Public Service Health Care Plan summary
This is a summary of the Public Service Health Care Plan (PSHCP), which is offered to eligible employees and retirees of the public service (including the Royal Canadian Mounted Police and the Canadian Forces) and participating employers, and members of certain designated groups. It does not contain all details or describe all limits, restrictions or exclusions. For additional information, please refer to the PSHCP Directive or the PSHCP Administration Authority Web site; or contact your departmental Compensation services, the Public Service Pay Centre or the Government of Canada Pension Centre.
The PSHCP is designed to supplement your provincial/territorial health insurance plan for reasonable and customary eligible expenses. This is referred to as Supplementary Coverage.
If you are posted outside of Canada by your employer or live outside of Canada as a retiree and no longer eligible under a provincial/territorial health insurance plan, please refer to the PSHCP Directive or the PSHCP Administration Authority Web site for a description of Comprehensive Coverage.
The following information is for members with Supplementary Coverage.
Eligibility
- Optional coverage for:
- Full-time and part-time employees and employees appointed for more than 6 months or who have completed 6 months of continuous employment
- Retired members with at least six years of pensionable service (some exceptions apply, please see Public Service Health Care Plan (PSHCP) Special Bulletin) in receipt of an ongoing recognized pension
- Eligible spouses or common-law partners and dependant children of plan members, including survivors
For definitions of terms used, please consult the PSHCP Directive definitions page.
Application and Effective Date
Active Member
To apply, you must complete and submit a Public Service Health Care Plan (PSHCP) online Application on the Compensation Web Applications (CWA). Alternatively, a paper PSHCP Employee Application form (PDF, 95 KB) can be submitted to your departmental Compensation services or the Public Service Pay Centre.
- If your completed application is received within 60 days from the date you become eligible for coverage, your PSHCP coverage will take effect on the first day of the month following receipt of your application.
- If your completed application is received more than 60 days after the date you become eligible for coverage, your PSHCP coverage will take effect on the first day of the fourth month following receipt of your application.
Retired Member
To apply, you must complete and submit a paper Public Service Health Care Plan (PSHCP) Pensioner Application Form (PDF, 91 KB) to the Pension Centre. If you were a member of the PSHCP as an active member, you may choose to continue your PSHCP coverage.
- If you were not a member of the PSHCP before retirement, your PSHCP coverage will take effect the first day of the fourth month after your completed application is received.
Positive Enrolment
Once your application is approved, you will be issued a certificate number which you will need to complete Positive Enrolment with the plan administrator, Sun Life Financial.
This entails providing information to Sun Life about yourself, your spouse/common-law partner and each eligible child, including full name, address, gender and age, and whether you or any of your dependants have coverage under another group health care plan. In order to receive your Public Service Health Care Plan (PSHCP) benefit card and have your claims paid under the PSHCP, you must complete positive enrolment. If you do not, your claims will not be paid.
If you were a PSHCP member prior to retirement or experienced any life changes, you may need to update your Positive Enrolment information.
Reimbursement Percentage
- 80% of eligible expenses or of stated maximums, if any
Eligible Expenses
Extended Health Provision
Prescription Drugs (Reimbursed at 80%):
- Drugs that legally require a prescription
- Certain life-sustaining drugs
- Smoking cessation aids: Lifetime maximum $1,000
- Erectile dysfunction drugs: Maximum $500 per calendar year
Vision Care (Reimbursed at 80%)
- Eye examination: 1 every 2 calendar years commencing odd years
- Eyeglasses or contact lenses: Maximum $275 every 2 calendar years commencing odd years
- Elective laser eye surgery: Lifetime maximum $1,000
Medical Practitioners (Reimbursed at 80%)
- Physiotherapist: Up to $500 and over $1,000 per calendar year
- Psychologist: Maximum $2,000 per calendar year
- Massage Therapist, Osteopath, Naturopath or Podiatrist/Chiropodist: Maximum $300 per calendar year per type of practitioner
- Chiropractor, Speech-Language Pathologist: Maximum $500 per calendar year per specialty
- Nursing services: Maximum $15,000 per calendar year.
