Update: Improvements and changes to the Public Service Health Care Plan
As previously announced, effective 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 successful negotiations amongst all parties and responds to the needs of a diverse Canadian public sector workforce, its retirees and dependants, while respecting the publicly funded nature of the benefits members receive.
Further details have now been included to explain how improvements and changes will be administered as of July 1, 2023.
For all services and products where the maximum reimbursement amount will increase, the increase will come into effect on July 1, 2023. This means that the increased reimbursement will only apply to items or services incurred on or after July 1, 2023.
For example, effective July 1, 2023, the benefit for massage therapy services increases from $300 to $500 annually. If a plan member submitted claims for $300 in massage therapy services incurred before July 1, 2023, they will be eligible to submit claims for another $200 after July 1, 2023, for services incurred after that date.
Additional information and examples are included in the ‘Details’ column in the table below.
Contents
Benefit | Coverage reimbursed at 80% | Details |
---|---|---|
Medical practitioners’ services | ||
1. Registered Dietitian | $300 per calendar year | New benefit
|
2. Occupational therapist | $300 per calendar year | New benefit
|
3. Lactation consultant | $300 per calendar year | New benefit
|
4. Acupuncturist | $500 per calendar year |
|
5. Nurse practitioner | N/A |
|
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
|
8. Gender Affirmation | $75,000 per lifetime | New benefit
|
Medical practitioner’s services | ||
9. Psychological services (Psychologist) | $5,000 per calendar year | Effective July 1, 2023, the PSHCP mental health COVID-19 temporary measures will become permanent. Increased benefit from $2,000 to $5,000
|
10. Physiotherapist | $1,500 per calendar year | On July 1st, 2023, the member experience for physiotherapy claims will change.
|
11. Massage therapist | $500 per calendar year | Increased benefit from $300 to $500
|
12. Osteopath | $500 per calendar year | Increased benefit from $300 to $500
|
13. Naturopath | $500 per calendar year | Increased benefit from $300 to $500
|
14. Podiatrist or chiropodist | $500 per calendar year |
|
15. Nursing services | $20,000 per calendar year | Increased benefit from $15,000 to $20,000
|
16. Electrologist | $1,200 per calendar year | A prescription is required unless the plan participant is undergoing treatment related to gender affirmation.
|
17. Speech language pathologist and audiologist | $750 per calendar year | Audiologists are now included under this benefit.
|
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 from $1,000 to $1,500
|
25. Needles and syringes for injectable drugs | $200 per calendar year | New benefit
|
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 people with Type I diabetes only |
28. Diabetic monitors | $700 per 5 years | New Benefit. Eligible with or without an insulin pump
|
29. Diabetic testing supplies | $3,000 per calendar year |
|
Durable Equipment | ||
30. Walkers and wheelchairs | No change | No longer restricted for use in a private residence only
|
31. Medical monitoring devices | Limited to one every 5 years | A prescription is required
|
Hospital Coverage for members with Supplementary 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
|
36. Family Assistance Benefits | $5,000 per travel emergency |
|
Relief provision | ||
37. Pensioner relief provision | N/A | Relief provision extended to include members who retire after April 1, 2015, extended until March 31, 2025, provided they meet the following criteria:
|
Benefit | Details |
---|---|
38. Mandatory Generic Drug Substitution | The PSHCP will implement Mandatory Generic Drug Substitution following a legacy period ending December 31, 2023.
|
39. Prior Authorization & Biosimilars | A Prior Authorization program will be implemented effective July 1, 2023, for a sub-set of specific prescription drugs that require special handling. For example, biologic drugs that are administered by a medical professional in a clinical setting.
Biosimilars, comparable cost-effective versions to originator biologic drugs, are proven to be as safe and effective as originator biologics.
|
40. Compound Drugs | The PSHCP will implement a change to compound drug eligibility following a legacy period ending December 31, 2023.
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41. Catastrophic Drug Coverage | Effective July 1, 2023, eligible drug expenses will be reimbursed at 100% when out-of-pocket drug expenses exceed $3,500 in a calendar year.
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Pharmacy Dispensing Fees | |
42. Frequency Limits | Effective July 1, 2023, pharmacist dispensing fee will be reimbursed up to a maximum of five times per year for maintenance drugs. Exceptions will be considered in situations such as:
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43. Fee Caps | Effective July 1, 2023, the PSHCP will reimburse up to a maximum of $8 for the pharmacy dispensing fee.
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The PSHCP Directive is currently being updated to reflect the above changes. It will be available effective July 1, 2023. At that time, should there be any discrepancy between this information in this Information notice and that contained in the PSHCP Directive, the PSHCP Directive applies.
Effective July 1, 2023, plan members can speak with the new plan administrator, Canada Life, regarding any details surrounding these plan changes.
Plan members are encouraged to keep medical receipts and records for at least one year following treatment or purchase of medical equipment and supplies and may be required to submit documentation to support claims as required by the plan administrator.
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