Public Service Health Care Plan Frequently asked questions - (General)

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/territorial health insurance plan. In other words, the PSHCP will reimburse you for all or part of your costs for eligible medical services and products after 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 of the PSHCP are set out in the PSHCP Directive.

You can also find information on the PSHCP webpage and in the PSHCP Member Booklet available on the Canada Life PSHCP Member Services website.

The Canada Life PSHCP Member Services website provides members with:

• Secure access to electronic claims submissions (for members living in Canada only)
• Benefit eligibility information
• Personalized claim forms
• Direct deposit information
• Access to update positive enrolment information

You can register online at Canada Life. An email address and password are required. If you need help registering, you can call Canada Life at:

• 1-855-415-4414 (toll-free in North America)
• 1-431-489-4064 (collect, International)

PSHCP members may also visit the PSHCP Administration Authority website.

The benefits provided under the Public Service Health Care Plan (PSHCP) 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:

• Level I provides for a maximum payment of $90 per day;
• Level II provides for a maximum payment of $170 per day; and
• Level III provides for a maximum payment of $250 per day.

Plan members are automatically covered for Level I benefits unless they choose Level II or III.

A complete description of what is covered under the Plan can be found in the PSHCP Directive.

You can find related information on the PSHCP webpage and in the PSHCP Member Booklet available on the Canada Life PSHCP Member Services website.

For Extended Health Care Benefits, the Plan generally reimburses you 80 % of eligible expense(s). For some services or products, however, there are annual maximum eligible expenses. For example, psychological services can be reimbursed to a maximum of $5000 per year. Note: Some services require a physician’s referral.

For Hospital Benefits, the plan includes three levels of hospital benefits that provide reimbursement up to a specific dollar amount in excess of standard ward charges.

The Public Service Health Care Plan (PSHCP) is a voluntary plan for full-time and part-time employees who are appointed for more than 6 months and retired employees of the public service with at least six years of pensionable service.

Applications must be completed and submitted either electronically using the secure online PSHCP Web Application on the Compensation Web Applications (CWA) or, by paper to your departmental Compensation services, the Public Service Pay Centre, Pension office or the Government of Canada Pension Centre. Members can also apply to cover eligible dependants.

Once you are registered you must complete your positive enrolment with the plan administrator, Canada Life, to provide information about yourself, your spouse/common-law partner and each eligible child.

Those already registered with an account on the Canada Life PSHCP Member Services website for the PSHCP can complete positive enrolment online using their email address and password.

Those not yet registered with an account on the Canada Life PSHCP Member Services website for the PSHCP can register, and then complete positive enrolment online.

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 through the Canada Life PSHCP Member Services website after you register. 

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.

Active members

The Government, as your employer, pays the full cost of your Extended Health Care Benefit and Hospital Level I coverage.

Employees who choose Level II or Level III Hospital Benefits will pay monthly contributions based on their category of coverage (single versus family).

Contributions are taken from employees’ pay one month in advance of coverage. In other words, contributions taken in June pay for coverage in July.

Members of the Executive Category receive 100% employer paid Family Level III Hospital coverage. This is a taxable benefit.

Retired members

Retired members with Supplementary coverage share the cost (50/50) of the Extended Health Provision with the Employer. The Employer pays the full cost of the Hospital Level I coverage under the Hospital Provision for retired members.

Retired members who choose Hospital Level II or III coverage are responsible for 100% of the additional contribution expense.

Under the PSHCP Relief Provision, retired members share the cost (75/25) of the Extended Health Provision with the Employer. The Employer pays the full cost of the Hospital Level I coverage under the Hospital Provision.

Retired members who choose Hospital Level II or III are responsible for 100% of the additional contribution expense.

Please also refer to the question What happens to my Public Service Health Care Plan coverage when I go on Leave Without Pay?

Yes. All plan members must complete their positive enrolment. Claims are not processed until this step is completed.

In order to appropriately administer Canada’s largest employer-sponsored health care plan, Canada Life needs accurate electronic information about plan members and their eligible dependants.

In addition, through positive enrolment, you provide a one-time consent for the use of your personal information to process benefits and administer the Public Service Health Care Plan.

