diff --git "a/data/processed/benefits.json" "b/data/processed/benefits.json" new file mode 100644--- /dev/null +++ "b/data/processed/benefits.json" @@ -0,0 +1,5582 @@ +[ + { + "id": "benefits-PSHCP-the-public-service-health-care-plan-pshc-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "the-public-service-health-care-plan-pshc-1", + "marginal_note": "The Public Service Health Care Plan (PSHCP) (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "The Public Service Health Care Plan (PSHCP) is an employer-sponsored \noptional health care plan offered to eligible employees and pensioners \n(retired members) of the federal public service including the Royal \nCanadian Mounted Police (RCMP), the Canadian Armed Forces (CAF), \nmembers of Parliament, federal judges, designated agencies and \ncorporations, the Veterans Affairs Canada (VAC) Client Group and their \neligible dependants. \nThe purpose of this PSHCP Member booklet is to provide you and \nyour eligible dependants with inf\normation on joining the PSHCP , your \nPSHCP membership, benefits exclusions and limitations, your claims \nmanagement and contact information. \nThis booklet is not a substitute for the PSHCP Directive, which provides \nthe complet\ne terms and conditions of the PSHCP . Where there is a \ndiscrepancy between this booklet and the PSHCP Directive, the PSHCP \nDirective will apply. The PSHCP Directive, effective July 1, 2023, can \nbe found on the National Joint Council website at ( njc-cnm.gc.ca/\ndirective/d9/v283/). \nThe PSHCP w\nas last negotiated in 2022 with improvements and \nchanges taking eff\nect July 1, 2023. The negotiations amongst all \nparties responded to the needs of a diverse Canadian public sector \nworkforce, its pensioners and eligible dependants, while respecting \nthe publicly funded nature of the benefits you receive. \nIn addition, a Gender-Based Analysis Plus (GBA Plus) at ( women-\ngender-equality.canada.ca/en/gender-based-analysis-plus) \nlens was \napplied to all neg\notiated changes and provisions. GBA Plus considers \nhow the interaction of identity factors may influence how people might \nexperience Government policies and initiatives. \nPSHCP Member booklet 7\nThe Public Service Health Care Plan (PSHCP) ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “The Public Service Health Care Plan (PSHCP)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-the-public-service-health-care-plan-pshc-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "the-public-service-health-care-plan-pshc-2", + "marginal_note": "The Public Service Health Care Plan (PSHCP) (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "The PSHCP provides reimbursement for all, or part of the expenses paid in full, for eligible services and \nproducts. \nUnless otherwise specified, eligible services and products must be prescribed by a physician, nurse \npr\nactitioner or dentist who is licensed or otherwise authorized in accordance with the applicable law to \npractice in the jurisdiction in which the prescription is issued. Other qualified health professionals may \nprescribe drugs if the applicable provincial or territorial legislation permits. \nThe PSHCP reimburses eligible expenses on a Reasonable and Customary basis subject to limitations \nidentified in the PSHCP Directive ( njc-cnm.gc.ca/directive/d9/v283/en). \nThe PSHCP has two types of coverage: \n1. Supplementary Coverage (if you live in Canada) \nThe PSHCP provides reimbursement for all or part of the expenses you incur for eligible services \nand pr\noducts after you and your eligible dependants take advantage of your provincial or territorial \nhealth insurance plan and any other third-party sources of health care assistance for which you have \na legal right. \n2. Comprehensive Coverage (if you live outside Canada) \nThe PSHCP provides coverage for you and your eligible dependants if you are deployed or posted \nout\nside of Canada or live outside of Canada as a pensioner (retired member) and are no longer \neligible under a provincial or territorial governmental health insurance plan.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “The Public Service Health Care Plan (PSHCP)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-governance-of-the-pshcp-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "governance-of-the-pshcp-1", + "marginal_note": "Governance of the PSHCP (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Governance of the PSHCP \nThe governance framework of the PSHCP is made up of several entities. Each plays a role in ensuring the \nproper administration of the PSHCP . \nGovernment of Canada \nThe Government of Canada, as Employer and Plan Sponsor, is responsible for the PSHCP . As Plan Sponsor, \nthe Government of Canada assumes full liability for the payment of all expenses related to the operation of \nthe PSHCP and the payment of claims. \nPSHCP Partners Committee \nThe PSHCP Partners Committee (The Committee) is a collaborative negotiations forum comprised of \nEmployer, Bargaining Agent and pensioner representatives mandated to make recommendations to the \nMinisters of the Treasury Board. The Committee is responsible for the administration, plan design changes, \ngovernance and any other issues related to the PSHCP . This includes making sure that the PSHCP remains \ncost-effective and capable of delivering sustainable benefits to all plan members while supporting member \nhealth and well-being. \nFederal PSHCP Administration Authority \nThe Federal PSHCP Administration Authority (Administration Authority) is a corporation without share \ncapital whose mandate is to oversee Canada Life’s execution of the Administrative Services Only contract \nof the PSHCP . The Administration Authority ensures that Canada Life delivers benefits efficiently and \neffectively to PSHCP members in accordance with the PSHCP provisions. The Administration Authority \nPSHCP Member booklet 8 \noperates in a shared governance model with the Treasury Board of Canada Secretariat (TBS) and is \naccountable to the PSHCP Partners Committee and the President of the Treasury Board. \nCanada Life \nThe Plan Administrator, The Canada Life Assurance Company (Canada Life), is responsible for the day-to-", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Governance of the PSHCP”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-governance-of-the-pshcp-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "governance-of-the-pshcp-2", + "marginal_note": "Governance of the PSHCP (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "day administration of the PSHCP . This includes consistent decisions and payment of eligible claims \nin accordance with the PSHCP Directive and providing services as specified in the PSHCP Directive \n(njc-cnm.gc.ca/directive/d9/v283/en) and PSHCP Administrative Services Only Contract. \nMSH International \nMSH International (MSH), a subcontractor of Canada Life, is responsible for administering the PSHCP out-of-\nprovince emergency travel assistance benefit and Comprehensive Coverage.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Governance of the PSHCP”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-eligibility-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "eligibility-1", + "marginal_note": "Eligibility (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Eligibility \nTo become a member of the PSHCP , you must meet the eligibility requirements described in the PSHCP \nDirective. Membership in the PSHCP is voluntary unless posted or deployed outside of Canada by your \nEmployer. \nEligible employee (active member) \n\n- You are a full-time or part-time federal public service employee appointed for more than 6 months or you \nhave completed 6 months of continuous employment. \n\n- You are a member of the Royal Canadian Mounted Police (RCMP). \n\n- You are a member of the Canadian Armed Forces (CAF) (only eligible dependants are covered). \n\n- You are a CAF Reservist (consult your orderly office). \nTo apply for the PSHCP \n\n- Complete and submit an electronic application form using the secure online Compensation Web \nApplications (CWA)\n, if available to you. Select Phoenix Pay System. You must be on a Government of \nCanada server to ac\ncess CWA. \n\n- Print and complete the PSHCP Employee Application Form ( pshcp.ca/wp-content/uploads/2013/06/\nemp-applic-adhes-006491.pdf) and submit it to y\nour departmental compensation office or Pay Centre. \n\n- Call your departmental compensation office or Pay Centre to request the PSHCP Employee Application \nForm by mail. Complete and return the form. \nPSHCP Member booklet 9\nEligible pensioner (retired member) \n\n- You are a pensioner with at least 6 years of cumulative pensionable service (some exceptions apply) and \nyou are in receip\nt of an ongoing recognized monthly pension. \n\n- You are an eligible surviving dependant of an employee or pensioner who has died and are eligible for \ncoverage under the PSHCP because you are in receipt of an ongoing monthly pension. \n\n- You are part of the Veterans Affairs Canada (VAC) Client Group. ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Eligibility”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-eligibility-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "eligibility-2", + "marginal_note": "Eligibility (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "For details and instructions on continuing your coverage into retirement, see Retirement. \nFor details and instructions on joining the PSHCP as an eligible surviving dependant, see Survivor. \nFor details and instructions on joining the PSHCP as a part of the VAC Client Group, see (VAC) Client Group. \nEligible dependant \n\n- Your spouse. \n\n- Your common-law partner, the person you are cohabiting with in a relationship for a period of at least one \nyear. \n\n- Your or your spouse’s/common-law partner’s unmarried children including a natural child, adopted \nchild or stepchild. A child for whom you stand in place of a parent may also be eligible (contact your \ncompensation office, Pay Centre or Pension Centre for requirements) if: \n\n- the child is under 21 years of age \n\n- the child is older than 21 and younger than 25 years of age and is attending an accredited school, \ncollege or university fulltime \n\n- the child is over 21 or 25 years of age, who was a dependant child under the PSHCP when becoming \nincapable of self-sustaining employment by reason of mental or physical impairment (to apply for \ncoverage of a dependant child with a disability, complete and submit the PSHCP Application for \nDependant with a Disability Coverage F\norm to Canada Life) \nIf you have both a legal spouse and a common-law partner, you can cover only one. The PSHCP will only \ncover the person y\nou include in your", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Eligibility”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-positive-enrolment-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "positive-enrolment-1", + "marginal_note": "Positive enrolment (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "positive enrolment. It is your responsibility to keep your positive \nenrolment informa\ntion up to date. \nA spouse’s or common-law partner’s coverage ends on the day they no longer meet the definition. \nA child’s coverage ends on the last day of the month they no longer meet the definition. \nYou may need to update your coverage level from Family to Single to avoid overpayment of contributions. If \nyes, see Changes to c\noverage. \nEffective coverage start date for you and eligible dependants under the PSHCP \nGenerally, if you apply within 60 days of becoming eligible, coverage is effective on the first of the month, \nfollowing the month your completed application form is received by your departmental compensation \noffice, Pay Centre or Pension Centre. For example, if your application is received on February 15, then your \ncoverage is effective March 1. \nPSHCP Member booklet 10 \nIf you do not apply for coverage within 60 days of becoming eligible, coverage will take effect on the \nfirst day of the fourth month, following the month your completed application form is received by your \ndepartmental compensation office, Pay Centre or Pension Centre. For example, if your application is \nreceived on February 15, then your coverage is effective June 1. \nIMPORTANT \nOnce your initial PSHCP application is approved by your departmental compensation office, Pay Centre \nor Pension Centre, you will receive your PSHCP certificate number. Your certificate number is your unique \nidentification number under the PSHCP . You must then complete positive enrolment with Canada Life \nbefore you submit claims. \nPositive enrolment \nPositive enrolment is the process where you provide Canada Life with information about you and your ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Positive enrolment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-positive-enrolment-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "positive-enrolment-2", + "marginal_note": "Positive enrolment (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "eligible dependant(s) to ensure your claims can be processed accurately. Through positive enrolment, you \nmust provide consent for the use of your personal information. See \nProtecting