Understanding Changes to the Interim Federal Health (IFH) Program John Norquay, HALCO Staff Immigration Lawyer February 1, 2013
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Background: Old IFH Program Prior to the new changes to the IFH Program that took effect on June 30, 2012, all refugee claimants and refused refugee claimants still legally in Canada were entitled to the same package of benefits. This old IFH package of benefits included: Health care similar to what Canadians receive under provincial health plans: E.g. health care for being sick, injured, having chronic diseases, child birth All prescription drugs Some supplemental services like assistive devices, dental, vision, home care, etc. 3
Background: New IFH As of June 30, 2012, there are 3 different categories of IFH coverage. Which category you are eligible for depends on: Your immigration status What country you are from There are 3 different categories of coverage: 1. IFH Health-Care Coverage 2. IFH Public Health or Public Safety Health-Care Coverage 3. IFH Expanded Health-Care Coverage 4
Types of IFH coverage available The last category, IFH Expanded Health-Care Coverage covers: Government-assisted refugees resettled from overseas Victims of human trafficking who hold a special Temporary Resident Permit Certain persons resettled from overseas by the government in a humanitarian emergency People eligible for Expanded Health-Care Coverage receive the same package of benefits as the old IFH Program. Because they did not have benefits cut, we will not address this coverage level in this presentation. 5
(1) IFH Health-Care Coverage Who is covered? Refugee claimants who are waiting for their refugee hearing/ decision, or were refused after their refugee hearing, but are appealing to Refugee Appeal Division, or were refused after their hearing or appeal, but are now appealing to Federal Court Note: Must not be from a Designated Country of Origin (DCO) 6
(1) IFH Health-Care Coverage Designated Countries of Origin (DCO) as of January 30, 2013: Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden, United Kingdom, United States of America. The list can be changed at any any time. 7
(1) IFH Health-Care Coverage What kind of coverage is available? This is coverage very similar to OHIP. It provides urgent and essential hospital, doctor, diagnostic and ambulance services. It includes things like seeing a doctor when you feel sick or have been injured, prenatal and childbirth care, and visits to a doctor to be monitored for a chronic health condition like heart disease or diabetes. It also covers medications and vaccines needed to prevent or treat a disease that is a risk to public health or a condition of public safety concern. 8
(1) IFH Health-Care Coverage For the purpose of the IFH program, services and products are not of an urgent and essential nature where they are: provided solely for the purpose of screening or prevention of a disease or injury (except for screening or prevention of diseases posing a risk to public health or screening of conditions of public safety concern); for elective purposes or primarily provided to improve quality of life with respect to a condition that causes minimal dysfunction and that is unlikely to deteriorate to a medical emergency within 12 months or the current period of eligibility, if shorter; for cosmetic purposes or convenience of the beneficiary; for fertility and sterilization purposes; CONTINUED ON NEXT SLIDE 9
(1) IFH Health-Care Coverage Continued (what is not covered): for the purpose of rehabilitation, including the cost of rehabilitation hospitals and facilities; primarily related to research or experimentation; not paid for by provincial or territorial health benefit programs; required by or paid by third parties such as insurance companies, business establishments (e.g. automobile insurance), or government agencies, but excluding immigration medical examinations; and for long term care and home care. 10
(1) IFH Health-Care Coverage Some of the diseases that pose a risk to public health for which there is prescription drug coverage: Botulism, Chickenpox, Chlamydia, Giardiasis, Gonorrhea, Group B Streptococcal Disease of the Newborn, Hepatitis A, Hepatitis B, Hepatitis C, Human Immunodeficiency Virus (HIV), Lab- Confirmed Influenza, Invasive Group A Streptococcal Disease, Invasive Meningococcal Disease, Invasive Pneumococcal Disease, Leprosy, Listeriosis, Lyme Disease, Malaria, Measles, Mumps, Rabies, Rubella, Severe Acute Respiratory Syndrome (SARS), Syphilis, Tetanus, Tuberculosis (TB), Viral Hemorrhagic Fevers (Crimean Congo, Ebola, Lassa, Marburg, Rift Valley), West Nile Virus Infection, Yellow Fever Complete list: http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/list-eng.php 11