Claims are not processed until you have completed positive enrolment. If you submit a claim but have not enrolled, the claim will be put on hold and Canada Life will notify you of the requirement to enrol. After you enrol, you can return your claims to Canada Life to have your claim processed.

Based on your consent, Canada Life will use your personal information to administer the Public Service Health Care Plan, and to adjudicate and pay your claims. For example, Canada Life may contact a health organization, such as a hospital, to confirm what type of hospital room you had or a professional health care provider, such as a physiotherapist or pharmacist, to verify the services they have provided.

Information will be collected and shared only for the purposes outlined in the Public Service Health Care Plan (PSHCP) Privacy Statement. Both the Privacy Statement and the consent wording on your enrolment form conform to privacy legislation, the Privacy Act and the Personal Information Protection and Electronic Documents Act.

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 also cover any of your or your spouse’s eligible dependant children. To be eligible as a dependant child, the person must be unmarried and either under the age of 21 or 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, you can continue to be covered under the Public Service Health Care Plan (PSHCP) when on leave without pay. However, depending on the length of your leave and the type of leave, you may be required to pay the full cost of your coverage (i.e. the employer and employee monthly contributions combined).

Before your leave begins, you should consult the Public Service Pay Centre or your departmental Compensation services for information about PSHCP coverage continuation and its financial impacts. If you wish to cancel your PSHCP coverage while on leave, you must provide a written request to the Public Service Pay Centre or your departmental Compensation services to opt out of the Plan. If not, your coverage will continue and you will have to pay all necessary contributions upon your return to work or discharge.

If you choose to continue your coverage while on leave, you can make arrangements to pay contributions in advance. To do so you must complete and return a Contribution Remittance for Period of Leave Without Pay form.

Failure to pay the required contributions will result in your coverage being cancelled 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 work, but you cannot do so retroactively. Note: Re-instatement may be subject to a waiting period of up to four months.

Refer to the PSHCP Directive for details.

The Public Service Health Care Plan (PSHCP) covers members and their dependants for up to $1 million (Canadian) in eligible medical expenses incurred as a result of an emergency while traveling on vacation or business.

Eligible expenses are described in the PSHCP Directive and the PSHCP Member Booklet available on the Canada Life PSHCP Member Services website. 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.

Eligible expenses mean charges more than 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 $1 million benefit coverage limit still applies.

If you are travelling outside Canada, be sure to take the Public Service Emergency Travel Assistance telephone numbers with you. These numbers are listed in the PSHCP Directive and found on the back of your PSHCP benefit card.

You can apply to cover dependants or cancel dependants’ coverage or 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 on the type of change you are making and the timeframe within which you make it.

Refer to the PSHCP Directive for details.

For active members, please refer to Submitting a benefit claim - Active members of the public service group insurance benefit plans.

For retired members, please refer to Submitting a benefit claim - Retired members of the public service group insurance benefit plans.

With the PSHCP benefit card, you and your eligible family members do not have to pay the full cost of eligible prescription drugs and medical supplies up front, and then submit a claim for reimbursement. You only have to pay your share of the cost of each prescription.

Claims will be adjudicated Monday-Friday: 6:00 am to 11:59 pm (ET)

Yes, though your coverage will be different. You will be eligible for Comprehensive coverage which is intended for plan members who are deployed or 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 the Basic Health Care Provision, 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 service expenses, excluding Hospital Services, which are the equivalent, as much 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 Armed Forces or a hospital of the armed forces of a foreign country.

Contribution rates for Comprehensive coverage can be found in the PSHCP Directive.

If you retire and begin receiving an immediate public sector pension (e.g. the Public Service Pension Plan, RCMP Pension Plan or Canadian Armed Forces Pension Plan) based on a minimum of six years of cumulative pensionable service, your coverage under the Public Service Health Care Plan (PSHCP) can continue without interruption.  

Members must apply within 60 days of their retirement date to have continuous PSHCP coverage.

If you do not receive an immediate pension, your coverage terminates when your employment ends. However, if a PSHCP contribution has been taken in the same month your employment ends, coverage will continue until the end of the following month.

