Improvements and changes to the Public Service Health Care Plan

As of July 1, 2023, changes will come into effect for all Public Service Heath Care Plan (PSHCP) members. The PSHCP is currently administered by Sun Life Financial. Following a competitive procurement process, which was unrelated to the new PSHCP changes, Canada Life Assurance Company will begin processing PSHCP claims as of July 1, 2023, which aligns with the effective date of the Plan changes below.

The PSHCP is negotiated at the PSHCP Partners Committee, comprised of Employer, Bargaining Agent and pensioner representatives. Improvements that modernize the PSHCP were the result of a successful collaboration amongst all parties and responds to the needs of a diverse Canadian public sector workforce, its retirees and dependants.

More information and details will be made available shortly.

Contents

PSHCP Improvements
Benefit Coverage reimbursed at 80% Details
Medical practitioners’ services
1. Registered Dietician

$300 per calendar year

  • New benefit
  • No prescription required
2. Occupational therapist

$300 per calendar year

  • New benefit
  • No prescription required
3. Lactation consultant

$300 per calendar year

  • New benefit
  • No prescription required
4. Acupuncturist

$500 per calendar year

  • Service can now be provided by acupuncturists
  • No prescription required
5. Nurse practitioner

N/A

Nurse practitioners can now prescribe medical supplies and prescriptions, if authorized by their provincial or territorial government

Miscellaneous Expenses
6. Batteries for hearing aids

$200 per calendar year

New benefit

7. Injectable lubricants for joint pain and arthritis

$600 per calendar year

  • New benefit
  • Prescription required
8. Gender Affirmation

$75,000 per lifetime

  • New benefit
  • Coverage for services designed to support and affirm an individual's gender identity
Medical practitioner’s services
9. Psychological services (Psychologist)

$5,000 per calendar year

  • Mental health services can now be provided across Canada by:
    • Psychotherapists
    • Social workers
    • Registered counsellors
  • Prescription not required
10. Physiotherapist

$1,500 per calendar year

  • Removal of member-paid corridor
  • Prescription not required
11. Massage therapist

$500 per calendar year

  • Increased benefit from $300 to $500
  • Prescription not required
12. Osteopath

$500 per calendar year

  • Increased benefit from $300 to $500
  • Prescription not required
13. Naturopath

$500 per calendar year

  • Increased benefit from $300 to $500
  • Prescription not required
14. Podiatrist or chiropodist

$500 per calendar year

Now includes foot care at a community nursing station

15. Nursing services

$20,000 per calendar year

Increased benefit from $15,000 to $20,000

16. Electrologist

$1,200 per calendar year

No prescription required if undergoing gender affirmation

17. Speech language pathologist

$750 per calendar year

  • Audiologists are now covered under this benefit
  • Prescription not required
Vision care
18. Prescription eyeglasses, contact lenses (purchase and repairs)

$400 every two years starting on the odd year

Increased benefit from $275 to $400

19. Laser eye surgery

$2,000 per lifetime

Increased benefit from $1,000 to $2,000

Drug benefit
20. Smoking cessation drugs

$2,000 per lifetime

Increased benefit from $1,000 to $2,000

Miscellaneous expenses
21. Wigs

$1,500 every 5 years

Increased benefit from $1,000 to $1,500

22. Orthopedic shoes

$250 per calendar year

Increased benefit from $150 to $250

23. Aerotherapeutic supplies

$500 per calendar year

Increased benefit from $300 to $500

24. Hearing aids

$1,500 every 5 years

Increased benefit

25. Needles and syringes for injectable drugs

$200 per calendar year

  • New benefit
  • Prescription required to confirm medical necessity
Diabetes Management
26. Insulin jet injector

$1,000 every 3 years

Increased benefit from $760 to $1,000

27. Continuous Glucose Monitor supplies

$3,000 per calendar year

New benefit - For Type I diabetics only

28. Diabetic monitors

$700 per 5 years

New benefit – Eligible with or without insulin pump

29. Diabetic testing supplies

$3,000 per calendar year

Removed blood testing requirement

Durable Equipment
30. Walkers and wheelchairs

No change

No longer restricted for use in a private residence only.

Now allows for claims for a new wheelchair within the five-year limit when a medical condition changes and requires a different type of chair. Reimbursement will be for the amount of the new chair less the amount reimbursed for the previously claimed chair (if claimed within the same five-year period).

31. Medical monitoring devices

Limited to one every 5 years

The following devices are now covered:

  • Oxygen saturation meter
  • Pulse oximeter
  • Saturometer
  • Blood pressure monitor
Hospital Coverage
32. Level I

$90 per day

Increased benefit from $60 to $90

33. Level II

$170 per day

Increased benefit from $140 to $170

34. Level III

$250 per day

Increased benefit from $220 to $250

Out-of-province benefit
35. Emergency benefit while travelling

$1 million per trip

Increased benefit from $500,000 to $1 million. Out-of-province coverage for 40 consecutive days, excluding any time out of the province for business on official travel status.

36. Family Assistance Benefits

$5,000 per travel emergency

Additional $200 per day for meals and accommodations

Relief provision
37. Pensioner relief provision

N/A

Relief provision to include members who retire after April 1, 2015, extended until March 31, 2025

PSHCP Changes
Benefit Details
38. Mandatory Generic Drug Substitution

The PSHCP will implement Mandatory Generic Drug Substitution following a 180-day legacy period commencing July 1, 2023.

During the legacy period, prescribed brand name drugs will still be reimbursed at 80% of their cost.

After the legacy period, all prescription drugs covered under the PSHCP will be reimbursed at 80% of the cost of the lowest-priced alternative generic drug.

Exceptions will be granted based on medical necessity.

39. Prior Authorization

A Prior Authorization system will be implemented for the PSHCP effective July 1, 2023.

A Prior Authorization system is a process administered by the plan administrator where certain drugs need to be pre-approved before they are reimbursed under the PSHCP. It is an evidence-based program that will be supported by medical professionals at Canada Life, the new plan administrator as of July 1, 2023.

Permanent legacy protections will be granted for members who were on prescribed drugs listed in the Prior Authorization formulary before July 1, 2023. However, members may need to switch their existing biologic drug to a biosimilar under the new system.

40. Compound Drugs

The PSHCP will implement a change to compound drug eligibility following a 180-day legacy period commencing July 1, 2023.

After the legacy period, compound drugs will require one active ingredient with a Drug Identification Number (DIN) that is covered under the PSHCP, to be reimbursed.

41. Catastrophic Drug Coverage

Effective July 1, 2023, eligible drug expenses will be reimbursed at 100% when out-of-pocket drug expenses incurred exceed $3,500 in a calendar year.

Pharmacy Dispensing Fees
42. Frequency Limits

Effective July 1, 2023, pharmacist dispensing fees will be reimbursed up to a maximum of five times per year for maintenance drugs. 

Exceptions will be granted if:

  • There are safety concerns with the prescribed drug (e.g. controlled substance)
  • There are storage limitations for the prescribed drug (e.g. requiring deep freeze temperatures)
  • The prescribed drug’s 3-month supply co-pay is more than $100
43. Fee Caps

Effective July 1, 2023, the PSHCP will reimburse up to a maximum of $8 for the pharmacy dispensing fee.

The fee cap will not apply to biologic or compound drugs.

Marie-Chantal Girard
Senior Assistant Deputy Minister
Employee Relations and Total Compensation Sector
Office of the Chief Human Resources Officer
Treasury Board of Canada Secretariat

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