Submitting a benefit claim – Active members of the public service group insurance benefit plans

When purchasing eligible prescription drugs and certain medical supplies at a pharmacy in Canada, you should present your Public Service Health Care Plan (PSHCP) benefit card. If your card is accepted, your pharmacy will use it to send the cost of your prescription to Sun Life for processing. Once your claim is processed, the amount paid by the Plan will be shown on your pharmacy receipt (i.e. 80%). You simply pay the 20% co-payment (unless you have coordinated your benefits with another plan).

If you have any problems with your benefit card, contact Sun Life.

In addition, plan members residing in Canada are able to submit their vision care and paramedical services claims through the Sun Life Member Services website or the my Sun Life Mobile app available on Apple and Android devices.

Other types of eligible health care expenses can be submitted by mail using a completed PSHCP Claim Form (PDF, 614 KB) for Supplementary Coverage or a PSHCP Claim Form for Out-of-Country Claims for Comprehensive Coverage. Attach supporting documentation (original receipts, bills, invoices, physician or practitioner statements, and/or questionnaires, etc.). Mail the form to the address indicated on the form along with the supporting documentation.

Note: Keep copies of your receipts, your completed claim form, and any other documentation provided. Originals will not be returned.

If you and your dependant spouse or common-law partner are covered under more than one health care plan, you may coordinate benefits for up to 100% of the actual eligible expenses. In situations where coordination of benefits is allowed, the combined reimbursement from all Plans cannot exceed the expenses incurred.

Coordination of benefits between two Public Service Health Care Plan (PSHCP) members is allowed.

To coordinate benefits under the PSHCP you must have Family Coverage and complete positive enrolment to include your spouse/common-law partner. See Getting Married or Reaching Common-Law Status section. Complete the applicable coordination of benefits section when submitting a PSHCP claim on the Sun Life Member Services website or a paper claim form.

To obtain your Public Service Health Care Plan (PSHCP) benefit card from Sun Life, you must be enrolled in the PSHCP and have completed positive enrolment. For information on how to enrol in the Plan and completing positive enrolment, consult New to the public service.

If you completed positive enrolment, you can print your PSHCP benefit card from the Sun Life Member Services website, access your benefit card using the my Sun Life app, or request that Sun Life send a card to you by mail.

Under the Public Service Health Care Plan (PSHCP), a claim must be received by Sun Life within 12 months following the calendar year in which the expense was incurred. This means that all your claims for expenses incurred in 2014 must be received by Sun Life no later than December 31, 2015.

For information about the status of your claim, you can either:

1. Consult the Sun Life Member Services website using your Access ID and password to log in; or
2. Contact Sun Life.

If your claim was refused under the Public Service Health Care Plan (PSHCP), you will be advised by an Explanation of Benefits letter (i.e. claim statement) from Sun Life on the my Sun Life Mobile app, the Sun Life Member Services website, or by mail. On this statement Sun Life will have provided an explanation in "Details of your health claims" section. If you have further questions contact Sun Life.

In the event you disagree with a claim decision, you have one year from the date of the PSHCP Claim Statement to register an appeal. When contacting Sun Life, please have your contract and certificate numbers ready. For information on How to Submit an Appeal refer to the PSHCP Administration Authority website.

Public Service Dental Care Plan (PSDCP) claims may be submitted electronically by your dentist. It is your responsibility to authorize your dentist to submit the claim and to ensure that your dentist has your current personal information including your plan and certificate number.

If your dentist does not submit your claim electronically on your behalf, ask your dentist to complete his/ her section of the PSDCP Claim Form, then complete your section and either:

• Submit your claim electronically on the PSDCP Member services website website. Sign into your account with your Access ID and password, then select “Submit Online Claims”;
• Submit your claim electronically on the Canada Life mobile app. Sign into your account using your email address and password then select “Make claim”; or
• Mail it to the address indicated on the form.

Note: It is your responsibility to keep a copy of your claims, including bills, receipts and declarations, for your records.

To register for PSDCP Member services website and access the Canada Life mobile app, you will need to find your Plan Number and Certificate/ ID Number.
Plan Numbers by group:

• Plan 55555 – National Joint Council Component
• Plan 55666 – Public Service Alliance of Canada
• Plan 55777 – Canadian Armed Forces Dependants’
• Plan 55888 – Royal Canadian Mounted Police Dependants’
• Plan 55999 – Canadian Armed Forces Reserves

Locate your Certificate/ ID Number:

• On your PSDCP benefit card
• Through the Phoenix Pay System application, if you have access to the Compensation Web Applications (CWA)
• By contacting the Public Service Pay Centre or your departmental compensation unit
• On an Explanation of Benefits statement sent to you by Canada Life
• By contacting Canada Life

Should you have any questions regarding the PSDCP Member services website or how to register, please call Canada Life at 1-855-415-4414.

If you and your dependant spouse or common-law partner are covered under more than one dental care plan, you may coordinate benefits for up to 100% of the actual eligible expenses. In situations where coordination of benefits is allowed, the combined reimbursement from all Plans cannot exceed the expenses incurred.

Coordination of benefits between two Public Service Dental Care Plan (PSDCP) members is allowed.

For information on which plan you should claim from first, refer to the Submitting your Coordination of Benefits Claims section of the PSDCP Member Booklet.