your private information. If \nyou do not complete positive enrolment and provide consent, Canada Life cannot process your claims. \nTo complete positive enrolment, you will need to provide the following information about you and your \neligible dependant(s), if applicable: \n\n- name \n\n- date of birth \n\n- gender – male, female, other or prefer not to answer \n\n- certificate number \n\n- contact information, including complete address \n\n- bank account information to set up direct deposit for claim payments \n\n- information about any other health benefit plans that you and your spouse or common-law partner may \nhave (for example, through another employer) \n\n- if the other coverage is with Canada Life, you will need the other plan’s details (i.e. plan number and \ncertificate/ID number) \n\n- information about any other health benefit plans your eligible dependant(s) child/children might have \nthrough another parent or guardian \n\n- your plan number which is determined by your birth month or member status: \n\n- January to March 52111 \n\n- April to June 52112 \n\n- July to September 52113 \n\n- October to December 52114 \n\n- Eligible surviving dependant (eligible spouse or common-law partner and children) 52115 \nFor example, if you are an employee or pensioner born in the month of November, your plan number is \n52114. If you are an eligible surviving dependant, your plan number is 52115, regardless of your month of \nbirth. \nPSHCP Member booklet 11\nHow to complete your initial positive enrolment by paper \nIf you need to make any updates to your last name or date of birth, change your coverage level from ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Positive enrolment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-positive-enrolment-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "positive-enrolment-3", + "marginal_note": "Positive enrolment (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Supplementary Coverage to Comprehensive Coverage (or vice versa), change from Family to Single \nCoverage (or vice versa), or change your Hospital Coverage Level I, II, III, which are all associated with your \npay or pension file, contact your departmental compensation office, Pay Centre or Pension Centre. \nHow to complete your initial positive enrolment online \n1. Visit (welcome.canadalife.com/pshcp/complete-positive-enrolment) and select Complete positive \nenrolment. This will bring you to the P\nSHCP positive enrolment page. This page is only to be used for \ninitial positive enrolment. See Keep your positive enrolment information up to date for instructions \non how to update y\nour positive enrolment information. \n2. On the PSHCP positive enrolment page, enter your last name, date of birth and certificate number, \nthen select Continue. \n3. You will need t\no complete the steps outlined on the screens, provide consent and submit your \npositive enrolment information. Y\nou will immediately receive a confirmation email and you will be \nable to view, download and print a PDF copy of your and your eligible dependant(s)’", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Positive enrolment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-pshcp-benefit-card-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "pshcp-benefit-card-1", + "marginal_note": "PSHCP benefit card (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "PSHCP benefit \ncard. \n4. Once positive enrolment is completed, create your account through the PSHCP Member Services \nwebsite (canadalife.com/pshcp) (see \nBenefits of a PSHCP Member Services account). \nThere are 2 ways to get a paper Positive Enrolment Form: \n1. Visit the PSHCP Member Services website ( canadalife.com/pshcp): \n\n- Select Forms. \n\n- Find, download and print the Positive Enrolment Form. \n2. Contact Canada Life to request that the Positive Enrolment Form be sent to you by mail. \nOnce you have your paper Positive Enrolment Form: \n1. Fill out the double-sided, 2-page PSHCP Positive Enrolment Form legibly. Double check the form to \nmake sure your informa\ntion is complete and accurate. Sign and date the form. \n2. Mail your Positive Enrolment Form to: \nThe Canada Life Assurance Company \nPSHCP Positive Enrolment \nPO BOX 6000 Stn Main \nWinnipeg, MB R3C 3A5 \nYou will receive a letter in approximately 3 weeks that includes a confirmation statement and a paper \nPSHCP benefit card. \nIf your f\norm was incomplete or illegible, your form will be returned to you by mail, within 3 weeks, and a \nnew form will need to be resubmit\nted to Canada Life. If you submit a claim before your positive enrolment \nis completed, the claim will not be assessed or retained, and you will need to resubmit the claim after you \ncomplete positive enrolment. \nOnce you have completed positive enrolment, you may submit claims under the PSHCP (see Claims \nmanagement). \nPSHCP Member booklet 12 \nPSHCP benefit card \nYour PSHCP benefit card, provides your plan and certificate numbers \n\n- You need to provide your PSHCP benefit card with your plan and certificate numbers to your pharmacy \nand registered health care providers so they can submit your claims to Canada Life electronically. \n", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “PSHCP benefit card”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-pshcp-benefit-card-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "pshcp-benefit-card-2", + "marginal_note": "PSHCP benefit card (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- Your plan and certificate numbers are needed to submit claims for your eligible dependant(s). \n\n- If your spouse or common-law partner is also a PSHCP member, you will have different certificate \nnumbers and you may have different plan numbers depending on your month of birth. Take note of your \nplan and certificate numbers to ensure that claims are submitted accurately. \n\n- Your benefit card includes both: \n\n- Canada Life contact information; and \n\n- MSH International contact information for out-of-province emergency travel assistance and for PSHCP \nmembers living outside of Canada.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “PSHCP benefit card”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-protecting-your-private-information", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "protecting-your-private-information", + "marginal_note": "Protecting your private information", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Protecting your private information \nCanada Life takes your privacy very seriously. It is a legal requirement to collect consent and indicate how and \nwhen Canada Life will use private information and who will not be able to access private information. This \nincludes providing consent to the Government of Canada, the PSHCP Administration Authority and Canada Life. \nYour consent allows Canada Life to collect, use and disclose personal information about you and your eligible \ndependant(s) for the purpose of processing claims in and out of Canada. Refer to the Privacy Statement (canada.\nca/en/treasury-board-secretariat/services/benefit-plans/health-care-plan/public-service-health-care-plan-\nprivacy-statement-september-2009) f\nor further information on how your privacy is protected. For a copy of \nthe Privacy Guidelines (canadalife.com/privacy), or if there are any questions about Canada Life’s personal \ninformation policies and pr\nactices, including with respect to service providers, reach out to Canada Life’s Chief \nCompliance Officer by referring to Contact Us: Privacy rights request (canadalife.com). \nProviding consent \nWhether completing positive enrolment online or by paper, you must carefully read the Authorization and \nDeclaration section and provide consent. If you do not provide consent, Canada Life cannot process your \nclaims. If you submit a claim but have not completed positive enrolment or provided consent, your claim \nwill not be processed, and you will not receive payment. \nNote: Make sure to read the Authorization and Declaration section during digital positive enrolment or \non the paper Positiv\ne Enrolment Form carefully before providing consent. For more information, please \nvisit Canada Life’s Privacy Guidelines ( canadalife.com/privacy). \nPSHCP Member booklet 13", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Protecting your private information”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-keep-your-positive-enrolment-information", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "keep-your-positive-enrolment-information", + "marginal_note": "Keep your positive enrolment information up to date", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Keep your positive enrolment information up to date \nYou can update or change your positive enrolment information at any time. To avoid any disruption \nof your claims being processed, you are responsible for keeping your personal information up to date, \nsuch as marital status, birth of a child/adoption, change in banking information, changes in your contact \ninformation, etc. \nTo make changes to your positive enrolment information, you have 3 options: \n1. Sign in to your PSHCP Member Services account ( canadalife.com/pshcp) and go to the profile \nsection t\no update your information. \n2. Print and complete the PSHCP Positive Enrolment Form and submit it to Canada Life. \n3. Contact Canada Life to request that a PSHCP Positive Enrolment Form form be sent to you by mail. \nComplet\ne and return the form to Canada Life. \nIMPORTANT \nIf you need to make any updates to your last name or date of birth, change your coverage level from \nSupplementary Coverage to Comprehensive Coverage (and vice versa), change from Family to Single \nCoverage (or vice versa), or change your Hospital Coverage Level I, II, III, which are all associated with your \npay or pension file, contact your departmental compensation office, Pay Centre or Pension Centre.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Keep your positive enrolment information up to date”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-registering-for-online-and-digital-tools-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "registering-for-online-and-digital-tools-1", + "marginal_note": "Registering for online and digital tools (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Registering for online and digital tools \nCommitment to the Environment \nThe Government of Canada and Canada Life are working to protect and preserve our planet for future \ngenerations. You can help reduce paper waste by managing your PSHCP correspondence, claims and \npersonal information digitally. Sign into your PSHCP Member Services account ( canadalife.com/pshcp) go \nto the ic\non in the top right corner of the screen, Your profile and Communications preferences. \nPSHCP Member booklet 14 \nPSHCP Member Services account \nBenefits of a PSHCP Member Services account \nBy creating a PSHCP Member Services account ( canadalife.com/pshcp), you can: \n\n- access your PSHCP benefit cards for you and your eligible dependant(s) (if applicable) \n\n- sign up for direct deposit for claim payments \n\n- submit claims electronically and access claims history \n\n- get notified when claims have been processed \n\n- access the details of benefits, claim forms and other important information \n\n- find health care providers who offer eClaims \n\n- submit co-ordination of benefits claims between 2 Canada Life plans or submit the remaining balance of a \nclaim already processed through another benefit plan \n\n- update your positive enrolment information, including your direct deposit information \n\n- access the Drug search feature to look up prescription drug information by entering a prescription drug \nname or drug identification number (DIN) \n\n- submit photos of receipts for all medical expenses \n\n- send supporting documentation requested by Canada Life, such as physician referrals and medical \nquestionnaires \n\n- securely contact Canada Life using the online chat or secure messaging from the Contact Us page \nHow to create a PSHCP Member Services account ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Registering for online and digital tools”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-registering-for-online-and-digital-tools-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "registering-for-online-and-digital-tools-2", + "marginal_note": "Registering for online and digital tools (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Positive enrolment must be completed before you create a PSHCP Member Services account. Allow at \nleast 48 hours aft\ner completing positive enrolment to register. This will allow for your information to transfer \nthrough the system and appear in your account. \nTo create an account: \n1. You will need your plan and certificate numbers. \n2. Go to the PSHCP Member Services website ( canadalife.com/pshcp). \n3. If you already have a Canada Life account, select Sign in. \n4. If you do not have a Canada Life account, select Register. \n5. Select Start now. \n6. Follow the prompts on the screen. \nIf you already have an online account for the Public Service Dental Care Plan (PSDCP), you can sign in to the \nPSHCP Member Services website ( canadalife.com/pshcp) using your PSDCP login