Your Public Service Pension and Benefits
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This is a summary of the Public Service Health Care Plan, which is offered to eligible employees and pensioners of the public service (including the RCMP and the Canadian Forces) and participating employers, and members of certain designated groups. It does not contain all details or describe all limits, restrictions or exclusions. For additional information, please refer to Public Service Health Care Plan Directive in detail or PSHCP (www) or contact your Compensation Advisor or Government of Canada Pension Centre.
The Public Service Health Care Plan is designed to supplement your provincial/territorial health insurance plan for reasonable and customary eligible expenses. If you are posted outside of Canada and are no longer eligible under a provincial/territorial health insurance plan or a non-government hospital insurance plan, please refer to Public Service Health Care Plan Directive in Detail or the PSHCP (www) for a description of Comprehensive Coverage (also available in certain other circumtances).
- Optional coverage for:
- Full-time and part-time employees and employees appointed for more than 6 months or who have completed 6 months of continuous employment
- Members of certain designated groups
- Pensioners (including survivors) receiving an immediate ongoing recognized pension, annuity or allowance
- Eligible spouse or common-law partner and eligible dependant children of plan members
- For definitions of terms used, please consult the Public Service Health Care Plan Directive definitions page
NOTE: Provisions for members of the RCMP and Canadian Regular and Reserve Forces
-
To apply for coverage if you are an active member, you must complete and submit either a
paper (www) (PDF 95KB) (Help on File Formats) application form to your compensation advisor or the
Compensation Web Applications (CWA) form.
If you are a retired member you must complete and submit a paper (www) (PDF 91KB) (Help on File Formats) application form to the Government of Canada Pension Centre.
- If your completed application is received within 60 days of the date you become eligible, coverage takes effect on the first day of the month following receipt of your application.
- If your completed application is received more than 60 days after the date you become eligible, coverage takes effect on the first day of the fourth month following receipt of your application.
- $60 per person or up to $100 per family per calendar year (does not apply to hospital and out-of-province emergency medical expenses)
- 80% of eligible expenses or of stated maximums, if any
(100%, no deductible)
- Three levels of coverage available, each providing a different maximum:
- Level I – $60 per day
- Level II – $140 per day
- Level III – $220 per day
(100%, no deductible)
-
Emergency treatment of injury or illness occurring on vacation or business travel: Maximum $500,000 per trip (Canadian currency)
- For vacation travel: Only emergency services obtained within 40 days of departure date from your province/territory of residence are covered
- Assistance services including transportation arrangements, medical referrals and advance payment of medical expenses
(80%, after deductible)
- Drugs that legally require a prescription
- Certain life-sustaining drugs
- Smoking cessation aids: Lifetime maximum $1,000
- Erectile dysfunction drugs: Maximum $500 per calendar year
NOTE: Provisions when out-of-pocket drug expenses (minus the deductible) exceed $3,000 per calendar year
(80%, after deductible)
- Eye examination: 1 every 2 calendar years commencing odd years
- Eyeglasses or contact lenses: Maximum $275 every 2 calendar years commencing odd years
(80%, after deductible)
- Physiotherapist: Up to $500 and over $1,000 per calendar year
- Psychologist: Maximum $1,000 per calendar year
- Massage Therapist, Osteopath, Naturopath or Podiatrist/Chiropodist: Maximum $300 per calendar year per type of practitioner
- Chiropractor, Speech-Language Pathologist: Maximum $500 per calendar year per specialty
- Nursing services: Maximum $15,000 per calendar year
(80%, after deductible)
- Dental expenses incurred for the treatment of an accidental injury to natural teeth or a jaw fracture
- Certain dental surgical expenses
(80%, after deductible)
- Expenses for certain supplies and services may be eligible, subject to maximums, such as ambulance transportation, hearing aids, orthotics and diabetic supplies. Please consult Public Service Health Care Plan Directive In Detail or the PSHCP (www).
(80%, after deductible)
- Coverage for certain medical services not available in the province or territory of residence: $25,000 per illness or injury
- Written referral by the attending physician required
- Employees: Your employer pays the full cost of Level I hospital coverage and other medical coverage. If you choose Level II or III hospital coverage, you pay for this coverage.
- Pensioners: You and your employer share the cost of Level I hospital coverage and other medical coverage. If you choose Level II or III hospital coverage, you pay the additional contribution for this coverage.
- If you and your dependant are covered under more than one group health plan, you may coordinate benefits up to 100% of the actual eligible expenses. Coordination of benefits between Public Service Health Care Plan members is allowed.
- When a member and/or dependant ceases to be eligible.