New Public Service Health Care Plan (PSHCP) administrator frequently asked questions

• No other plan is affected by the new PSHCP administrator. The other group insurance benefit plans, including dental care benefits, disability insurance and life insurances, are separate plans governed by different contracts. They remain under the same administrators with no changes to their benefits.

• On December 1, 2021, the Government of Canada announced that the Canada Life Assurance Company (Canada Life) was awarded the Administrative Services Only contract for the PSHCP. This was the outcome of a competitive procurement process led by Public Services and Procurement Canada.
• Canada Life will begin processing PSHCP claims on July 1, 2023, following a transition period. Sun Life will continue as the administrator until June 30, 2023.

• Under an Administrative Services Only (ASO) contract, the Government of Canada funds its own employee benefits plan. The government hires a third-party administrator, often an insurance company, to perform specific administrative services, such as claims processing and claims payment.

• The new contract procures the following third-party administrative services for up to 12 years:
  • claims processing and payment services
  • positive enrollment and membership management services
  • provider registration and management services
  • audit and claim verification
  • reporting services
  • member communication and information services
  • provider communication and information services
  • Veterans Affairs Canada Remittance Administration Services
• The contract also recognizes the importance of greenhouse gas emission reduction and diversity and inclusion.

• An open, fair and transparent competitive procurement process with an agile engagement process was used. It actively sought industry feedback on the Government of Canada’s requirements for the administration of the PSHCP. Following that engagement, a Request For Proposal (RFP) inviting industry to submit formal bids was published on buyandsell.gc.ca. Each bid was reviewed by subject matter experts and scored on the mandatory and point-rated criteria set out in the RFP.

• The government is committed to overall employee compensation, including benefits, that is reasonable, affordable and sustainable, and aligned with that of other public and private sector employers. The Treasury Board of Canada Secretariat, as sponsor of the PSHCP, must competitively retender the PSHCP service contract as part of the continuous life cycle of a public service benefits plan.

• Public Services and Procurement Canada last launched a competitive procurement process to retender the ASO contract for the PSHCP in 2007 and awarded the contract in 2009.

• Canada Life will become the plan administrator, taking over the day-to-day operations of the PSHCP, on July 1, 2023.
• The objective of the new contract is ongoing excellence in claims processing and payment services. In addition, the new contract introduces several new and/or enhanced services, such as:
  • electronic claims submission for paramedical providers such as optometrists and physiotherapists. This will allow registered providers to submit claims on behalf of plan participants. Participants will have to pay only their share up front, instead of paying the full cost of the service and waiting for reimbursement.
  • enhanced member communications tools
  • a dedicated website that will give providers access to their PSHCP statements, information and member communications
  • artificial intelligence/machine learning to support PSHCP audit activities
  • enhanced security to protect PSHCP data

• The new contract is for the administration of the PSHCP and will have no impact on PSHCP benefits. All PSHCP benefit changes are negotiated by the Public Service Health Care Plan Partners Committee, a collaborative negotiation forum comprised of bargaining agents, the employer and pensioner representatives.
• September 2022, Improvements and changes to the Public Service Health Care Plan were announced by the Government of Canada. The changes respond to the needs of a diverse Canadian public sector workforce, its retirees and dependants and will come into effect July 1, 2023, to coincide with transition to Canada Life.
• The current plan administrator, Sun Life, will deliver PSHCP benefits to active and retired members and their families on behalf of the Government of Canada until June 30, 2023. Sun Life will continue to adhere to the terms of the PSHCP contract as it reviews claims, reimburses eligible claims and communicates with plan members.

• The PSHCP has over 1.5 million participants, including members and their families.

• Contact Public Services and Procurement Canada for this and other contract details.

• You will receive regular updates on the transition progress and will be asked to take a few simple actions before the move to Canada Life. In the meantime, be sure to keep your Positive Enrolment information up to date on the Sun Life Plan Member Services website or mobile app (including your dependants’ information and your postal and email addresses).

• The selection of a new administrator has no impact on PSHCP contribution rates. PSHCP rates are reviewed annually and any recommended changes are approved by the President of the Treasury Board.

• The procurement of this contract has no impact on PSHCP negotiated benefits. Plan changes are negotiated by the Public Service Health Care Plan Partners Committee, a joint negotiation forum consisting of bargaining agents (unions), a pensioner representative and the employer.

• The PSHCP Partners Committee, the joint negotiation forum consisting of bargaining agents, a pensioner representative and the employer, is an important part of the plan’s governance and was engaged throughout the retendering process.

• Phoenix and the plan administrator’s systems operate independently. The only interaction will be the exchange of data files with member eligibility information, through the Shared Services Canada Managed Secure File Transfer service.

• Sun Life will be required to securely transfer all PSHCP member data, information and documents to Canada Life during the implementation process.