credentials. You will be \nprompted t\no view either your PSHCP or PSDCP coverage information or any other Canada Life accounts. If \nyou are not sure if your plans are already connected, go to the icon in the top right corner of the screen. If \nyou see the option to switch plans, they are already connected, and no further action is required. If you do \nnot see the option to switch plans, select the link named connect your PSDCP now. \nIf you have any questions, contact Canada Life. \nPSHCP Member booklet 15", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Registering for online and digital tools”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-my-canada-life-at-work-mobile-app", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "my-canada-life-at-work-mobile-app", + "marginal_note": "My Canada Life at Work mobile app", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "My Canada Life at Work mobile app \nBy using the My Canada Life at Work app, you can: \n\n- submit claims \n\n- review your coverage \n\n- review past claims \n\n- save your PSHCP benefit card directly to your phone \nHow to get started \n1. Register for a PSHCP Member Services account ( canadalife.com/pshcp) if you have not already. \n2. Download the My Canada Life at Work app from your app store. \n3. Sign in using the same email address and password you use for your PSHCP Member Services \nacc\nount. \nImportant device settings \n\n- It is important to turn on your automatic updates to ensure fixes and updates download immediately to \nyour device. \n\n- The mobile app presents in the language set on your mobile device and may be different than the \nlanguage preference you indicated during positive enrolment with Canada Life. Be sure to set your mobile \ndevice to your language preference. \n\n- If you require TTY, ensure the device setting for this option is on. \nIf you are already a member of the Public Service Dental Care Plan and have the mobile app \nIf you are an employee and a member of the Public Service Dental Care Plan (PSDCP), continue using the My \nCanada Life at Work mobile app. If your device is set up for automatic updates, your app will automatically \nupdate to include your PSHCP and PSDCP information. If your device is not set up for automatic updates, \nyou will need to manually update the app from the App Store or Google Play. \nOnce the app has updated, and you sign in, you will be asked to view either your PSHCP or PSDCP coverage \ninforma\ntion or any other Canada Life accounts. You will be able to switch views between the plans. \nIf you use biometrics (face recognition, touch or fingerprint ID) to sign in, you will need to use the Switch \nPlan function under the pr\nofile section of the app. \nIf you have any questions, please contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “My Canada Life at Work mobile app”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-msh-pshcp-member-portal", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "msh-pshcp-member-portal", + "marginal_note": "MSH PSHCP Member Portal", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "MSH PSHCP Member Portal \nBenefits of the MSH PSHCP Member Portal account \nMSH is the administrator for out-of-province emergency travel assistance for members living in Canada and \nfor Comprehensive Coverage for members living outside of Canada. \nBy creating an online account through the MSH PSHCP Member Portal ( pshcp-msh.ca), you can: \n\n- submit claims, along with a photo or electronic copy of your receipts \nPSHCP Member booklet 16 \n\n- view your profile and personal information (read-only. To make changes to your positive enrolment \ninformation see Keep your positive enrolment information up to date. Your information will update in \ny\nour MSH account within 48 hours) \n\n- access claim forms and other documents \nHow to create an MSH PSHCP Member Portal account \nTo create an account: \n\n- Go to the MSH PSHCP Member Portal ( pshcp-msh.ca) and select Login. \n\n- Select Register here. \n\n- Enter the exact email address, plan number, certificate number, last name and date of birth you used \nduring positive enrolment with Canada Life. \n\n- Create and confirm a password and select and enter a security question. A verification email will be sent \nto you within 5 minutes. \n\n- Verify your account by clicking on the link in the verification email and entering the verification code \nprovided. (Note that the code expires after 30 minutes. If it expires, you will need to repeat the process to \nget a new code). \nYou cannot change any of your positive enrolment information, including your email address, through the \nMSH P\nSHCP Member Portal.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “MSH PSHCP Member Portal”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-contributions-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "contributions-1", + "marginal_note": "Contributions (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Contributions \nThe PSHCP is funded through contributions from: \n\n- the Government of Canada \n\n- participating employers \n\n- plan members \nThe PSHCP monthly contribution rates are comprised of 2 components, the cost associated with the \nE\nxtended Health Provision and the cost for the Hospital Provision. These components have different cost \nsharing arrangements. The contribution rates can be found in Schedule V of the PSHCP Directive, found on \nthe National Joint Council website (njc-cnm.gc.ca/directive/d9/v283/s821/en#s821-tc-tm). \nMember contributions depend on the type and level of coverage selected (for example, employee versus \npensioner\n, Single versus Family coverage and selected level of the Hospital Provision). \nContributions are made monthly and appear as deductions on payroll statements or pension benefit \ns\ntatements. \nEmployee members \nThe Employer pays 100% of the Extended Health Provision and Hospital Level I. You are responsible for \n100% of the additional c\nontributions for Hospital Level II and III, unless otherwise specified. \nPSHCP Member booklet 17\nNote: For executives, the Employer pays 100% of the Extended Health Provision and Hospital Level III. \nPensioners \nThe Employer pays 50% of the Extended Health Provision and 100% of Hospital Level I. You are responsible \nfor 100% of the additional contributions for Hospital Level II and III. \nPSHCP Relief Provision for pensioners \nA pensioner may apply for the PSHCP Relief Provision. The Employer pays 75% of the Extended Health \nProvision and 100% of the Hospit\nal Level I, if the pensioner meets the following requirements: \n\n- became a pensioner member of the PSHCP on or before March 31, 2025 \n\n- is in receipt of a Guaranteed Income Supplement (GIS); or \n", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Contributions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-contributions-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "contributions-2", + "marginal_note": "Contributions (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- has a net taxable income with their spouse or common-law partner, as reported on their income tax \nNotice of Assessment, that is lower than the GIS thresholds established for the Old Age Security Act \nFor the most current GIS thresholds, visit the Service Canada website ( servicecanada.gc.ca/eng/services/ \npensions/oas/p\nayments). \nIf you believe you are eligible, complete the PSHCP Relief Application Form ( tpsgc-pwgsc.gc.ca/\nremuneration-compensation/services-paye-pay-services/form/html/481-eng) and r\neturn it to your \nPension Centre. Should y\nou require a paper form, call your Pension Centre to request that it be sent to you \nby mail.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Contributions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-changes-to-coverage", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "changes-to-coverage", + "marginal_note": "Changes to coverage", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Changes to coverage \nYou are responsible for making sure that your coverage meets your needs, and that your positive enrolment \ninformation and employment data are up to date, such as your last name or date of birth. If you need to \nmake any updates to your last name or date of birth, change your coverage level from Supplementary \nCoverage to Comprehensive Coverage (and vice versa), change from Family to Single Coverage (or vice \nversa), or change your Hospital Coverage Level I, II, III, which are associated with your pay or pension file, \ncontact your departmental compensation office, Pay Centre or Pension Centre. Confirming your coverage \nlevel is accurate will ensure you are paying the right contribution rate and help avoid an overpayment of \ncontributions.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Changes to coverage”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-from-supplementary-to-comprehensive-and-", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "from-supplementary-to-comprehensive-and-", + "marginal_note": "From Supplementary to Comprehensive (and vice versa)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "From Supplementary to Comprehensive (and vice versa) \nCoverage for Outside of Canada \nTo transfer from Supplementary to Comprehensive Coverage, you must complete a PSHCP Employee \nApplication F\norm (pshcp.ca/wp-content/uploads/2013/06/emp-applic-adhes-006491.pdf) or the PSHCP \nPensioner Applica\ntion Form (pshcp.ca/wp-content/uploads/2013/06/pens-applic-adhes-006492-2.pdf) \nand submit it to your departmental compensation office, Pay Centre or Pension Centre. \nIf your application to transfer is received by the designated officer within 60 days of no longer being \ncov\nered by a provincial or territorial health insurance plan, coverage is effective the first of the month \nfollowing the date of receipt. If an application is received more than 60 days after no longer being covered \nunder a provincial or territorial health insurance plan, coverage is effective the first of the fourth month \nfollowing the date of receipt. \nPSHCP Member booklet 18 \nMembers posted or deployed outside of Canada by their Employer are required to have Comprehensive \nCoverage under the PSHCP for the month of departure from Canada. \nWhen transferring from Comprehensive to Supplementary Coverage, the Supplementary Coverage cannot \nstart until the da\nte the coverage commences under a provincial or territorial health insurance plan.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “From Supplementary to Comprehensive (and vice versa)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-from-single-to-family-and-vice-versa-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "from-single-to-family-and-vice-versa-1", + "marginal_note": "From Single to Family (and vice versa) (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "From Single to Family (and vice versa) \nIf you have Single coverage and wish to change your status from Single to Family or vice versa, you must \ncomplete a PSHCP Employee Application Form ( pshcp.ca/wp-content/uploads/2013/06/emp-applic-\nadhes-006491.pdf) or the \nPSHCP Pensioner Application Form ( pshcp.ca/wp-content/uploads/2013/06/\npens-applic-adhes-006492-2.pdf) and submit it t\no your departmental compensation office, Pay Centre or \nPension Centre. \nIf y\nou are an employee and have access to the Compensation Web Applications (CWA), you can make these \nchanges through the C\nWA. You must be on a Government of Canada server to access CWA. \nYour contribution rates may be affected. \nSingle to Family \nIf your application is received within 60 days of acquiring a new eligible dependant(s), coverage will be \neffective as of the date the eligible dependant(s) was acquired. \nIf the application is received after 60 days of acquiring a new eligible dependant(s), coverage will be \neffectiv\ne on the first day of the fourth month following the month of receipt. \nFamily to Single \nA dependant’s coverage will end no later than 2 months following the date your application is received. \nThe reduced contribution rate will start the month prior to the effective date of the single coverage (if \napplicable). \nExcept in the case of the death of a dependant or administrative error, contributions will not be refunded \nretr\noactively when dependant coverage is cancelled. \nIMPORTANT \nAfter making any changes to your Single or Family coverage, you must also update your positive enrolment \ninformation with Canada Life through your PSHCP Member Services account, please see Positive \nenrolment. \nYou can also print the Positive Enrolment Form from the PSHCP Member Services website ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “From Single to Family (and vice versa)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-from-single-to-family-and-vice-versa-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "from-single-to-family-and-vice-versa-2", + "marginal_note": "From Single to Family (and vice versa) (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "(canadalife.com/pshcp) or contact Canada Life to request that a form be sent to you by mail. \nIf you wish to add or remove an eligible dependant(s) and maintain Family coverage, simply update your \npositive enrolment inf\normation through your PSHCP Member Services account ( canadalife.com/pshcp). \nFor information on how, please see Positive enrolment.