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

The new contract

  1. 1. Are other plans affected by the selection of a new Public Service Health Care Plan (PSHCP) administrator?
    • 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.
  2. 2. Who is the new Public Service Health Care Plan (PSHCP) administrator?
    • 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.
  3. 3. What is an Administrative Services Only (ASO) contract?
    • 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.
  4. 4. What is the purpose of the new PSHCP Administrative Services Only (ASO) contract?
    • 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.
  5. 5. How was the new PSHCP administrator selected?
    • 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.
  6. 6. Why is the government changing PSHCP administrators?
    • 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.
  7. 7. When was the PSHCP ASO contract last retendered?
    • 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.
  8. 8. What changes with the new contract?
    • 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 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.

How to prepare for the new contract

  1. 1. What do I need to do to prepare for the transition to Canada Life?
    • 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).
  2. 2. How will the transition affect PSHCP contribution rates?
    • 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.
  3. 3. How will the transition affect PSHCP benefits?
    • 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.
  4. 4. Has the government engaged with bargaining agents (unions)?
    • 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. 
  5. 5. Will the new PSHCP service contract affect Phoenix?
    • 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.

The PSHCP and its processes

  1. 1. How will my privacy be protected when the administration of the Public Service Health Care Plan (PSHCP) transfers from one company to another?
    • Sun Life will be required to securely transfer all PSHCP member data, information and documents to Canada Life during the implementation process.
  2. 2. What personal information is being securely transferred from the current PSHCP administrator to the new administrator?
    • As part of the transition process, Sun Life will securely transfer the following personal information to Canada Life:
      • claims history, including the portion of annual and lifetime maximums that you and your covered dependants’ have used as of June 30, 2023
      • your positive enrolment information, which includes direct deposit details, coordination of benefits, and email address
      • referrals
      • information about your dependants, especially if you have completed forms to continue their coverage past the age of 25
  3. 3. Will annual and lifetime benefit maximums reset to zero when Canada Life starts to administer the plan on July 1, 2023?
    • 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.
  4. 4. Who do I contact if I have a question about a claim or coverage?
    • 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.
  5. 5. Will the transition to a new PSHCP administrator affect deadlines for submitting claims?
    • No. You must still submit your claim by the end of the calendar year following the year the expense was incurred. The July 1, 2023 transition to Canada Life will have no impact on claims in process or claims submitted after that date for eligible expenses incurred before the transition.
  6. 6. How many participants are enrolled in the PSHCP?
    • The PSHCP has over 1.5 million participants, including members and their families.
  7. 7. What is the value of the PSHCP contract?
    • Contact Public Services and Procurement Canada for this and other contract details.
  8. 8. Where do I send my PSHCP claims?
    • Until June 30, 2023, continue to send your claims and correspondence to Sun Life. As of July 1, 2023, claims should be sent to Canada Life.
  9. 9. What if I disagree with a claim decision?
    • 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.
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