Public Service Health Care Plan Directive Table of Contents General Application Effective Date Purpose and Scope of the PSHCP Claims Appeal Procedure Management of the Public Service Health Care Plan PSHCP Governance Financial Management Amendment of the Plan Directive Definitions 1 Eligibility 1.1 Employees, Civilian Members of the RCMP 1.2 Members of the RCMP and of the CAF Regular and Reserve Component 1.3 Pensioners 1.4 Dependants 2 Commencement, Amendment and Termination of Coverage 2.1 When an Application is Required 2.2 Effective Date of Coverage Waiting Period 2.3 Termination of Coverage Voluntary Cessation of Coverage Involuntary Cessation of Coverage 3 Contributions 3.1 General 3.2 Payment of Contributions While on Leave Without Pay (LWOP) 3.3 Employee Contributions Only 3.4 Employee and Employer Contributions 3.5 Retroactive Change in Coverage 3.6 Administrative Errors 4 Available Coverage 4.1 Supplementary Coverage 4.2 Comprehensive Coverage 4.3 Eligibility for Provisions Employees, Dependants of Members of the CAF and of the RCMP Pensioners 5 Plan Provisions 5.1 Claims 5.2 Appeals 5.3 Payment of Benefits 5.4 Co-Payment 5.5 Overpayments 5.6 Coordination of Benefits 5.7 Subrogation 5.8 General Exclusions and Limitations 6 Extended Health Provision 6.1 General 6.2 Drug Benefit (For All Members) PSHCP Benefit Card Prior Authorization Mandatory Generic/Biosimilar Substitution Pharmacy Dispensing Fees and Frequency Limits Catastrophic Drug Coverage in the Event of High Drug Costs Exclusions 6.3 Vision Care Benefit (For All Members) Exclusions 6.4 Medical Practitioners Benefit (For All Members) Exclusions 6.5 Miscellaneous Expense Benefit (For All Members) Exclusions 6.6 Dental Benefit (For All Members) Lower Cost Alternative Accidental Injury Oral Surgical Procedures Exclusions 6.7 Out-of-Province Benefit (For Members with Supplementary Coverage) Emergency Benefit While Travelling Emergency Travel Assistance Services Official Travel Status Referral Benefit Exclusions 7 Hospital Provision (For All Members) 7.1 General 7.2 Eligible Expenses - Level I, II and III Exclusions 8 Basic Health Care Provision (For All Members with Comprehensive Coverage) 8.1 General 8.2 Eligible Expenses Exclusions 9 Hospital (Outside Canada) Provision (For All Employees with Comprehensive Coverage, Excluding Pensioners) 9.1 General 9.2 Eligible Expenses Exclusions 10 Summary of Maximum Eligible Expenses Length of Time a Prescription is Valid Schedule I – Participating Employers Schedule II – Employers Withdrawn from the PSHCP Schedule III - Designated Persons, Boards and Agencies Schedule IV - Recognized Ongoing Pension Benefits Schedule V - Monthly Contribution Rates Appendix A – Employee Monthly Contribution Rates Appendix B – Members of the Canadian Armed Forces CAF/RCMP Monthly Contribution Rates Appendix C – Pensioner Monthly Contribution Rates Appendix D – Employer Monthly Contribution Rates Schedule VI - Full Employer-Paid Coverage Schedule VII - Life-Sustaining Drugs Next Related Links Print Full Directive Definitions Schedule I – Participating Employers Schedule II – Employers Withdrawn from the PSHCP Schedule III - Designated Persons, Boards and Agencies Schedule IV - Recognized Ongoing Pension Benefits Schedule V - Monthly Contribution Rates Schedule VI - Full Employer-Paid Coverage Schedule VII - Life-Sustaining Drugs