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “From Single to Family (and vice versa)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-hospital-level-i-ii-or-iii-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "hospital-level-i-ii-or-iii-1", + "marginal_note": "Hospital Level I, II or III (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Hospital Level I, II or III \nMembers of the PSHCP are required to select a level of coverage under the Hospital Provision, which \nprovides reimbursement for hospital room and board charges, other than standard ward charges, for each \nday of hospitalization. The level of coverage chosen will determine the maximum amount that may be \nPSHCP Member booklet 19\nreimbursed (subject to Reasonable and Customary Charges) and will also have an impact on your monthly \nPSHCP contributions. Monthly PSHCP contributions for Hospital Levels II and III are calculated based on the \noverall cost of those levels of Hospital coverage. \nThere are 3 levels of coverage, reimbursed at 100%, indicating the maximum amount you may be \nreimbursed for e\nach day in a hospital: \n\n- Level I: $90 \n\n- Level II: $170 \n\n- Level III: $250 \nFor example, if you have Level II coverage, you may be reimbursed up to $170 per day for accommodation \nexpenses above the s\ntandard ward charges for a hospital stay. \nTo change your level of coverage under the Hospital Provision and authorize changes to contributions, you \nmust submit a PSHCP Emplo\nyee Application Form ( pshcp.ca/wp-content/uploads/2013/06/emp-applic-\nadhes-006491.pdf) or P\nSHCP Pensioner Application Form ( pshcp.ca/wp-content/uploads/2013/06/pens-\napplic-adhes-006492-2.pdf) t\no your departmental compensation office, Pay Centre or Pension Centre. \nIf you are an employee and have access to the Compensation Web Applications (CWA), you can make these \nchanges through the CWA. Y\nou must be on a Government of Canada server to access CWA. \nGenerally, an increase to the level of Hospital Provision will take effect on the first day of the fourth \nmonth following the dat\ne of receipt of the application. For all other situations, contact your departmental ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Hospital Level I, II or III”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-hospital-level-i-ii-or-iii-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "hospital-level-i-ii-or-iii-2", + "marginal_note": "Hospital Level I, II or III (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "compensation office, Pay Centre or Pension Centre. \nChanges to your coverage level under the Hospital Provision do not impact your positive enrolment \ninformation with Canada Life, ho\nwever, will affect your contribution rates ( njc-cnm.gc.ca/directive/d9/\nv283/s827/en).", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Hospital Level I, II or III”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-retirement", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "retirement", + "marginal_note": "Retirement", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Retirement \nIf you are a former employee of the federal public service and in receipt of a public service pension, or if you \nretired on or after March 31, 2015, with at least 6 years of cumulative pensionable service, you are eligible \nfor coverage under the PSHCP . \nFor employees transitioning directly to receive an immediate ongoing monthly pension, you can maintain \ncontinuous PSHCP co\nverage. Your retirement package from your departmental compensation office or \nPension Centre will include a form to authorize PSHCP pensioner deductions from your pension benefit \npayment. \nWhile your coverage is continuous, your claims may be denied during transition as your pay and pension \nfiles are updated. If this happens, r\nesubmit these claims to Canada Life once your PSHCP contributions start \nbeing deducted. Canada Life will reprocess the claims and issue a reimbursement for eligible claims. \nIf you require maintenance medication such as insulin, you should buy enough before you retire or pay \nout-of-pocke\nt for your medication and submit the claim once pensioner contribution deductions have been \ninitiated. See Day supply limit section for more information. \nPSHCP Member booklet 20 \nNote: Some federal agencies, Crown corporations and territorial governments do not participate in the \nPSHCP . Even if your former employer did not participate in the PSHCP , as a retired member you may be \neligible to join. To find out if you are eligible, contact your Pension Centre.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Retirement”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-survivor-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "survivor-1", + "marginal_note": "Survivor (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Survivor \nIf a PSHCP member dies, the PSHCP coverage is not automatically transferred to their eligible surviving \ndependant(s). \nA surviving spouse or common-law partner may apply for coverage as a member in their own right under \nthe PSHCP , if in r\neceipt of an ongoing recognized monthly pension ( njc-cnm.gc.ca/directive/d9/v283/s826/\nen). No\nte, if the surviving spouse or common-law partner are already members of the PSHCP , they cannot \nalso apply for co\nverage as a survivor. The same person cannot be registered in the PSHCP as both a member \nand a survivor. \nChildren, in receipt of an ongoing recognized monthly pension are eligible to apply to be a member if they \nare the only surviv\nor. Contact your Pension Centre for more information. \nIn the event of your death, ensure your survivors have the contact information for your departmental \ncompensation offic\ne, Pay Centre or Pension Centre. \nTo apply for survivor coverage under the PSHCP , contact the deceased member’s departmental \ncompensation offic\ne, Pay Centre or Pension Centre and send the PSHCP member’s death certificate. \n\n- If the survivor receives an ongoing recognized monthly pension and eligible for coverage under the \nPSHCP , they will receive help from the deceased member’s departmental compensation office, Pay Centre \nor Pension Centre on how to apply by completing the PSHCP Pensioner Application Form. The form \nis also found at pshcp.ca/forms-and-documents. \nApplicants need to choose the appropriate level of \ncov\nerage (Single or Family and Hospital Provision) before submitting the form. \n\n- If approved for PSHCP coverage, the eligible surviving dependant must complete positive enrolment. See \nPositive enrolment. \n", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Survivor”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-survivor-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "survivor-2", + "marginal_note": "Survivor (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- The plan number will be 52115 for eligible surviving dependant(s) (spouse or common-law partner, or \neligible children) and there is no change to the certificate number. \nIf the application is received within 60 days of the member’s death and the surviving dependant’s eligibility \nis confirmed, co\nverage will begin the first day of the month following receipt. \nIf the application is received more than 60 days after the member’s death, coverage will begin on the first \nday of the fourth month follo\nwing receipt. Coverage then continues for as long as the eligible surviving \ndependant(s) remains entitled to an ongoing recognised monthly pension and the required contributions \nare paid.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Survivor”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-veterans-affairs-canada-vac-client-group-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "veterans-affairs-canada-vac-client-group-1", + "marginal_note": "Veterans Affairs Canada (VAC) Client Group (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Veterans Affairs Canada (VAC) Client Group \nYou may be eligible to join the PSHCP under the VAC Client Group, if you are a former CAF member and \ncannot o\ntherwise participate in the PSHCP as an employee or pensioner. \nVAC is responsible for determining your eligibility. Your VAC certificate number, starting with V50 or V59, will \nbe provided on the appr\noval letter from VAC. \nPSHCP Member booklet 21\nVisit the VAC website ( veterans.gc.ca/eng/e_services) to download the PSHCP Application Form (VAC630) \nor call VAC toll-fr\nee at 1-866-522-2122 (English line) to request that a form be sent to you by mail. \nTo send your VAC PSHCP application by mail: \nVeterans Affairs Canada \nPO Box 6000 \nMatane QC G4W 0E4 \nVAC positive enrolment process \nOnce you receive approval from VAC to join the PSHCP , you can print the PSHCP Positive Enrolment with \nPre-authorized Debit Form and instructions found on the PSHCP Member Services website ( welcome.\ncanadalife.com/pshcp/vac). \nAlterna\ntively, you can contact Canada Life to request that a paper PSHCP Positive Enrolment with Pre-\nauthorized Debit Form be sent to you b\ny mail. \nThe VAC Client Group is paper-based, therefore once you complete the 6-page Positive Enrolment with Pre-\nauthorized Debit Form, please mail it to: \nThe Canada Lif\ne Assurance Company \nBAS DG1227 \nPO Box 6000 Stn Main \nWinnipeg, MB R3C 3A5 \nWhat is needed to complete your paper PSHCP Positive Enrolment with Pre-authorized Debit Form: \n\n- The 6-page paper PSHCP Positive Enrolment with Pre-authorized Debit Form \n\n- Your banking information to set up pre-authorized debit for contribution rate collection by Canada Life \n\n- A void cheque or printout with your banking information from your banking institution \nTo start your health benefits coverage: ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Veterans Affairs Canada (VAC) Client Group”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-veterans-affairs-canada-vac-client-group-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "veterans-affairs-canada-vac-client-group-2", + "marginal_note": "Veterans Affairs Canada (VAC) Client Group (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "1. Complete the 6-page paper PSHCP Positive Enrolment with Pre-authorized Debit Form and mail it to \nCanada Life. \n2. Double check the form to make sur\ne your information is complete, accurate, and legible. \n3. Sign and date the form, otherwise it will be sent back. \n4. Mail the completed and signed form to: \nThe Canada Life Assurance Company \nBAS DG1227 \nPO Box 6000 Stn Main \nWinnipeg MB R3C 3A5 \nOnce positive enrolment is complete, you will receive 2 letters from Canada Life: \n\n- a letter that includes a confirmation of coverage statement and a paper PSHCP benefit card \n\n- a second letter indicating the monthly contribution rate based on your chosen coverage option as well as \nthe scheduled monthly contribution withdrawals \nPSHCP Member booklet 22 \nIMPORTANT \nIf your PSHCP Positive Enrolment with Pre-authorized Debit Form is incomplete or illegible, it will be \nreturned to you by mail and you will need to resubmit to Canada Life. If you submit a claim before your \npositive enrolment is completed, the claim will not be assessed or retained. You will need to resubmit the \nclaim after you complete positive enrolment. \nIf your PSHCP Positive Enrolment with Pre-authorized Debit Form is not received by Canada Life by the date \nindica\nted in your approval letter from VAC, your health benefits coverage may be terminated, and you will \nbe required to reapply through VAC. A three (3)-month waiting period will apply. \nFor more detailed information on contributions, please refer to the Contributions page of the PSHCP \nDirective \n(njc-cnm.gc.ca/directive/d9/v283/s821/en#s821-tc-tm). \nIf you have questions about completing the form, please contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Veterans Affairs Canada (VAC) Client Group”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-leave-without-pay-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "leave-without-pay-1", + "marginal_note": "Leave without pay (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Leave without pay \nContinued coverage during Leave without pay \nYour Employer may authorize Leave without pay (LWOP) for various reasons. Generally, you can continue \nyour PSHCP coverage during a LWOP period. Depending on the length and type of LWOP , you may be \nrequired to pay the full cost of your PSHCP coverage (the associated employee and Employer contributions). \nThe table in this section outlines the different scenarios. \nYou can pay your contributions in advance or when you return to work. If you choose to pay them when you \nre\nturn to work, you must make payments on a schedule that does not exceed the time you were on leave. \nConsult your departmental compensation office, Pay Centre or Pension Centre about your options. \nPSHCP Member booklet 23\nLeave without pay options Employee contributions Employer contributions \n\n- first 3 months of any period of \nauthorized Leave without p\nay \n(LWOP) \n\n- maternity leave or parental leave \n\n- sick leave (including pregnancy) \n\n- caregiving leave \n\n- disability or long-term disability \nleave \n\n- pre-r\netirement leave \n\n- leave during an income averaging \narrangement \n\n- educational le\nave at the request of \nthe Employer \n\n- leave t\no serve in another \norganization if it is t\no the \nadvantage of the Government of \nCanada \n\n- leave for training or other activities \nas part of service in the CAF or \nReser\nves \nEmployee pays regular share of \nbenefits \n100% Hospital Lev\nel II or III \nEmployer pays regular share of \nbenefits \n100% Extended He\nalth Provision and \nHospital Level I \nIf y\nou proceed on any other type of \nauthorized leave without pay aft\ner \nthe first 3 months. \nEmployee pays regular share of \nbenefits plus Employer share (aft\ner \n90 days) \n100% of Extended Health Provision \nand Hospital Level I, II and III \nEmplo", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Leave without pay”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-leave-without-pay-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "leave-without-pay-2", + "marginal_note": "Leave without pay (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "yer pays regular share for first \n90 days only \n0% of Extended Health Provision and \nHospital Level I, II and III \nIn c\nases of: \n\n- a laid-off employee who chooses \nto continue cov\nerage for up to 1 \nyear \n\n- a suspension or unauthorized \nleave \n\n- certain CAF R\neservists (njc-cnm.