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

If you are a member of the Public Service Health Care Plan (PSHCP) or Pensioners' Dental Services Plan (PDSP) as a retired member, the following information is intended to outline how to submit a claim for reimbursement.

You may want to know…

  • How do you submit a claim for benefits under the Public Service Health Care Plan?

    When purchasing eligible prescription drugs and certain medical supplies at the pharmacy in Canada, you should present your Public Service Health Care Plan (PSHCP) benefit card. If your card is accepted, your pharmacy will use it to send the cost of your prescription to Sun 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 simply pay the 20% co-payment (unless you have coordinated your benefits with another plan).

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

    In addition, plan members residing in Canada are able to submit their vision care and paramedical services claims through the Sun Life Member Services website or the my Sun Life Mobile app available on Apple and Android devices.

    Other types of eligible health care expenses can be submitted by mail using a completed PSHCP Claim Form (PDF, 614 KB) for Supplementary Coverage or a PSHCP Claim Form for Out-of-Country Claims for Comprehensive Coverage. Attach supporting documentation (original receipts, bills, invoices, physician or practitioner statements, and/or questionnaires, etc.). Mail the form to the address indicated on the form along with the supporting documentation.

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

  • How do you coordinate benefits under the Public Service Health Care Plan?

    If you and your dependant 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 section. Complete the applicable coordination of benefits section when submitting a PSHCP claim on the Sun Life Member Services website or a paper claim form.

  • How do you obtain a Public Service Health Care Plan Benefit Card?

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

    If you completed positive enrolment, you can print your PSHCP Benefit Card from the Sun Life Member Services website, access your benefit card using the my Sun Life Mobile app, or request that Sun Life send a card to you by mail.

    If you completed positive enrolment using a paper form, Sun Life will mail you your benefit card.

  • Is there a deadline for submitting a Public Service Health Care Plan claim?

    Under the Public Service Health Care Plan (PSHCP), a claim must be received by Sun Life within 12 months following the calendar year in which the expense was incurred. This means that all your claims for expenses incurred in 2014 must be received by Sun Life no later than .

  • Where can you obtain information about the status of your Public Service Health Care Plan claim?

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

    1. Consult the Sun Life Member Services website using your Access ID and password to log in; or
    2. Contact Sun Life
  • How do you find out why your Public Service Health Care Plan claim was refused?

    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 Sun Life by email, the my Sun Life Mobile app, the Sun Life Member Services website, or by mail. On this statement Sun Life will have provided an explanation in “Details of your health claims” section. If you have further questions contact Sun 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 Sun Life, please have your contract and certificate numbers ready. For information on How to Submit an Appeal refer to the PSHCP Administration Authority website.

  • How do you submit a claim under the Pensioners' Dental Services Plan?

    Pensioners' Dental Services Plan (PDSP) claims may be submitted electronically by your dentist. It is your responsibility to authorize your dentist to submit the claim on your behalf and to ensure that your dentist has your current information including your plan and certificate number.

    If your dentist does not submit the claim electronically on your behalf, ask your dentist to complete his/her section of the PDSP Claim Form, then complete your section and either:

    • submit your claim electronically through the PDSP Member Services website and click on the "Submit a Claim" button. You will need an Access ID and password to access your account; or
    • mail it to the address indicated on the form.

    If you wish to have a form sent to you, contact Sun Life.

    Note: It is your responsibility to keep a copy of your claims, including bills, receipts and declarations, for your records.

  • How do you coordinate benefits under the Pensioners' Dental Services Plan?

    If you and your covered family members are covered under another dental 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.

    Note: Coordination of benefits between two members of the Pensioners' Dental Services Plan (PDSP) is not allowed under the Plan.

    For information on which plan you should claim from first, refer to the Coordination of benefits with other plans section of the PDSP Member Booklet.

  • Is there a deadline for submitting a Pensioners' Dental Services Plan claim?

    Under the Pensioners' Dental Services Plan (PDSP), claims must be submitted within 15 months of the date the expenses have been incurred.

  • Where can you obtain information about the status of your Pensioners' Dental Services Plan claim?

    For information about the status of a submitted Pensioners' Dental Services Plan (PDSP) claim, you can either:

  • How do you find out why your Pensioners' Dental Services Plan claim was refused?

    If your claim was refused under the Pensioners' Dental Services Plan (PDSP), you will have received either an electronic or paper Explanation of Benefits letter (i.e. claim statement) from Sun Life. On this statement Sun Life provides an explanation of your claim. If you have further questions contact Sun Life.

    In the event you disagree with a claim decision, refer to the Member Appeals section of the PDSP Member Booklet.

  • What online services are available to group insurance benefit plan members?

    As a member of the Public Service Health Care Plan (PSHCP) you can access your account via the internet and mobile application.

    The following features will be available on the Sun Life Member Services website and through the my Sun Life Mobile app:

    • electronic claims submissions
    • track claims that are being processed and view your completed claims
    • find out what is covered under your Plan quickly and conveniently
    • locate health practitioners nearest to you using the “provider search” feature
    • review your drug claim history, drug coverage, and explore potential alternative drugs in real time to discuss with your health practitioner
    • access your PSHCP benefit card any time

    Web specific features:

    • submit coordination of benefits claims between two Sun Life plans or submit the remaining balance of a claim already processed through another insurer
    • complete and update your positive enrolment information
    • sign up for direct deposit or update your banking information currently on file for quick reimbursement of your benefits claims
    • access your PSHCP benefit card any time and print copies for your dependants

    Mobile app specific features:

    • submit photos of receipts for more complex medical expenses, such as treatments lasting more than one hour, lab tests, equipment, and medical supplies
    • provide supporting documentation requested by Sun Life, such as physician referrals and questionnaires for a claim without having to send documents by mail
    • add your PSHCP benefit card to your Apple Wallet (not available on Android)
    • activate the Touch ID sign-in feature to log in securely

    As a member of the Pensioners’ Dental Services Plan (PDSP), you can access your account on the PDSP Member Services website.

    The following features are available:

    • sign up for direct deposit and paperless Explanation of Benefits (i.e. claim statement)
    • obtain your coverage information
    • download and print personalized claim forms
    • view the status of your claims and print details of past claims
    • determine eligibility for the next oral exam
    • view and elect for paperless PDSP Communiqués and email notification
  • How do you register for the online services?

    An Access ID and password is necessary to enter each of the websites. These can be obtained by registering online at:

    • Public Service Health Care Plan (PSHCP) Sun Life Member Services website – click on Register now!

      For security purposes, a password will be sent separately to you by mail.

    • Pensioners' Dental Services Plan (PDSP) Member Services website – click on Need an Access ID? Register now!

      For security purposes, a password will be sent separately to you by mail.

    Please note that even though both plans are administered by Sun Life, a member must register for these services under each plan separately.

Visit Public service pension plan for information on pension.

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