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

Electronic

• In Canada

  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 accepted, your pharmacy will use it to send the cost of your prescription to Canada 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 pay the 20% co-payment (unless you have coordinated your benefits with another plan).

  In addition, you can present your benefit card to a registered health care provider (e.g. massage therapist, physiotherapist) to have them submit claims electronically on your behalf. Health care providers can visit Telus Health for information on how to register.

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

  You can also submit your claims through the Canada Life PSHCP Member Services website or Canada Life’s My Canada Life at Work^TM mobile app, including claims incurred outside of Canada, if not for a medical emergency.

• Outside of Canada

  Members with Comprehensive coverage or members with Supplementary coverage who have eligible out-of-province Emergency Benefit claims can submit their claims to MSH International on the MSH PSHCP Member Portal.

  Mail

  PSHCP claims can also be submitted by mail using the appropriate completed PSHCP Claim Form for Supplementary Coverage or for Comprehensive Coverage.

  Mail the form to the address indicated on the form along with supporting documentation (original receipts, bills, invoices, physician or practitioner statements, and/or questionnaires, etc.).

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

If you and your dependent 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.

Complete the applicable coordination of benefits section when submitting a PSHCP claim on the Canada Life PSHCP Member Services website, My Canada Life at Work^TM mobile app or a paper claim form.

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

If you complete your positive enrolment online, you’ll immediately receive a PDF copy of your benefit card, which you can download to your phone or computer for your records. Plan member and dependant benefit cards are accessible any time through the PSHCP Member Services website after you register. 

Once you have completed positive enrolment and registered for an account on the Canada Life PSHCP Member Services website , you can also access your benefit cards and save them on your mobile wallet using Canada Life’s My Canada Life at Work^TM mobile app.

If you complete your positive enrolment by paper, you’ll receive a paper benefit card for the plan member only. The benefit card will be mailed to the address you provided on your PSHCP Positive Enrolment Form approximately 4 weeks after Canada Life receives your completed form.  

Under the Public Service Health Care Plan, a claim must be received by Canada Life within 12 months following the calendar year in which the expense was incurred. For example, claims for expenses incurred in 2023 must be received by Canada Life no later than December 31, 2024.

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

1. Consult the Canada Life PSHCP Member Services website using your email address and password to log in; or
2. Consult Canada Life’s My Canada Life at Work^TM mobile app using the same email address and password used to access your account on the Canada Life PSHCP Member Services website; or  
3. Contact Canada Life.

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 Canada Life by email or mail, on Canada Life’s My Canada Life at Work^TM mobile app, or on the Canada Life PSHCP Member Services website. On this statement, Canada Life will have provided an explanation of your health claim. If you have further questions contact Canada 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 Canada Life, please have your plan and certificate numbers ready. For information on How to Submit an Appeal, refer to the Federal PSHCP Administration Authority website.

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.

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.

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

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

• Consult the PDSP Member Services website and use your Access ID and password to log in; or
• Contact Sun Life.

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.

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

The following features are available:

Canada Life PSHCP Member Services website

1. Submit electronic claim.
2. Attach receipts, photo receipts (which is required) and other supporting documents to claims for expenses such as lab tests, equipment, and medical supplies.
3. Attach documents requested by Canada Life, such as referrals, proofs of payment, estimates and drug forms, to recently completed claims.
4. Track claims that are being processed and view your completed claims.
5. Learn what is covered under the Plan quickly and conveniently.
6. Locate health practitioners using the "provider search" feature.
7. Review drug coverage and claim history for you and your dependants.
8. Explore alternative drugs to discuss with your health practitioner.
9. Access and print your PSHCP benefit card.
10. Coordinate benefits claims between two Canada Life plans or submit the remaining balance of a claim already processed through another insurer.
11. Complete or update your personal account (“positive enrolment”) information.
12. Sign up for direct deposit or update your banking information.
13. Use Two-Step Verification to verify your identity and protect your personal information. Canada Life will text or email you (your choice) with a one-time security code.

My Canada Life at Work^TM mobile app

1. View your personal account information, including dependant and banking information.
2. Submit electronic claims, coordinate benefits claims between two Canada Life plans, track claims progress and view claims history for you and your dependants.
3. Attach receipts, photo receipts and other supporting documents to claims for expenses such as lab tests, equipment, and medical supplies.
4. Sign up for electronic explanation of benefits statements.
5. View and save your and your dependants PSHCP benefit cards to your mobile wallet.
6. View your health coverage and balances. 
7. Enable and sign into your account with Face and Touch ID.

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

Public Service Health Care Plan

To access your PSHCP online account, you will need a personal email address and password. If you do not already have an account, you can register on the Canada Life PSHCP Member Services website. You will need your plan and certificate numbers to register.

For security purposes, an email will be sent to you with an activation code to complete the registration process.

To access Canada Life’s My Canada Life at Work^TM mobile app, you must first have registered to the PSHCP Member Services website. Once registered:

• Download the My Canada Life at Work^TM mobile app for iPhone and Android devices from the App Store or from Google Play.
• Sign into the app using your username and password for the PSHCP Member Services account.
• You can choose to enable Face or Touch ID to sign into your account faster.

Pensioners’ Dental Services Plan

To access the Pensioners’ Dental Services Plan Member Services website, click on Register and enter your email address.

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