\ngc.ca/directive/d9/v283/s819/\nen#s819-tc-tm_2) (c\nonsult your \norderly office) \n\n- certain eligible sur\nviving \ndependants (consult your \ndepartment\nal compensation office, \nPay Centre or Pension Centre) \nEmployee pays regular share of \nbenefits \nEmployee also pays Emplo\nyer share \nof benefits \n0% of Extended He\nalth Provision and \nHospital Level I, II and III \n100% of E xtended Health Provision \nand Hospital \nLeave without p\nay for reasons not \nlisted above \nEmplo yee pays regular share of \nbenefits \nEmployee also pays Employer share \nof benefits \n0% of Extended He\nalth Provision and \nHospital Level I, II and III \n100% of E xtended Health Provision \nand Hospital \nPSHCP Member booklet 24 \nSeasonal lay-off \nIf you are an employee who goes on seasonal lay-off, you and your eligible dependant(s) may continue your \nPSHCP coverage by paying the required contributions in advance. You must contact your departmental \ncompensation office, Pay Centre or Pension Centre regarding contributions for continued coverage before \ngoing on leave. \nDiscontinuing coverage during LWOP \nYou may also choose to cancel your PSHCP coverage by providing a written request to your departmental \ncompensation office, Pay Centre or Pension Centre. If you do not arrange to cancel, your coverage will \ncontinue, and you will be responsible for the contributions upon your return to work. If you do not return \nto work following your LWOP , you are responsible for payment of the contributions on termination of \nemployment. ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Leave without pay”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-leave-without-pay-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "leave-without-pay-3", + "marginal_note": "Leave without pay (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "If you cancelled your PSHCP coverage during your LWOP , you must wait until you return to work to reapply. \nCov\nerage will be effective on the first day of the fourth month following receipt of the PSHCP Employee \nApplica\ntion Form (pshcp.ca/wp-content/uploads/2013/06/emp-applic-adhes-006491.pdf) by your \ndepartment\nal compensation office, Pay Centre or Pension Centre. \nEmployees and members of the Canadian Armed Forces (CAF) or Royal Canadian Mounted Police (RCMP) on \nloan t\no serve with an international organization or on authorized educational LWOP outside of Canada are \neligible for PSHCP Comprehensive Coverage. Contact your departmental compensation office, Pay Centre or \nPension Centre.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Leave without pay”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-voluntary-cessation-of-coverage", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "voluntary-cessation-of-coverage", + "marginal_note": "Voluntary cessation of coverage", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Voluntary cessation of coverage \nThe PSHCP is optional for most plan members. \nFor members deployed or posted outside Canada, Comprehensive Coverage is mandatory. \nTo terminate coverage under the PSHCP , you must submit a written request to your departmental \ncompensa\ntion office, Pay Centre or Pension Centre. You may also use the Compensation Web Applications \n(CWA)\n, if available to you. You must be on a Government of Canada server to access CWA. Contribution \ndeductions will s\ntop no later than 2 months following the date your request is received. \nCoverage will continue for the month following the last contribution deduction. For example, if the last \ncontribution deduc\ntion is taken in September, coverage will end October 31. \nCoverage cannot be cancelled retroactively.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Voluntary cessation of coverage”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-involuntary-cessation-of-coverage", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "involuntary-cessation-of-coverage", + "marginal_note": "Involuntary cessation of coverage", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Involuntary cessation of coverage \nIf your coverage under the PSHCP is terminated because you are no longer eligible, coverage for you and \nyour eligible dependant(s) will continue for the month following the last contribution deduction. \nPSHCP Member booklet 25", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Involuntary cessation of coverage”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-before-incurring-an-expense", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "before-incurring-an-expense", + "marginal_note": "Before incurring an expense", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Before incurring an expense \nSome products and services may be costly. Before you incur expenses, know your PSHCP features and how \nthey impact your reimbursements.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Before incurring an expense”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-claims-to-a-provincial-or-territorial-pl", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "claims-to-a-provincial-or-territorial-pl", + "marginal_note": "Claims to a provincial or territorial plan", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Claims to a provincial or territorial plan \nIf you are entitled to benefits under a provincial or territorial plan or any other third-party source of health \ncare assistance for which you have a legal right and are also covered under the PSHCP , you must submit to \nthe other plan first. \nProcess: \n1. Submit a claim to your provincial or territorial plan or any other third-party source of health care \nassist\nance for which you have a legal right. \n2. Wait for the claim to be processed. \n3. Submit a claim for the remaining eligible expenses to the PSHCP with the explanation of benefits \nst\natement from the other plan.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Claims to a provincial or territorial plan”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-reasonable-and-customary-charges", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "reasonable-and-customary-charges", + "marginal_note": "Reasonable and Customary Charges", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Reasonable and Customary Charges \nAll expenses claimed under the PSHCP are subject to Reasonable and Customary Charges. \nCanada Life determines the appropriate Reasonable and Customary Charges in accordance with average \nbilling for y\nour geographic area and any published fee guides from provincial or territorial associations. \nThese charges are continually updated and vary by province and territory. \nThe Reasonable and Customary Charges for paramedical providers such as massage therapists, \nopt\nometrists or chiropractors are listed in your PSHCP Member Services account ( canadalife.com/pshcp) \nor contact Canada Life. \nThe Reasonable and Customary Charges for prescription drugs are determined by the PSHCP pharmacy \nbenefits manag\ner, TELUS Health. \nIf your claim is higher than the established Reasonable and Customary Charges, you will be reimbursed 80% \nof the Re\nasonable and Customary Charges, not the full amount you paid. \nExample: \nYou pay $75 for a 1-hour chiropractic \ntreatment. \nThe Reasonable and Customary \nCharg\ne in your geographic area is \n$60. \nIneligible expense amount is $15. \n$75 - 60 = $15 \n80% x $60 = $48 \nYou will be reimbursed $48. \nPSHCP Member booklet 26", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Reasonable and Customary Charges”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-co-payment", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "co-payment", + "marginal_note": "Co-payment", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Co-payment \nThe PSHCP will reimburse you for 80% of the Reasonable and Customary Charges incurred for an eligible \nexpense, subject to the PSHCP’s maximums (some exceptions apply). The remaining 20% of eligible \nexpenses is your co-payment and will not be reimbursed. \nExample: \nYou pay $75 for a 1-hour chiropractic \ntreatment. \nThe Reasonable and Customary \nCharge in your geographic area is \n$60. \nIneligible expense amount is $15. \n$75 - $60=$15 \n80% x $60 = $48 \nYou will be reimbursed $48. \n$60 - $48 = $12 \nYour 20% co-payment amount is \n$12. \nIMPORTANT \nWhen your pharmacy or paramedical provider submits claims directly to Canada Life on your behalf, \nCanada Life pays them 80% of the eligible expenses for you. Your out-of-pocket costs are reduced \nimmediately. You will not be reimbursed for the remaining 20% co-payment amount, or any other ineligible \nexpenses.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Co-payment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-maximum-eligible-expenses", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "maximum-eligible-expenses", + "marginal_note": "Maximum eligible expenses", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Maximum eligible expenses \nSome PSHCP benefits have a maximum on the total amount that may be claimed in a given period. Most \nparamedical services have a maximum eligible expense, see Summary of Maximum Eligible Expenses in \nthe PSHCP Dir\nective (njc-cnm.gc.ca/directive/d9/v283/s836/en#s836-tc-tm). \nExample: \nChiropractic services are limited to $500 in expenses per calendar year, reimbursed at 80% for a total of \n$400. \nIn 2024, you visit your chiropractor \n10 times at $75 per treatment. \n$75 x 10 visits = $750 \nThe Reasonable and Customary \nCharg\ne is $60. \n$60 x 10 visits = $600 eligible \nexpenses \nIneligible e\nxpense amount is $150. \n$750 - $600 = $150 \n$600 - $400 = $200 \nOf the $600 in eligible expenses, you \nwill only be reimbur\nsed to the annual \nmaximum of $400 in 2024. \nIneligible expense amount is $200. \nIneligible expenses $150 + $200 = $350 total out of pocket for 2024", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Maximum eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-estimate-of-reimbursement", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "estimate-of-reimbursement", + "marginal_note": "Estimate of reimbursement", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Estimate of reimbursement \nIt is recommended that before you incur a large expense, you request an estimate from Canada Life to \nconfirm if the product or service is eligible for coverage under the PSHCP , how much of the expense will be \nreimbursed, and how much you will be responsible for.