• As part of the transition process, Sun Life will securely transfer the following personal information to Canada Life:
  • Claims history, approvals and referrals and the portion of annual and lifetime maximums that you and your covered dependants have used as of June 30, 2023
  • Your name, contact information and dependant information. When completing positive enrolment, you will be asked to provide your banking information and to re-enter your dependant information

• Positive Enrolment starts in March 2023. All members will be contacted directly by Canada Life with instructions, in their preferred method of communications indicated with Sun Life (e.g. by email or mail). Once you complete your positive enrolment, you will be prompted to create your online PSHCP account on the new PSHCP Member Services Website with Canada Life.

  If you were born in	Your plan number will be	You will be contacted directly by us to complete positive enrolment
  January, February, March	52111	Late March, early April 2023
  April, May, June	52112	Early April 2023
  July, August, September	52113	Mid April 2023
  October, November, December	52114	Late April 2023

• When Canada Life becomes the administrator for the PSHCP on July 1, 2023, your certificate number will remain the same. However, you will be issued a new plan number. The new plan number will be based on your birth month. Knowing your new plan number will be important for you and your covered eligible dependants to submit a claim or have a provider submit a claim for you.

  Your plan number will be as follows (based on your birth month or status as a member):

  January, February, March: 52111
  April, May, June: 52112
  July, August, September: 52113
  October, November, December: 52114

  Eligible Surviving Dependants (spouse and eligible children): 52115

• If your spouse or common-law partner is also covered under the PSHCP as a member, you may have different plan numbers depending on your birth month. Take note if they have a different plan number to ensure claims are submitted accurately.

• Once you complete your positive enrolment with Canada Life on the PSHCP Member Services Website, you will have access to your new digital benefit card. If you complete your positive enrolment by paper, you will be mailed a confirmation of your positive enrolment that includes a new paper benefit card.

• The new claim forms will be available July 1, 2023 from Canada Life on the new PSHCP Member Services Website or by contacting the Canada Life Contact Centre.
• We encourage you to file your claims electronically. The Government of Canada and Canada Life are working to protect and preserve our planet for future generations. You can help reduce paper waste and receive your refund faster by submitting all your claims online.
• More information on how to submit claims electronically will be provided as we get closer to July 1, 2023.

• Yes, if you live outside of Canada, your positive enrolment process will be the same, however there will be a change to your out of country carrier.
• Effective July 1, 2023, MSH International will be the new PSHCP out-of-province emergency travel assistance and comprehensive coverage provider. Members will have access to a new on-line portal to manage comprehensive coverage and out of province claims.
• More information on this will follow.

• No. Canada Life will receive your and your covered dependants claims history as well as the annual and lifetime benefit maximums used or remaining in order to appropriately apply plan maximums and adjudicate claims.

• Claims incurred before July 1, 2023 but not submitted until after this date must be submitted to Canada Life.

• You are encouraged to submit your claims regularly to ensure timely reimbursement of eligible expenses under the Plan. However, should you not have submitted your claims incurred on or before June 30, 2023 to Sun Life, you can submit them to Canada Life starting July 1, 2023.
• Remember, there is a deadline for submitting your PSHCP claims to be eligible for reimbursement. You must submit your PSHCP claims within 12 months following the end of the calendar year the expense was incurred, that is, claims must be received no later than December 31st of the year following the calendar year in which the expenses were incurred.

• You should always keep copies of your receipts, your completed claim forms, referrals and any other documentation related to your claims for at least one year, in the event they are needed for future audits or appeals. Originals will not be returned by the plan administrator. 

• As of June 30, 2023, your PSHCP membership information will be securely sent to Canada Life. You must therefore send the details requested of you to Canada Life after July 1, 2023.

• Until June 30, 2023, questions about claims and coverage should go to Sun Life. As of July 1, 2023, questions will be answered by Canada Life.

• Please cash your cheques immediately to keep them from becoming stale-dated.

• Until December 31st, 2024, members will be able to access their claims history and individual claim statements (for claims filed with Sun Life prior to and including June 30th, 2023, only), through the Sun Life website and Sun Life mobile app.
• Effective January 1, 2025, members will no longer have access to the Sun Life system and should print any required tax information accordingly.
• Claim statements dated on or after July 1, 2023, will be available online through the Canada Life Member Services website.

If you do not agree with a claim decision, you may send a letter of appeal to the Public Service Health Care Plan Administration Authority. All appeals must be submitted in writing. Send your appeal to:

PSHCP Administration Authority
P.O. Box 2245, Station D
Ottawa, ON K1P 5W4

The Appeals Committee of the PSHCP Board of Directors will review your appeal to determine whether your claim was processed in accordance with the provisions of the PSHCP Directive. Those provisions are negotiated between the Government of Canada and Bargaining Agent and retiree representatives, at the PSHCP Partners Committee. The plan administrator does not have a seat at the negotiating table and does not make decisions about what is covered under your plan.