As a retired member, your contribution rates will be different from those you paid as an employee. The rates for pensioners are listed in the monthly contribution rates under Schedule V of the Public Service Health Care Plan (PSHCP) Directive.

Refer to the PSHCP Directive for full information on rates and coverage.

Generic drug is the term used for a product that contains the same medicinal ingredients as its corresponding brand name drug. Use of generic equivalent drugs is widespread in Canada. Health Canada approves all generic drugs for safety, effectiveness and quality, using the same standards for generic-equivalent medication as for the brand name drug.

You can verify with your pharmacist, but it’s possible that your pharmacist dispensed a generic drug to replace the brand name drug your doctor prescribed.

It was decided in 2006 that the Public Service Health Care Plan (PSHCP) would adopt the practice of substitution of generic for brand-name drugs; therefore, the PSHCP reimburses the cost of the lowest-cost equivalent drug, unless your doctor indicates "No substitution" on the prescription.

Not all drugs have a generic equivalent; however, where they do, generic drugs often cost less than the brand name drug, which results in a lower cost for your 20% share of the prescription. In the case where the brand name drug is less expensive, the lower cost prescription will be dispensed.

If you and your physician have discussed this issue, and they believe that you need to take the brand name drug rather than the generic equivalent, you may still be covered for the brand name drug, reimbursed at 80%, if processed electronically at the pharmacy using the PSHCP benefit card.

The following will apply:

• A Brand Name Drug Coverage form must be completed by your physician and submitted to the plan administrator for review.
• Exceptions will be based on the plan administrator’s assessment of medical necessity.

You always have a choice. If you wish to pay the higher cost of the brand name drug, you can ask your pharmacist to dispense the brand name.

The Plan will pay the cost of the lowest-priced generic equivalent, and your share of the cost will increase.

The Public Service Health Care Plan (PSHCP) supplements provincial and territorial health insurance plans for members and their dependants residing in Canada. When members use the PSHCP benefit card to pay for a prescription, they are assessed against their provincial or territorial supplementary drug plan. With the implementation of the PSHCP benefit card, we can exercise greater care to ensure that the Plan only pays for eligible prescriptions, and that provincial coverage pays first, where applicable.

Some members have had their claims denied because the annual dollar threshold in certain provinces has already been surpassed.

When members provide proof of provincial coverage, the amount not paid by the province can be submitted to Canada Life for the member’s supplementary benefit.

For more information, contact the Canada Life PSHCP Member Contact Centre, from Monday to Friday, 8:00 a.m. to 5:00 p.m., member’s local time, at 1-855-415-4414 (toll free in North America) or for international calls (collect) at 1-431-489-4064.

For more information on provincial/territorial health coverage, visit the Health Canada website.

The Public Service Health Care Plan (PSHCP) provides coverage for eligible prescription drugs and medical supplies through the PSHCP benefit card.

If your doctor has prescribed a medication for an extended period, you can receive up to a 100-day supply at a time.

If you will be travelling and need more than a three-month supply, contact the Canada Life PSHCP Member Contact Centre. Canada Life will make a notation on your file so that you can purchase an additional 100-day supply with your PSHCP benefit card. This file update will take two business days to reach your pharmacy.

For more information, contact the Canada Life PSHCP Member Contact Centre, from Monday to Friday, 8:00 a.m. to 5:00 p.m., member’s local time, at 1-855-415-4414 (toll free in North America) or for international calls (collect) at 1-431-489-4064.

When you use your Public Service Health Care Plan (PSHCP) benefit card to purchase a prescription, the pharmacist is required to accept the price paid by Canada Life for eligible prescription drugs and medical supplies. This price file applies across Canada and represents the normal mark-up and cost that the pharmacy can charge.

Because the price file is monitored electronically through the use of the PSHCP benefit card, if you do not use the card when purchasing your prescription, you may be charged more than the established price file. If this occurs, when you submit your paper claim to Canada Life it will be evaluated based on the price file amount and your reimbursement will be reduced.

If you use your PSHCP benefit card for all transactions, you will not be charged the difference between what the pharmacy would otherwise charge and the established price file.