Dental Treatment (Reimbursed at 80%)
- Dental expenses incurred for the treatment of an accidental injury to natural teeth or a jaw fracture
- Certain dental surgical expenses
Other Services and Supplies (Reimbursed at 80%)
- Expenses for certain supplies and services may be eligible, subject to maximums, such as ambulance transportation, hearing aids, orthotics, diabetic supplies and aerotherapeutics devices. Please consult the Public Service Health Care Plan (PSHCP) Directive or the PSHCP Administration Authority Web site.
Out-of-Province Emergency Medical Expenses (Reimbursed at 100%)
- Emergency treatment of injury or illness occurred on vacation or business travel: Maximum $500,000 per trip (Canadian currency)
- For vacation travel: Only emergency services obtained within 40 days of departure date from your province/territory of residence are covered
- For business travel: Only emergency services for the entire period while on "official travel status"
- Assistance services including transportation arrangements, medical referrals and advance payment of medical expenses
Out-of Province Referral Benefit (Reimbursed at 80%)
- Coverage for certain medical services not available in the province or territory of residence: $25,000 per illness or injury
- Written referral by the attending physician required
Hospital Provision
Hospital (Reimbursed at 100%)
- Specified dollar amounts per day, for daily hospital accommodation charges in a licensed hospital not covered by a provincial/ territorial health care plan
- Three levels of coverage available, each providing a different maximum towards a semi-private or private hospital accommodation:
- Level I – $60 per day
- Level II – $140 per day
- Level III – $220 per day
Co-ordination of Benefits
If you and your dependant are covered under more than one group health plan, you may coordinate benefits up to 100% of the actual eligible expenses. Coordination of benefits between Public Service Health Care Plan (PSHCP) members is allowed.
Cost Sharing / Contributions
The Public Service Health Care Plan (PSHCP) monthly contribution rates are comprised of two components, the cost associated with the Extended Health Provision and the cost for the Hospital Provision. These components have different cost sharing arrangements.
Active Member
- Your employer pays the full cost of the Extended Health Provision and Hospital Level I coverage under the Hospital Provision. If you choose Level II or III hospital coverage, you are responsible for 100% of the additional expense for this coverage.
- Provisions for contributions while on leave without pay
- Provisions for members of the Executive Group and other designated groups - Full Employer-Paid Coverage
Retired Member
- You and your employer share the cost of the Extended Health Provision and Hospital Level I coverage under the Hospital Provision. If you choose Hospital Level II or III coverage, you are responsible for 100% of the additional expense for this coverage.
- You will pay 50% of the cost of your Extended Health Provision coverage effective following a four year phase in period beginning (see table below).
| Effective Date | Cost Sharing for Retired Members | |
|---|---|---|
| Retired Member | Government of Canada | |
| 31.25% | 68.75% | |
| 37.5% | 62.5% | |
| 43.75% | 56.25% | |
| 50% | 50% | |
Public Service Health Care Plan Relief Provision
If you joined the Public Service Health Care Plan (PSHCP) as a retired member on or before and are either in receipt of a Guaranteed Income Supplement (GIS) benefit, or have a net income or a joint net income lower than the GIS thresholds, you may be eligible for the PSHCP Relief Provision.
- To apply, complete a PSHCP Relief Provision Application Form and return it to the Pension Centre. For the most current GIS threshold amounts, please visit the Service Canada Web site.
- If you are approved for the relief provision, it will be applied on the first day of the second month after the pension centre receives your completed application form.
- You and your employer share the cost of the Extended Health Provision and Hospital Level I coverage under the Hospital Provision. You will pay 25% for the Extended Health Provision of your coverage. The employer will pay the other 75%. If you choose Hospital Level II or III coverage, you are responsible for 100% of the additional expense for this coverage.
Coverage ends automatically
- When a member and/or dependant ceases to be eligible.
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