, ON K1A 0K9