Submitting a benefit claim - active members of the public service group insurance benefit plans

Electronic

• In Canada

  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 accepted, your pharmacy will use it to send the cost of your prescription to Canada 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 pay the 20% co-payment (unless you have coordinated your benefits with another plan).

  In addition, you can present your benefit card to a registered health care provider (e.g. massage therapist, physiotherapist) to have them submit claims electronically on your behalf. Health care providers can visit Telus Health for information on how to register.

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

  You can also submit claims through the Canada Life PSHCP Member Services website or Canada Life’s My Canada Life at Work^TM mobile app, including claims incurred outside of Canada or province/territory of residence, if not for a medical emergency.

• Outside of Canada

  Members with Comprehensive coverage or members with Supplementary coverage who have eligible out-of-province Emergency Benefit claims can submit their claims to MSH International on the MSH PSHCP Member Portal.

  Mail

  PSHCP claims can also be submitted by mail using the appropriate completed PSHCP Claim Form for Supplementary Coverage or for Comprehensive Coverage.

  Mail the form to the address indicated on the form along with supporting documentation (original receipts, bills, invoices, physician or practitioner statements, and/or questionnaires, etc.).

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

If you and your dependent 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.

Complete the applicable coordination of benefits section when submitting a PSHCP claim on the Canada Life PSHCP Member Services website, My Canada Life at Work^TM mobile app or a paper claim form.

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

If you complete your positive enrolment online, you’ll immediately receive a PDF copy of your benefit card, which you can download to your phone or computer for your records. Plan member and dependant benefit cards are accessible any time through the Canada Life PSHCP Member Services website after you register. 

Once you have completed positive enrolment and registered for an account on the Canada Life PSHCP Member Services website , you can also access your benefit cards and save them on your mobile wallet using Canada Life’s My Canada Life at Work^TM mobile app.

If you complete your positive enrolment by paper, you’ll receive a paper benefit card for the plan member only. The benefit card will be mailed to the address you provided on your PSHCP Positive Enrolment Form approximately 4 weeks after Canada Life receives your completed form.

Under the Public Service Health Care Plan, a claim must be received by Canada Life within 12 months following the calendar year in which the expense was incurred. For example, claims for expenses incurred in 2023 must be received by Canada Life no later than December 31, 2024.

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

1. Consult the Canada Life PSHCP Member Services website using your email address and password to log in;
2. Consult Canada Life’s My Canada Life at Work^TM mobile app using the same email address and password used to access your account on the Canada Life PSHCP Member Services website; or
3. Contact Canada 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 Canada Life by email or mail, on Canada Life’s My Canada Life at Work^TM mobile app, or on the Canada Life PSHCP Member Services website. On this statement, Canada Life will have provided an explanation of your health claim. If you have further questions, contact Canada 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 Canada Life, please have your plan and certificate numbers ready. For information on How to Submit an Appeal, refer to the Federal PSHCP Administration Authority website.

Positive enrolment must be completed before any dental claims can be paid.

If you and your dependant spouse or common-law partner are covered under more than one dental care plan, you may be eligible to coordinate your benefits for up to 100% of the actual eligible expenses.

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 coordination of benefits 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:

• sign into your PSDCP Member Services account
• sign into your My Canada Life at Work mobile app, or
• contact Canada Life

When your claim is processed, you will receive a notification that an explanation of benefits statement from Canada Life is ready to be reviewed by text, email or mail. You can also sign into your PSDCP Member Services account. The explanation of benefits statement provides details on how your claim was processed and the amount reimbursed.

If you disagree with a claim decision, first try to resolve the issue with Canada Life. Appeals should be submitted to Canada Life in writing or can be submitted online through the PSDCP Member Services website.

If you wish to submit an appeal over the phone, supporting documents or dental information must be sent to Canada Life by mail for review.

If you are still not satisfied, you can submit an appeal to the appropriate PSDCP Board of Management. Consult the PSDCP Appeal Checklist.

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.