Budget 2014 announced that the Government will take steps to ensure that the costs of the Public Service Health Care Plan for retirees are shared fairly between them and the Government as employer.
The Public Service Health Care Plan (PSHCP) is an optional health care plan for federal Public Service employees and their eligible dependants.
It is designed to supplement your provincial health insurance plan. In other words, the Plan will reimburse you for all or part of your costs for eligible medical services and products once you have taken advantage of the benefits provided under your provincial/territorial health insurance plan or other third party source of health care assistance to which you are legally entitled. Complete details on the Public Service Health Care Plan are set out in the PSHCP Directive.
You can also find information on the Public Service Health Care Plan page of the TBS web site or directly in the plan member booklet "Public Service Health Care Plan - Benefits Coverage and Plan Provisions".
In addition, the Plan Administrator, Sun Life Financial, has an Internet service to provide members with secure access to claims information and other services. An Access-ID and a Personal Identification Number (PIN) are needed. You can get these by calling the Administrator. The contact information is located on their web site.
If you do not have access to the Internet or you need a copy of the plan member booklet, you should contact your compensation advisor.
PSHCP members may also visit the PSHCP Administration Authority web site.
The benefits covered under the Health Care Plan fall into 2 broad categories: Extended Health Care Benefits and Hospital Benefits.
Extended Health Care Benefits – the PSHCP reimburses plan members for reasonable and customary charges for specific medical services and products. Examples of these are prescription drugs, private nursing services, eyeglasses and contact lenses, some physiotherapist and massage therapist services, orthotics and ambulance services.
Hospital Benefits – members and their dependants are covered for hospital charges in excess of standard ward charges up to specified limits. There are 3 levels of coverage available to members:
If you join the Plan, you are automatically covered for Level I benefits unless you elect for Level II or III.
A complete description of what is covered under the Plan can be found on the Treasury Board of Canada Secretariat Web Site under the heading PSHCP Directive.
You can find related information on the TBS Public Service Health Care Plan page on the TBS web site or directly on the plan member booklet "Public Service Health Care Plan - Benefits Coverage and Plan Provisions".
For Extended Health Care Benefits, there is a deductible amount of $60 per person or $100 per family each calendar year. After that amount has been satisfied, the plan generally pays you 80 % of expenses.
For Hospital Benefits, there is no annual deductible.
For some services or products, there are annual maximum eligible expenses: For example, psychologist’s services can be reimbursed to a maximum of $1000 per year. Also, some services require a physician's referral.
The PSHCP is a voluntary plan for employees who are appointed for more than 6 months. It is available to full time and part time employees. Eligible employees must apply for coverage. Members can also apply to cover eligible dependants.
On joining, Plan members receive a benefit card showing their certificate number and the level of coverage they have chosen.
Once you have applied to be a Plan member, the Government as your employer pays the full cost of your Extended Health Care Benefit and Level I of your Hospital Benefit.
Employees who choose Level II Hospital Benefits will pay a premium of $1.10 per month for Single coverage or $3.53 per month for Family Coverage.
Employees choosing Level III Hospital Benefits will pay $5.31 per month for Single coverage or $10.34 for Family Coverage.
Contributions are deducted from employees’ paycheques.
Members of the Executive Category are provided with Family Coverage Level III Hospital Benefits and these are fully paid by the Employer.
Please also refer to the Question on Leave Without Pay.
As a plan member, you can apply for coverage for the person to whom you are legally married. Alternatively, you may apply for coverage for the person with whom you have lived for a continuous period of at least one year, whom you have publicly represented as your spouse and with whom you continue to live as if that person were your spouse.
You may apply for coverage for your dependant child or the dependant child of your spouse. To be eligible as a dependant child, the person must be unmarried and either under the age of 21 or be under the age of 25 and a full time student. A child who is dependent upon you for support because he or she is incapable of engaging in sustainable employment by reason of mental or physical impairment may also be covered under certain circumstances, as set out in the PSHCP Directive.
IMPORTANT: There are time limits for applying for coverage of new dependants. Refer to the PSHCP Directive for details.
Generally speaking, you can continue to be covered under the PSHCP. However, depending upon the length of your leave and the type of leave, you may be required to pay the full cost of your coverage.
Before proceeding on leave, you should arrange with your compensation advisor to continue your PSHCP coverage. Failure to pay the required contributions will result in your coverage being terminated at the end of the month following the month for which your last contribution was made. You may re-instate your coverage when you return to duty but you cannot do so retroactively.