(1) IFH Health-Care Coverage Prescription drugs are also covered for conditions of public safety concern, which are mental illnesses where a doctor has confirmed a person is a risk to public safety (e.g. psychotic disorders, schizophrenia) The major IFH cut for refugee claimants waiting for their hearing or appeal who are not from a Designated Country of Origin is the loss prescription drug coverage for diseases other than diseases posing a risk to public health or conditions of public safety concern. However, if someone is on Ontario Works/ODSP, they can still get prescription drug coverage through their drug card. 12
(2) IFH Public Health or Public Safety Health-Care Coverage Who is covered? DCO Refugee claimants who are waiting for their hearing or appeal and are from a Designate Country of Origin (DCO) All rejected refugee claimants who have exhausted their appeals but are still legally in Canada because: Removal has not been scheduled yet; Person is being permitted to remain in Canada for another immigration process to complete; Person is from a Temporary Suspension of Removal country (currently: Haiti, Zimbabwe, Dem. Rep. of Congo, Iraq, Afghanistan); Cannot obtain travel document or is Stateless Other possible reasons 13
(2) IFH Public Health or Public Safety Health-Care Coverage When a non-dco refugee claimant loses their hearing and all appeals are exhausted, their IFH coverage level will automatically be lowered from Health-Care Coverage to Public Health or Public Safety Health-Care Coverage 14
(2) IFH Public Health or Public Safety Health-Care Coverage What kind of coverage is available? This coverage is extremely limited. It covers only health care services and medications needed to diagnose, prevent or treat a disease posing a risk to public health or to diagnose or treat a condition of public safety concern. If a person in this category does not have a public health illness or public safety condition, they will not have any health care coverage at all. 15
Who doesn t get any coverage? The following groups of people are not eligible for any health care coverage: Refugee claimants who have withdrawn or abandoned their claim or who have been found not eligible to make a claim Applicants for a Pre-Removal Risk Assessment who have not previously made a refugee claim Rejected refugee claimants who were asked to report for removal from Canada but did not attend (underground/non-status) Visitors and foreign students (some students have limited health care through their university or college) 16
What to do in an emergency? Hospital emergency rooms will not turn away a patient in a medical emergency. If a person does not have IFH, or their IFH does not cover the required health services, the hospital will bill the patient. Each hospital has its own policy for when it will forgive a debt. 17
What to do in an emergency? Immigration Canada can grant Health-Care Coverage or Pubic Health or Public Safety Health-Care Coverage to anyone if there are exceptional or compelling circumstances. However, Immigration Canada has not published any guidelines for what will be considered exceptional or compelling circumstances. Requests must be sent in writing to the Immigration Canada office responsible for the patient s area. Medical evidence must be included. 18
Additional info: OHIP eligibility The following Ontario residents are eligible for Ontario Health Insurance Plan (OHIP) benefits: Canadian citizens and Permanent Residents Accepted Convention Refugees and Protected Persons Work Permit holders who have a full-time job that is expected to last at least 6 months (this does not include refugee claimant work permit holders) People in the Live-In Caregiver Program or Seasonal Agricultural Worker Program People who have applied for permanent residence from within Canada and have received first stage approval or approval in principle This includes spouses being sponsored and Humanitarian and Compassionate grounds applicants Most people issued 3 or 5 year Temporary Resident Permits 19
Other Important Details IFH coverage must be renewed by sending a paper application in the mail four (4) weeks prior to the person s IFH coverage expiry date. The renewal application and instructions can be found here: http://www.cic.gc.ca/english/information/applications/ ifh.asp Use the link to look up which office to send the application to. Depending on where you live, you will be mailing it to a different office. 20
HIV & AIDS Legal Clinic Ontario (HALCO) John Norquay, Staff Lawyer norquaj@lao.on.ca 65 Wellesley Street, East, Suite 400 Toronto, Ontario, Canada Telephone: 416-340-7790 / 1-888-705-8889 www.halco.org