The Public Service Health Care Plan provides coverage for a wide variety of health-related products and services for the majority of active and retired PAFSO members. However, as with any health care benefits plan, certain restrictions apply.
Before incurring expenses for a product or service, you should read the related provisions to ensure you understand the parameters of what is covered by the Plan. Many items that are covered by the PSHCP are subject to maximum eligible expenses, and general exclusions and limitations.
The PSHCP partners committee oversees the administration of the PSHCP. The partners committee includes three employer representatives and three representatives from the federal public sector unions from the National Joint Council (NJC) and one pensioner representative from the National Association of Federal Retirees (NAFR). PAFSO is not currently a member of the PSHCP partners committee.
On July 1, 2023, Canada Life will replace Sun Life as administrator of the PSHCP. For out-of-privince emergency travel assistance and comprehensive coverage, MSH International will replace Allianz Global Assistance. These changes will bring several improvements to the current plan. For more information about how these changes will affect the current plan, you can refer to these relevant pages on the PSHCP website or this update from Treasury Board.
Though we did participate alongside the other bargaining agents at the NJC in recent consultations regarding the PSHCP, PAFSO has a more limited role when it comes to navigating the plan. The health care plan is not covered by the collective bargaining agreement. It also falls outside of the scope of labour relations. As such, PAFSO does not provide advice concerning the plan’s coverage or entitlements. Instead, members are advised to consult the PSHCP website for the most up-to-date information.
The PSHCP is designed to supplement the coverage already provided under the provincial or territorial plan in your province or territory of residence. This supplementary coverage consists of extended health provisions such as drug, vision care, dental and hospital benefits among others. The plan also includes comprehensive coverage for members residing outside of Canada, and not covered by a provincial or territorial plan. Click here to learn more about the PSHCP’s coverage of a wide range of health-related products and services.
There are four different ways a plan member can file a claim. You can use the benefit card at participating pharmacies, submit an electronic claim through either the plan administrator’s website or their mobile application or submit a paper claim by mail.
Plan members residing outside Canada who incur expenses under the Comprehensive Coverage Provision of the PSHCP may send their claims directly to Allianz Global Assistance.
Find out more on the claims process here on the PSHCP website.
Use this link to find all the relevant electronic forms, member booklet and other important documents.
The appeal process is available to all members of the PSHCP. If you do not agree with the insurer’s decision about your claim, you may send a letter of appeal to the Administration Authority for review.
The appeal must be submitted in writing. The Appeals Committee of the PSHCP Board of Directors will review your appeal to determine whether your claim was processed in accordance with the provisions that govern the PSHCP, and that all administrative procedures have been followed to ensure appropriate individual coverage.
Prior to submitting an appeal, you should make every effort to resolve the issue with the insurer. As this type of appeal process does not fall within our jurisdiction and is not considered an employment-related matter, PAFSO does not provide representation or assistance in accordance with our Protocol on Representation.
Learn more about the PSHCP appeals process here on their website.
For the latest information regarding the plan, please consult this in-depth FAQ on their website.