Health Care Coverage and Claims while OUTCAN
This document provides an overview of health care coverage for you and your family as a Canadian Armed Forces (CAF) member while you are living outside of Canada (OUTCAN) during a posting.
In particular, the following questions should be considered:
- What health care coverage choices do you have OUTCAN?
- What should you consider when setting up your health care coverage?
- How do you submit claims?
- How do you get additional information?
What are your choices of health care coverage while OUTCAN?
Global Allianz is the provider of comprehensive coverage under the Public Service Health Care Plan (PSHPC) for you and your family during a posting outside Canada (OUTCAN).
CAF members and their families posted to the United States, have access to a health care coverage program called TRICARE, which is provided by the United States Department of DefenseFootnote 1 .
TRICARE has a network of military medical facilities across the United States. You and your family can gain access to these facilities upon enrolment in the Defense Enrollment Eligibility Reporting System (DEERS).
While TRICARE is available to CAF members and their families, this is subject to prioritization. In addition, some exceptions apply. Therefore, CAF members should get additional information from their assigned Orderly Room at their OUTCAN location. For example, you may be required to get medical care on the economy (you pay upfront) and then submit your claims to Global Allianz for reimbursement, even if TRICARE is available.
Note: Dental care services are covered under Canada Life (formerly known as Great West Life).
What should you consider when setting up your health care coverage?
- Check your provincial or territorial health care coverage requirements as well as options for extending this coverage. To learn more, consult CAF Connection: Health Care Information by Province and Territory.
- You have two options for PSHCP coverage: comprehensive and supplementary. Prior to being posted, assigned, and employed OUTCAN, you must get comprehensive coverage that will start one month prior to your departure from Canada. If you want supplementary coverage, then you must update your coverage to include it. For more information on updating your coverage, consult the Public Service Health Care Plan Directive or contact the Public Service Health Care Plan.
- Once OUTCAN, before committing to any medical or dental procedure, check your policy and ask questions whenever possible. You may discover issues that prohibit plan reimbursement. For example, the health care practitioner who is providing the service must meet the plan’s requirements. This includes having acceptable credentialsFootnote 2. In other words, if the plan requires a doctor to perform a certain procedure and that procedure is performed by a nurse practitioner, it is unlikely you would receive a reimbursement.
- You should ensure all of your prescriptions, including eye glasses, are up-to-date. You should also ensure that all of your doctor and dental appointments are current. This is essential because costs will vary from what you are accustomed to in Canada. In addition, it may take time to find the services and providers you need while OUTCAN.
- To help pay for medical costs, you may qualify for an advance from your orderly roomFootnote 3. For example, if you must travel to get suitable health care that is not available in your location, check applicable health care plan rules and consult your orderly room.
How do you submit claims?
- You can submit claims electronically for quicker reimbursement, however, you must also send a hard-copy paper submission by mail to the insurance coverage provider for validation.
- Given that mail services vary according to location, you should plan to:
- keep an additional copy of your claim to present in case there are any issues,
- affix adequate postage to your claim’s envelope, and
- meet all national mail requirements such as allowable envelope size.
- All claims incurred must be submitted within the same calendar year (by Dec 31)
- You can submit claims electronically; and
- Claims incurred must be submitted within the same calendar year (by Dec 31).
Note: In the case of an emergency:
- Identify yourself at the local Emergency Room/Urgent Care
- If you need administrative assistance, contact your OUTCAN Coordination and Support (URS).
- The Family Information Line can also be accessed 24/7 to assist,
- 1-800-866-4546 (International 00-800-771-17722)
How do I get additional information?
You can get additional information by visiting the following resources:
- How to submit a claim to PSHCP
- Out of Country PSHCP (Outside Canada) claim form
- Allianz Contact Information
- What is Comprehensive Coverage
- Frequently Asked Questions (PSHPC)
- Health Care Travel for members and family members:
- CAF members: Military Foreign Service Instruction - Chapter 10
- The Family Information Line can also be accessed 24/7 - 1-800-866-4546 (International 00-800-771-17722), https://www.cafconnection.ca/National/Stay-Connected/Family-Information-Line.aspx
If you are a Department of National Defence (DND) civilian employee or a Staff of the Non-Public Fund, Canadian Forces (NPF,CF) on assignment or employment OUTCAN, refer to the links below for more information or contact our office for assistance.
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