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Estimate of reimbursement”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-pshcp-member-booklet", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "pshcp-member-booklet", + "marginal_note": "PSHCP Member booklet", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "PSHCP Member booklet 27\nEstimate for a predetermination with Canada Life \nTo obtain an estimate for what will be reimbursed for a product or service, ask your provider for a document \noutlining the service(s), medical equipment or supplies and the estimated cost of the expense. \nYou may request an estimate of what will be covered by Canada Life either online or by mail. \nHow to submit an estimate online: \nTo request an estimate through your PSHCP Member Services account ( canadalife.com/pshcp) sign in and \nselect Make a claim. When ask\ned to select a claim type, choose Other claims and estimates. Follow the \nsteps until you are presented with a claim form. You may either: \n\n- upload the estimate document from your provider (no need to use the claim form) \n\n- download and complete the claim form (indicate on the form that it’s for an estimate) and then upload it \nalong with any supporting documents \nHow to submit an estimate by paper: \nPrint, complete legibly and sign the appropriate claim form found on the Your forms page of the PSHCP \nMember Services website at (welcome.canadalife.com/pshcp/forms) \nor contact Canada Life to request a \nform by mail. \nCanada Life will send y\nou a predetermination of", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “PSHCP Member booklet”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-benefits-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "benefits-1", + "marginal_note": "Benefits (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "benefits statement using the method of communication \nindicated in y\nour file. It will provide: \n\n- a decision on if the expense is covered by the PSHCP \n\n- an estimate of the dollar amount that is eligible for reimbursement when there is no coordination of \nbenefits. Note: This may differ from the actual amount that is covered \nEstimate for a predetermination with MSH \nTo obtain an estimate for what will be reimbursed for a product or service for emergency out-of-province or \nComprehensive out-of-country claims, ask your provider for a document outlining the service(s), medical \nequipment or supplies and the estimated cost of the expense. \nYou may request an estimate of what will be covered by MSH by mail. \nHow to submit an estimate by mail: \n1. Download and complete legibly the appropriate claim form found on MSH PSHCP Member Portal \n(pshcp-msh.ca). \n\n- If you would like a paper claim form to be sent to you by mail, contact MSH at: 1-833-774-2700 \n(North America, call toll-free) or 1-365-337-7427 (international, call collect). \n2. Print the claim form, and make sure to include the estimate document from your provider and any \nother supporting documents. \n3. Mail your r\nequest to: \nMSH International \nPO Box 4903 Stn A \nToronto ON M5W 0B1 \nPSHCP Member booklet 28 \nMSH will send you a predetermination of benefits statement using the method of communication indicated \nin your file. It will provide: \n\n- a decision on if the expense is covered by the PSHCP \n\n- an estimate of the dollar amount that is eligible for reimbursement when there is no coordination of \nbenefits. Note: This may differ from the actual amount that is covered \nIneligible providers \nCanada Life has a responsibility to protect the health and well-being of members and the integrity of the ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Benefits”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-benefits-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "benefits-2", + "marginal_note": "Benefits (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "PSHCP . Canada Life maintains a national list of ineligible service providers, clinics, facilities and medical \nsuppliers, due to concerns about their practices or their credentials. Claims from these providers will be \ndenied. \nYou are encouraged to review this list before incurring expenses. You may do so through your PSHCP \nMember Servic\nes account (canadalife.com/pshcp) by selecting Find a Provider. \nWhile you may still choose to get services or supplies from an ineligible provider, these will be at your own \nexpense. \nIf y\nou have concerns about the practices of a paramedical provider or medical supplier, please contact \nthe Canada Life Tip line ( canadalife.com/contact-us/fraud-complaints/fraud-concerns) by email or call \n1 866 810-8477. \nBenefits", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Benefits”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-the-pshcp-has-2-types-of-coverage-supple-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "the-pshcp-has-2-types-of-coverage-supple-1", + "marginal_note": "The PSHCP has 2 types of coverage: Supplementary Coverage and Comprehensive Coverage (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "The PSHCP has 2 types of coverage: Supplementary Coverage and \nComprehensive Coverage \nCoverage type Who is covered What is covered \nSupplementary Coverage (employee, \nretired member, dependant or \nsurvivor living in Canada) \nThis coverage is intended for \nmembers and their eligible \ndependant(s) who ar\ne covered under \na provincial or territorial health \ninsurance plan. \nThe PSHCP supplements the \nco\nverage provided under the \nprovincial or territorial plan in the \nmember’s province or territory of \nresidence. \nThis coverage consists of the: \n\n- Extended Health Provision \n(including the Drug, Vision \nCare, Medic\nal Practitioner, \nMiscellaneous, Dental and Out-of-\nProvince Benefits) \n\n- Hospital Provision Level I, II, III \nPSHCP Member booklet 29\nCoverage type Who is covered What is covered \nComprehensive Coverage (employee \nliving outside of Canada) \nThis coverage is intended for \nmembers who are posted or \ndeployed by their Employer, as well \nas their eligible dependant(s) who \nare living with the member outside \nCanada and who are not covered \nunder a provincial or territorial \nhealth insurance plan or in a non-\ngovernment hospital insurance plan. \nThis coverage consists of the: \n\n- Extended Health Provision \n(including Drug, Vision Care, \nMedical Practitioner, Miscellaneous \nand Dental Benefits) excluding the \nOut-Of-Province Benefit \n\n- Basic Health Care Provision \n\n- Hospital Provision Level I, II, III \n\n- Hospital Outside Canada Provision A person covered under \nComprehensive Coverage will \ncontinue to be covered under \nthis benefit after their return to \nCanada until they become eligible \nto be insured under a provincial or \nterritorial health insurance plan. \nNote: If you live outside Canada \n(for example, in the USA), but work ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “The PSHCP has 2 types of coverage: Supplementary Coverage and Comprehensive Coverage”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-the-pshcp-has-2-types-of-coverage-supple-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "the-pshcp-has-2-types-of-coverage-supple-2", + "marginal_note": "The PSHCP has 2 types of coverage: Supplementary Coverage and Comprehensive Coverage (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "in Canada, you are not entitled to \nComprehensive Coverage. \nIf a dependant is living in Canada, \nthey continue with Supplementary \nCoverage. \nComprehensive Coverage (retired \nmember living outside Canada) \nThis coverage is intended for retired \nmembers living outside Canada who \nare not covered under a provincial or \nterritorial health insurance plan. \nThis coverage consists of the: \n\n- Extended Health Provision \n(including Drug, Vision Care, \nMedical Practitioner, Miscellaneous \nand Dental Benefits) excluding the \nOut-Of-Province Benefit \nIf a dependant is living in Canada, \nthey continue with Supplementary \nCoverage. \n\n- Basic Health Care Provision \n\n- Hospital Provision Level I, II, III \n\n- Excluding Hospital (Outside \nCanada) Provision", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “The PSHCP has 2 types of coverage: Supplementary Coverage and Comprehensive Coverage”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-general-exclusions-and-limitations-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "general-exclusions-and-limitations-1", + "marginal_note": "General exclusions and limitations (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "General exclusions and limitations \nNo benefit is payable for: \n\n- expenses for which benefits are payable under a Workers’ Compensation Act or a similar statute or \nenactment, or by any government agency \n\n- expenses for services and supplies, provided or prescribed by a person who is ordinarily a resident in the \npatient’s home or who is related to the patient by blood, marriage, or common-law partnership \n\n- expenses for services or products for cosmetic purposes only, or for conditions not detrimental to health, \nexcept those required as a result of accidental injury \n\n- expenses for services or products normally provided without charge \nPSHCP Member booklet 30 \n\n- expenses for services provided in connection with medical examinations for insurance, school, camp, \nassociation, employment, passport or similar purposes \n\n- expenses for services provided by a licensed physician practicing in Canada where the participant is \neligible to be insured under a provincial or territorial health insurance plan, except for services that are \nspecifically included under the PSHCP Directive ( njc-cnm.gc.ca/directive/d9/v283/en) \n\n- expenses for experimental products or treatments, for which substantial evidence provided through \nobjective clinical testing of the products or treatment’s safety and effectiveness for the purpose and under \nthe conditions of the use recommended, does not exist to Canada Life’s satisfaction \n\n- expenses for benefits that are legally prohibited by a government for coverage \n\n- the portion of charges which are payable under a provincial or territorial health insurance plan, a \nprovincial or territorial drug plan, or any provincially or territorially sponsored program, whether or not \nthe participant is participating in the plan or program \n", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “General exclusions and limitations”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-general-exclusions-and-limitations-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "general-exclusions-and-limitations-2", + "marginal_note": "General exclusions and limitations (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- the portion of charges for services rendered or supplies provided in a hospital outside of Canada, that \nwould normally be payable under a provincial or territorial health or hospital insurance plan if the \nservices or products had been rendered in a hospital in Canada \n\n- this limitation does not apply to the eligible expenses under the Hospital (outside Canada) Provision, the", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “General exclusions and limitations”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-extended-health-provision", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "extended-health-provision", + "marginal_note": "Extended Health Provision", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Extended Health Provision or the Out-of-Province Benefit \n\n- the portion of charges that are the legal liability of any other party \n\n- specific exclusions identified under each Plan benefit \nExtended Health Provision \nThe purpose of this provision is to provide coverage for specified services and products not covered under \nprovincial or territorial health insurance plans, or if you reside outside Canada. It is also to provide coverage \nfor specified services and products not covered under the Basic Health Care Provision of the PSHCP . \nAll members of the PSHCP are covered under this provision, except those with Comprehensive Coverage \nwho are not eligible for the Out-of-Province Benefit. \nThe Extended Health Provision includes the following benefits: \n\n-", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Extended Health Provision”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-drug-benefit", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "drug-benefit", + "marginal_note": "Drug Benefit", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Drug Benefit \n\n- Vision Care Benefit \n\n- Medical Practitioners Benefit \n\n- Miscellaneous Expense Benefit \n\n- Dental Benefit \n\n- Out-of-Province Benefit (for members with Supplementary Coverage only) \n\n- Emergency Benefit While Travelling \n\n- Emergency Travel Assistance Services \n\n- Referral Benefit \nSome of these benefits may be subject to Reasonable and Customary Charges, and to certain limits as \nspecified in the eligible e\nxpenses tables. All benefits are subject to co-payment unless otherwise specified. \nPSHCP Member booklet 31\nDrug Benefit", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Drug Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-eligible-expenses-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "eligible-expenses-1", + "marginal_note": "Eligible expenses (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Eligible expenses \nTo be eligible, expenses must be: \n\n- Reasonable and Customary Charges \n\n- prescribed by a physician, dentist, nurse practitioner (if authorized by provincial or territorial legislation), \nor other qualified health professional, if the applicable provincial or territorial legislation permits them to \nprescribe the drugs \n\n- dispensed by a pharmacist or physician \n\n- used to treat the specific condition or conditions for which Health Canada has approved the prescription \ndrug. The use of a prescription drug to treat a condition or conditions that the prescription drug was \nnot approved by Health Canada for, is commonly referred to as “off-label” use of the prescription drug. \nShould you have any questions, contact Canada Life. \nIn the tables below, where it is indicated that additional medical documentation is required, this may mean \njust a prescrip\ntion is required. \nNote: Medical documentation may include, but is not limited to a prescription, medical history etc. \nEligible expenses are charges for: \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \nat 80% Benefit De\ntails \nDrugs that require a \nprescription by law \nFor each member and their \neligible dependant(s) up \nto the R\neasonable and \nCustomary Charges \nA controlled drug or drug \nrequiring a prescrip\ntion \nthat includes a Drug \nIdentification Number \n(DIN) \nNo additional medical \ndocumentation is r\nequired \nLife-sustaining \nprescription drugs \nF\nor each member and their \neligible dependant(s) up \nto the R\neasonable and \nCustomary Charges \nEligible prescription drugs \nare list\ned in Schedule VII of \nthe PSHCP Direc\ntive \n(njc-cnm.gc.ca/directive/\nd9/ v283/s829/en#s829-\ntc-tm) \nNo additional medical \ndocument\nation is r\nequired \nPrescription injectable \ndrugs ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-eligible-expenses-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "eligible-expenses-2", + "marginal_note": "Eligible expenses (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "For each member and their \neligible dependant(s) up \nto the R\neasonable and \nCustomary Charges \nIncludes insulins and \nallergy serums \nNo additional medic\nal \ndocumentation is r\nequired \nCompound prescription \ndrugs \nFor each member and their \neligible dependant(s) up \nto the R\neasonable and \nCustomary Charges \nMust include at least 1 \nactive ingr\nedient that is an \neligible prescription drug \nunder the PSHCP \nNo additional medical \ndocumentation is r\nequired \nPSHCP Member booklet 32 \nIs additional medical PSHCP reimburses Benefit Details documentation at 80% required? \nVitamins and minerals For each member and their \neligible dependant(s) up \nto the Re\nasonable and \nCustomary Charges \nWhen prescribed for the \ntreatment of a chr\nonic \ndisease where the use of \nthe product(s) is proven \nto have therapeutic \nvalue and where it is \nconfirmed by a physician \nor nurse practitioner \nthat alternatives are not \navailable \nYes, additional medical \ndocumentation is requir\ned. \nMore information can be \nfound here \n(welcome.canadalife.