Refer to the PSHCP Directive for details.
The PSHCP covers members and their dependants for up to $500,000 (Canadian) in eligible medical expenses incurred as a result of an emergency while traveling on vacation or business.
Eligible expenses are described in the Public Service Health Care Plan Directive and the Benefits Coverage and Provisions Booklet . They include charges for hospital accommodation and the services of a physician. They can also include reasonable costs for medical evacuation, family assistance for travel, meals and childcare, for example.
Eligible expenses mean charges in excess of the amount payable by a provincial or territorial health insurance plan for emergency treatment of injury or disease which occurs within 40 days from the date of departure from your province or territory of residence.
The 40 day time limit does not apply in the case of employees who are travelling on official government business. They are covered for the entire period of official travel status. However, the $500,000 benefit coverage limit still applies.
If you are travelling outside Canada, be sure to take with you the Public Service Emergency Travel Assistance telephone numbers. These numbers are listed in the Public Service Health Care Plan Directive.
You can apply to cover dependants or cancel dependants’ coverage or to amend your level of Hospital Provision coverage at any time except while you are on leave without pay. The effective date of the amended coverage will depend upon the type of change you are making and the timeframe within which you make it.
Refer to the PSHCP Directive for details
Claims are made by completing the PSHCP claim form, attaching original bills and receipts and forwarding these to the PSHCP administrator, Sun Life Assurance Company of Canada. The PSHCP Claim Form is available online. Once you have submitted your first claim, the administrator will provide you with a personalized claim form for future use.
There are time limits for submitting claims and these are described in the Plan Document and the Plan member booklet.
Questions about PSHCP claims should be directed to Sun Life Assurance Company of Canada at:
Alternatively, members can find information on the status of their claims from the Plan Administrator, Sun Life Financial. An Access-ID and a Personal Identification Number (PIN) are needed. You can get these by calling the Plan Administrator. The contact information is located on their web site.
Yes, though your coverage will be different. You will be eligible for Comprehensive coverage which is intended for plan members who are posted outside Canada and who are not covered under a provincial or territorial health insurance plan or a non-government hospital insurance plan.
Comprehensive coverage includes Basic Health Care, the Extended Health Provision, the Hospital provision and the Hospital Expense (Outside Canada) provision. A full description of these provisions can be found in the PSHCP Directive.
The Basic Health Care provision provides reimbursement for services, excluding Hospital Services, which are the equivalent as far as possible to those services available to individuals residing in Canada and covered under a provincial/territorial health insurance plan.
The Hospital Expense (Outside Canada) provision provides reimbursement for reasonable and customary charges for hospital confinement in a general hospital, a hospital of the Canadian Forces or a hospital of the armed forces of a foreign country.
Contribution rates are virtually the same as the contribution rates for employees living in Canada.
If you retire and begin receiving an immediate on-going pension under the Public Service Pension Plan, you may continue your PSHCP membership without interruption.
If you do not receive an immediate pension, your coverage terminates when your employment terminates. However, if a PSHCP contribution has been taken in the month in which your employment terminates, coverage will continue until the end of the following month.
As a pensioner, your contribution rates will be different from those you paid as an employee. The rates for pensioners living in Canada are listed in Schedule V of the Public Service Health Care Plan Directive.
Pensioners living outside Canada will pay higher rates and may not be covered for the same Hospital expenses as pensioners living inside Canada.
Refer to the PSHCP Directive for full information on rates and coverage.
To this end, Economic Action Plan 2014 notes the intention to transition to equal cost sharing (50:50) for retired federal employees under the Public Service Health Care Plan, and to increase the number of years of service required to be eligible to participate in the Plan in retirement from two to six.
The Government intends to pursue changes that will make the Plan for retired federal employees more comparable with the plans of other large employers in the public and private sectors. This would ensure that the Plan is more affordable and sustainable in the future.
The Government intends to ensure that current low-income pensioners are not adversely affected by the change in contributions. There will be no change to the health care contributions of public servants while they are employees.
For a retired plan member opting for individual coverage in his/her retirement, a move to equal cost sharing would increase his/her annual contributions to the Plan from $261 to roughly $550.
The Government is continuing to engage with bargaining agents and key stakeholders towards a timely resolution on these proposals and is prepared to consider reasonable Plan improvements provided they are fair to taxpayers.