# 2017-001 Medical and Dental Care, In Vitro Fertilization

Case summary

F&R Date: 2017–03–30

In December 2015, the province of Ontario removed in vitro fertilization (IVF) funding from the Ontario Health Insurance Plan (OHIP) and began the Ontario Fertility Program (OFP) which allows eligible Ontarians of any sex, gender, sexual orientation or family status to build their families. The program requires that a patient be an Ontario resident with a valid OHIP card. The province will fund a one-time IVF cycle for women under the age of 43 after consulting with a doctor to determine whether IVF is the most appropriate family-building option. After this change, the grievor underwent one cycle of IVF at a significant cost. She was unable to take part in the OFP because, as a CAF member, she was not permitted to obtain an OHIP card. Therefore, she requested reimbursement under the CAF Spectrum of Care (SoC). Her request was denied by staff of the Director Medical Policy who stated that she did not meet the SoC criteria for funding of IVF (bilateral blocked fallopian tubes) and that the SoC is not linked to any changes in provincial health care plans.

The grievor argued that the SoC is very limiting with respect to the criteria for IVF. It was her view that IVF meets the SoC criteria to include it as a health service. She also pointed out that, as a tax payer in Ontario, she should be afforded the same provincial benefits as other residents. However, she noted that she could not use the benefits of the OFP because she cannot have an OHIP card. She requested reimbursement for the IVF treatment she underwent in the province of Ontario which would otherwise have been covered if she were not a member of the CAF.

The Commander Canadian Forces Health Services Group, acting as the initial authority (IA), denied the grievance. He stated that the grievor did not meet the SoC criteria of bilateral blocked fallopian tubes for funding of IVF. He indicated that the CAF infertility benefits are based on medical need and a medical definition of infertility, that being “a disease defined by the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination." In contrast, he pointed out that the OFP is a social program given that it has been removed from OHIP. He also noted that, in 2015, the province of Quebec significantly scaled back their program and now provides tax credits. He noted that no province in Canada insures infertility treatments through a health care system, which may lead the CAF to review its provision of IVF and stop funding it altogether. The IA found that the SoC was applied correctly in the grievor's case.

The Committee stated that there was no evidence on file that the grievor suffered from bilateral blocked fallopian tubes, and therefore was not entitled to funding of IVF through the SoC. The Committee also agreed that, since no other province in Canada provided infertility treatment through provincial health insurance, it would be difficult to conclude that it should be covered by the CAF in the SoC. The Committee recommended that the grievance be denied.

The Committee confirmed with the Ontario government that CAF members are prohibited from holding an OHIP card. Despite the Committee's recommendation above, the Committee found that CAF members who reside in Ontario are treated differently from other Ontario residents, and consequently do not have access to a social program because of their ineligibility for Ontario's insured services. The Committee stated that the CAF authorities would be in the best position to advocate a change in the Ontario policy on behalf of their members so they too could access provincial social programs. It was the Committee's view that the CDS should direct the Chief of Military Personnel to entertain discussions with the Ontario authorities on this issue.

FA decision summary

The Final Authority (FA), the Director Canadian Forces Grievance Authority, agreed with the Committee's findings and recommendation that the grievance be denied.