\ncom/content/dam/rfp/\nwelcome-sites/pshcp/\nrequest-for-coverage-of-\nprescribed-vitamins-or-\nminerals-M7520-VM.pdf) \nA\nsthma delivery \nmedication devices \nF or each member and their \neligible dependant(s) up \nto the Re\nasonable and \nCustomary Charges \nIncluding devices that are \nintegral t\no the product and \naerochambers with masks \nfor the delivery of asthma \nmedication \nNo additional medical \ndocumentation is requir\ned \nSpecialized infant \nformulas \nFor each member and their \neligible dependant(s) up \nt\no the Re\nasonable and \nCustomary Charges \nWhen the covered infant \nhas an intolerance t\no both \nbovine and soy protein \nthat has been confirmed \nin writing by their licensed \nphysician or nurse \npractitioner \nYes, additional medical ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-eligible-expenses-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "eligible-expenses-3", + "marginal_note": "Eligible expenses (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "documentation such as a \nprescrip\ntion or doctor’s \nnote is required. It must \nindicate that the child has \na bovine or soy intolerance. \nReplacement therapeutic \nnutrients \nFor each member and their \neligible dependant(s) up \nt\no the Re\nasonable and \nCustomary Charges \nFor the treatment of an \ninjury or disease ex\ncluding \nallergies or aesthetic \nailment when there is \nno other nutritional \nalternative available \nYes, additional medical \ndocumentation such as a \nprescrip\ntion or doctor’s \nnote is required. It must \nindicate there is no other \nnutritional alternative \navailable. \nContraceptives For each member and their \neligible dependant(s) up \nto the Re\nasonable and \nCustomary Charges \nIncluding oral \ncontracep\ntives and non-\noral contraceptives such \nas patches, vaginal rings, \ncontraceptive implants \n(intrauterine and arm), and \nintrauterine devices (IUDs), \nincluding copper IUDs \nNo additional medical \ndocumentation is requir\ned \nSmoking cessation aids $2,000 in a lifetime Including aids that do not \nrequire a prescrip\ntion \nNo additional medical \ndocumentation is requir\ned \nErectile dysfunction \nprescription drugs \n$500 each c\nalendar year Not applicable No additional medical \ndocumentation is requir\ned \nPSHCP Member booklet 33", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-exclusions", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "exclusions", + "marginal_note": "Exclusions", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Exclusions \nThe PSHCP does not pay for: \n\n- prescription drugs, which based on Canada Life’s assessment of eligibility, centered on industry best \npractices and medical necessity, are experimental \n\n- publicly advertised items or products, which based on Canada Life’s assessment of eligibility centered on \nindustry best practices and medical necessity, are household remedies \n\n- vitamins, minerals and protein supplements other than expenses that would qualify for reimbursement \nunder eligible expenses shown above \n\n- therapeutic nutrients other than those that would qualify for reimbursement under eligible expenses \nshown above \n\n- diets and dietary supplements, infant foods, and sugar or salt substitutes other than expenses that would \nqualify for reimbursement under eligible expenses shown above \n\n- lozenges, non-medicated mouth washes, non-medicated shampoos, contact lens care products, and skin \ncleansers, protectives, or emollients \n\n- prescription drugs used for cosmetic purposes \n\n- prescription drugs used for a condition or conditions not recommended by the manufacturer of the \nprescription drugs \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \n\n- expenses payable under a provincial or territorial prescription drug plan \n\n- expenses for contraceptives that are barrier methods, such as male or female condoms, diaphragm and \ncervical caps, as well as spermicide products such as foams and jellies", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Exclusions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-prior-authorization-program-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "prior-authorization-program-1", + "marginal_note": "Prior Authorization Program (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Prior Authorization Program \nThe PSHCP Prior Authorization Program is a process where a sub-set of prescription drugs require pre-\napproval before they can be reimbursed under the PSHCP . To receive Prior Authorization for coverage \nand reimbursement of certain prescription drugs, you must submit a request and obtain approval from \nCanada Life. \nPrior Authorization provides an opportunity for you, or your eligible dependant(s), to talk with your medical \nprofessional about treatment options. This process is intended to promote less invasive and less expensive, \nbut equally effective treatments where medically appropriate. \nFor a claim to be considered under the PSHCP Prior Authorization Program, additional information from \nyou and your physician, nurse practitioner or other medical professional is needed to help determine if: \n\n- the prescription drug represents reasonable treatment for you or your eligible dependant’s condition \n\n- there are lower cost medications available that are reasonable treatment for you or your eligible \ndependant’s medical condition \n\n- coverage is available for the prescribed drug under other programs to which you or your eligible \ndependant(s) have a legal right, such as a provincial, territorial or other health insurance plan \nSome prescription drugs may not be eligible under the PSHCP . There are various reasons a prescription \ndrug may be excluded or have restricted coverage, including: \nPSHCP Member booklet 34 \n\n- Canada Life is currently reviewing the prescription drug for efficacy, safety and cost effectiveness \n\n- the prescription drug has been reviewed and does not meet the requirements for coverage under the \nPSHCP \nShould you require Prior Authorization for a prescription drug, your medical professional (typically a ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Prior Authorization Program”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-prior-authorization-program-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "prior-authorization-program-2", + "marginal_note": "Prior Authorization Program (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "physician or specialist) must c\nomplete a Prior Authorization Form which can be found on the Your forms \npage of the PSHCP Member Services website (welcome.canadalife.com/pshcp/forms). You may also \ncontac\nt Canada Life to request that a form be sent to you by mail. \nCanada Life may revoke a Prior Authorization decision if medical evidence is found to no longer support the \nprescription drug f\nor which Prior Authorization was approved. \nIf you do not agree with a Prior Authorization decision, you can ask Canada Life to review your file. Once \nall avenues of re\nview with Canada Life have been exhausted, you may submit an appeal to the PSHCP \nAdministration Authority, Public Service Health Care Plan | How to Submit an Appeal ( pshcp.ca/appeals/\nhow-to-submit-an-appeal/), which is the final le\nvel of review for claims under the PSHCP . See PSHCP \nAdministra\ntion Authority appeals. \nAdditional information \nIf you or your eligible dependant(s) are on existing prescription treatments as of July 1, 2023, you are \nsubject to permanent grandparenting for ongoing medications. Grandparenting does not apply to members \non biologic medications where a biosimilar is available. \nNew treatments are subject to the PSHCP Prior Authorization Program, according to which pre-approval is \nrequired f\nor certain prescription drugs. \nFor a listing of the prescription drugs that require Prior Authorization, visit the Your forms page of the \nPSHCP Member Services website (welcome.canadalife.com/pshcp/forms) \nto view the listing of Prior \nAuthoriza\ntion forms. You may also contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Prior Authorization Program”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-mandatory-generic-substitution-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "mandatory-generic-substitution-1", + "marginal_note": "Mandatory Generic Substitution (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Mandatory Generic Substitution \nGeneric drugs are safe and effective alternatives to brand name drugs and are reviewed and approved by \nHealth Canada. Generic drugs contain identical active ingredients to the brand name drug. \nEffective July 1, 2023, the PSHCP implemented Mandatory Generic Substitution, which applies to all new \nprescriptions aft\ner this date. The PSHCP may limit the coverage of a prescription drug to the lowest-cost \ngeneric drug equivalent. This lowest-cost equivalent must also be considered reasonable treatment for you \nor your eligible dependant’s condition. \nAs of January 1, 2024, all prescription drugs covered under the PSHCP will be reimbursed at 80% of the cost \nof the lowes\nt-cost generic drug equivalent. \n\n- If a person cannot take the generic version of the prescription drug they are prescribed due to a medical \nreason, they may still be eligible for the brand name drug, reimbursed at 80%. \n\n- To seek an exception, a Request for Brand Name Prescription Drug Coverage Form must be completed by \nthe attending physician or nurse practitioner and submitted to Canada Life for review. You can find this \nform on the Your forms page of the PSHCP Member Services website (welcome.canadalife.com/pshcp/ \nforms) \nor contact Canada Life to request that the form be sent to you by mail. \nPSHCP Member booklet 35\nYou have 3 options when you fill a prescription: \n\n- take the lowest-cost alternative generic drug equivalent and pay less, in most cases \n\n- ask for the brand name drug and pay the difference between the cost of the generic drug equivalent and \nthe brand name drug \n\n- discuss the issue with a medical professional, and if they determine that the brand name drug is required ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Mandatory Generic Substitution”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-mandatory-generic-substitution-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "mandatory-generic-substitution-2", + "marginal_note": "Mandatory Generic Substitution (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "rather than the generic drug equivalent, your medical professional may fill out a Request for Brand Name \nPrescription Drug Coverage form, and if approved, the PSHCP will pay the applicable cost of the new \nbrand name drug \nYou can find this on the Your forms page of the PSHCP Member Services website (welcome.canadalife.com/\npshcp/forms). Y\nou may also contact Canada Life to request that the form be sent to you by mail.