Under the Public Service Dental Care Plan (PSDCP), claims must be submitted within 15 months of the date the expenses are incurred.

For information about the status of a submitted Public Service Dental Care Plan (PSDCP) claim, you can either:

• Consult the PSDCP Member services website and use your Access ID and password to log in.
• Consult the Canada Life mobile app by using your email address and password to log in.
• Contact Canada Life.

If your claim was refused under the Public Service Dental Care Plan (PSDCP), you will be advised by either an electronic or paper Explanation of Benefits letter (i.e. claim statement) from Canada Life. On this statement Canada Life will have provided an explanation.  If you have further questions contact Canada Life.

In the event you disagree with a claim decision, refer to Appealing an Assessment

Sun Life is the insurer for the Disability Insurance (DI) Plan.

If you think your total disability will exceed 13 continuous weeks, notify your immediate supervisor or manager who will take care of the next steps with the Public Service Pay Centre (Pay Centre) or departmental compensation services. The forms that you, your employer and your doctor must complete and the Employee DI claim guide can be found on Sun Life DI webpage.

Industrial Alliance is the insurer for the Public Service Management Insurance Plan Long-Term Disability (PSMIP-LTD).

If you think your total disability will exceed 13 continuous weeks, notify your direct supervisor or manager who will take care of the next steps with the Public Service Pay Centre (Pay Center) or departmental compensation services.

The forms that you, your employer and your doctor (attending physician) must complete can be found on the Industrial Alliance PSMIP-LTD website.

The completed claim forms and supporting documentation must be received by the insurer at least two months prior to the end of the 13-week elimination period and no later than 90 days after the end of the elimination period to avoid any delay in the payment of benefits to which you may be entitled.

Public Service Health Care Plan

As a member of the Public Service Health Care Plan (PSHCP) you can access your account using the internet and Sun Life’s mobile application.

The following features are available on the Sun Life Member Services website and through the my Sun Life Mobile app:

• Submit electronic claims.
• Attach receipts, photo receipts and other supporting documents to claims for expenses such as lab tests, equipment, and medical supplies.
• Attach documents requested by Sun Life’s Client Care Centre, such as referrals, proofs of payment, estimates and drug forms, to recently completed claims.
• Track claims that are being processed and view your completed claims.
• Learn what is covered under the Plan quickly and conveniently.
• Locate health practitioners using the "provider search" feature, book online appointments with some paramedical providers and discover which health-care professionals offer virtual services (identified with the ‘virtual visits icon’).
• Review drug coverage and claim history for you and your dependants.
• Explore alternative drugs to discuss with your health practitioner.
• Access your PSHCP benefit card.

Features only available on the website:

• Coordinate benefits claims between two Sun Life plans or submit the remaining balance of a claim already processed through another insurer.
• Complete or update your personal account (“positive enrolment”) information.
• Sign up for direct deposit or update your banking information.
• Print your PSHCP benefit card.
• Use Two-Step Verification to verify your identity and protect your personal information. Sun Life will text or call you (your choice) with a one-time security code.

Features only available on the mobile app:

• Submit claims for paramedical sessions of an hour or less.
• Add your PSHCP benefit card to your iPhone’s Apple Wallet.
• Activate the Touch ID sign-in feature to log in securely.

Public Service Dental Care Plan

• As a member of the Public Service Dental Care Plan (PSDCP), you can access your account on the PSDCP Member Services website and the Canada Life mobile app. When you access your account online, you can submit claims, review your coverage, access your PSDCP benefit card, and more!

Disability Insurance Plan

• As a member of the Disability Insurance (DI) plan, you can consult the Sun Life website to help you with the claim submission process. Here you will find the DI claim forms, the Employee DI claim guide, the manager’s or supervisor’s DI plan guide, and additional resources.

Public Service Management Insurance Plan

• As a member of the Public Service Management Plan (PSMIP), you can consult the Industrial Alliance PSMIP-LTD website to help you with your claim submission process. Here you will find the PSMIP Long-Term Disability (LTD) claim package, helpful information to assist with the application process and additional resources.

Public Service Health Care Plan

You will need an Access ID and password to enter the Sun Life Member Services website. To obtain an Access ID and password, register online at Sun Life Member Services. For security purposes, a password will be sent to you separately by mail.

To access the my Sun Life Mobile app for the PSHCP, you must first have registered to the Sun Life Member Services website. Once registered:

• Download the my Sun Life Mobile app for iPhone and Android devices from the App Store or from Google Play.
• Sign into the app using your access ID and password.
• Select "Submit a claim".
• Select your claim type (e.g. Vision care).
• Follow the steps to submit your claim.

Public Service Dental Care Plan

To access the Canada Life mobile app for the PSDCP, download the Canada Life mobile app for iPhone and Android devices from the App Store or Google Play.

• You must first register an account before you are able to sign in. To register, you must enter your member ID (certificate number) and plan number provided to you on your PSDCP benefit card.
• Sign into the app using your email address and password.
• Select "Make claim", then select "Start online claim".
• Select your claim type and follow the steps to submit your claim.

Disability Insurance plan

To access the claim submission process, visit the Sun Life website.

Public Service Management Insurance Plan

To access the Long-Term Disability claim submission process, visit the Industrial Alliance PSMIP-LTD website.