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Mandatory Generic Substitution”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-biosimilar-substitution", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "biosimilar-substitution", + "marginal_note": "Biosimilar substitution", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Biosimilar substitution \nThe PSHCP will reimburse 80% of a biosimilar drug when it is available as a substitute for an originator \nbiologic drug. Claims for biologics may be denied or have their reimbursement limited to 80% of the cost \nof the biosimilar treatment, where a biosimilar is available. Biologic and biosimilar drugs are reviewed and \napproved by Health Canada. Biosimilar drugs are highly similar in terms of quality, efficacy and safety to an \noriginator biologic drug that has previously been authorized for use. \n\n- If you or your eligible dependant(s) is on a biologic drug where there is a biosimilar available, Canada Life \nmay contact you directly with details regarding the switch to a biosimilar equivalent drug. If you or your \neligible dependant(s) cannot take the biosimilar version of the drug prescribed due to a medical reason, \nyou may apply for an exception. \n\n- If an exception is required, have your medical professional fill out a Request for Originator Biologic \nDrug Cover\nage form. If approved, the PSHCP will pay the applicable cost of the brand name originator \nbiologic. You can find this f\norm on the Your forms page of the PSHCP Member Services website (welcome.\ncanadalife.com/pshcp/forms) or cont\nact Canada Life to request that the form be sent to you by mail. \n\n- Factors that are considered when assessing requests for exceptional coverage of a biologic drug may \ninclude clinical rationale, logistics of receiving medication and exceptional circumstances.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Biosimilar substitution”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-pharmacy-dispensing-fees-and-frequency-l-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "pharmacy-dispensing-fees-and-frequency-l-1", + "marginal_note": "Pharmacy Dispensing Fees and Frequency Limit (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Pharmacy Dispensing Fees and Frequency Limit \nDispensing Fee Cap \nAll pharmacies charge a dispensing fee, also known as professional fees, to issue a prescription drug. \nDispensing fees are charged for services, such as storing and preparing medication, prescription verification \nand medication reviews to check for interactions and counselling. \nYou and your eligible dependant(s) are covered for up to $8, reimbursed at 80%, for pharmacy dispensing \nfees. Ex\nceptions may apply to some provinces or territories due to pharmacy regulations. \nDue to provincial pharmacy regulations, the dispensing fee frequency limit is not being applied in \nSaskat\nchewan. Please contact your provincial health authority for details. \nDue to provincial pharmacy regulations, neither the dispensing fee cap nor dispensing fee frequency limit \nare being applied in Quebec. Please c\nontact your provincial health authority for details. \nDispensing fee caps are a common industry practice among employer-sponsored plans. \nPSHCP Member booklet 36 \nDispensing fees vary between pharmacies. For this reason, you may want to do a cost comparison and shop \naround to find out which pharmacies may save you money on prescription drug claims. The dispensing fee \ncap does not apply to biologic or compound prescription drugs. \nDispensing Fee Frequency Limit \nThe PSHCP has a Dispensing Fee Frequency Limit, which limits the number of dispensing fees covered \nunder the PSHCP for the same prescription drug within a calendar year. The frequency limit only applies to \nmaintenance prescription drugs. \nYou and your eligible dependant(s) may claim up to 5 dispensing fees per year for maintenance medications \nunder the PSHCP\n. To reduce the number of times a dispensing fee is charged and to stay within the ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Pharmacy Dispensing Fees and Frequency Limit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-pharmacy-dispensing-fees-and-frequency-l-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "pharmacy-dispensing-fees-and-frequency-l-2", + "marginal_note": "Pharmacy Dispensing Fees and Frequency Limit (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "annual limit, speak to your pharmacy to inquire if a 90-day supply of the maintenance medications can be \nprovided. This practice may reduce expenses for both you and for the plan. \nExceptions will be considered in situations such as: \n\n- safety concerns with the prescribed drug (for example, controlled substance, compliance packaging/ \nblister packs, etc.) \n\n- storage limitations for the prescribed drug (for example, requiring deep freeze temperatures) \n\n- the prescribed drug’s 3-month supply co-pay is more than $100 (the proportion of eligible expenses not \nreimbursed by the PSHCP) \n\n- pharmacy regulations in some provinces or territories \nTo request an exception, you and your prescribing health care provider will need to complete the Request \nfor Dispense F\nee Frequency Limit Exception Form. You can find this form on the Your forms page of the \nPSHCP Member Services website (welcome.canadalife.com/pshcp/forms) \nor contact Canada Life to \nreques\nt that the form be sent to you by mail. \nDay supply limit \nThe day supply limit for prescription drugs under the PSHCP is 100 days for both acute and maintenance \nprescription drugs. If you require an exception to the 100-day supply limit for a prescription drug due to \ntravelling for an extended period, you may request up to a 200-day supply from your pharmacist. \nHow to request additional day supply from your pharmacist \n1. Contact your pharmacy to find out how far in advance you need to order your prescriptions. \n2. Provide your PHSCP benefit card and applicable dates to your pharmacist to submit your request. \nYour pharmacis\nt has been given instructions on how to submit your vacation supply claims. \nYou do not need to contact Canada Life for approval of this exception. \nTo request up to a 200-day supply for reasons other than travel, such as transitioning to retirement coverage \nunder the PSHCP\n, you must contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Pharmacy Dispensing Fees and Frequency Limit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-catastrophic-drug-coverage-in-the-event-", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "catastrophic-drug-coverage-in-the-event-", + "marginal_note": "Catastrophic drug coverage in the event of high prescription drug expenses", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Catastrophic drug coverage in the event of high prescription drug expenses \nCatastrophic drug coverage provides protection for you and your eligible dependant(s) who incur high \nprescription drug expenses in any given calendar year. Eligible prescription drug expenses incurred in a \ngiven calendar year will be reimbursed at 80% until $3,500 in out-of-pocket drug expenses is reached, then \neligible prescription drugs will be reimbursed at 100% for the rest of the calendar year. \nPSHCP Member booklet 37", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Catastrophic drug coverage in the event of high prescription drug expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-vision-care-benefit-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "vision-care-benefit-1", + "marginal_note": "Vision Care Benefit (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Vision Care Benefit \nEligible expenses \nEligible expenses are the Reasonable and Customary Charges for: \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses at \n80% \nBenefit Details \nEye exams 1 eye exam every 2 \ncalendar years beginning \nevery odd year \nMust be performed by an \noptometrist \nNo additional medical \ndocumentation is required \nEyeglasses or contact \nlenses \n$400 every 2 calendar years \nbeginning every odd year \nMust be necessary \nfor the correction of \nvision and prescribed \nby an optometrist or \nophthalmologist \nIncludes repairs \nNo additional medical \ndocumentation is required \nLaser eye surgery $2,000 in a lifetime per \ncovered person under the \nPSHCP , and not per eye or \nper procedure \nSurgery must be performed \nby an ophthalmologist and \ndoes not include expenses \nincurred for cataract \nsurgery \nNo additional medical \ndocumentation is required \nThe initial purchase \nof intraocular lenses, \neyeglasses or contact \nlenses \nFor each member and their \neligible dependant(s) up \nto the Reasonable and \nCustomary Charges \nNecessary for the \ncorrection of vision and \nrequired as a direct result \nof surgery or an accident \nwhere the purchase is \nmade within 6 months of \nsuch accident or surgery \nNo additional medical \ndocumentation is required \nArtificial eyes \nWhen an eligible \ndependant is \n21 years old or younger \nOnce every 12 months of \nthe last purchase \nEarlier replacement may \nbe allowed if medically \nrequired because of \ngrowth or shrinkage of \nsurrounding tissue \nNo additional medical \ndocumentation is required \nWhen a member or their \neligible dependant is over \nage 21 \nOnce every 60 months of \nthe last purchase \nEarlier replacement may \nbe allowed if medically \nrequired because of \ngrowth or shrinkage of \nsurrounding tissue ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Vision Care Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-vision-care-benefit-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "vision-care-benefit-2", + "marginal_note": "Vision Care Benefit (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "No additional medical \ndocumentation is required \nPSHCP Member booklet 38 \nExclusions \nNo benefit is payable for: \n\n- eye-related procedures which use lasers but where the laser does not reshape the cornea with the goal of \ncorrecting common vision problems \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Vision Care Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-medical-practitioners-benefit", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "medical-practitioners-benefit", + "marginal_note": "Medical Practitioners Benefit", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Medical Practitioners Benefit \nEligible expenses for the services of a medical practitioner include only those services that are within \ntheir area of expertise and require the skills and qualifications of such a medical practitioner. Following \nprovincial or territorial regulations, the medical practitioner must be registered, licensed or certified to \npractice in the jurisdiction where the services are rendered.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Medical Practitioners Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-physician-s-services-and-laboratory-serv-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "physician-s-services-and-laboratory-serv-1", + "marginal_note": "Physician’s services and laboratory services (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Physician’s services and laboratory services \nIf one or more provinces or territory covers physician’s services and laboratory services that are not covered \nby your own province or territory, consideration for coverage may be given. For more information consult \nthe PSHCP Directive ( njc-cnm.gc.ca/directive/d9/v283/en). \nEligible expenses \nIn the table below, where it is indicated that additional medical documentation is required, this may mean \njust a prescription is required. \nThe PSHCP covers services by the professionally qualified health practitioners listed below. Eligible \ne\nxpenses are the Reasonable and Customary Charges for: \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \na\nt 80% Benefit Details \nAcupuncturist $500 per calendar year Including services \npr\novided by a registered \nacupuncturist \nNo additional medical \ndocument\nation is required \nChiropractor $500 per calendar year \nf\nor all items and services \ncombined \nIncluding radiographs \nperf\normed by a \nchiropractor \nNo additional medical \ndocument\nation is required \nDietitian $300 per calendar year Dietitians are experts in \nidentifying and tr\neating or \npreventing disease-related \nmalnutrition conditions \nand/or conducting \nmedical nutrition therapy \nincluding the provision of \nconsultative nutritional \nservices \nNo additional medical \ndocument\nation is required \nPSHCP Member booklet 39\nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nElectrologist $1,200 per calendar year \nfor all ser\nvices combined \nIncluding electrolysis \ntre\natments performed by a \nlicensed physician for: \n\n- the permanent removal \nof ex\ncessive hair from \nexposed areas of the \nface and neck when the \nmember or their eligible \ndependant(s) suffers \nfrom severe emotional ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Physician’s services and laboratory services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-physician-s-services-and-laboratory-serv-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "physician-s-services-and-laboratory-serv-2", + "marginal_note": "Physician’s services and laboratory services (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "trauma because of this \ncondition \n\n- a prescription is required \nfrom a psy\nchiatrist, \npsychologist or licensed \nphysician unless \nundergoing treatment \nrelated to gender \naffirming care \n\n- the prescription is valid \nfor 3 y\nears \nYes, additional medical \ndocumenta\ntion may be \nrequired \nLactation consultant $300 per calendar year Services covered by the \npro\nvince or territory \nof residence must be \nexhausted first \nNo additional medical \ndocumenta\ntion is required \nMassage therapist $500 per calendar year Massage therapists \nmanipulat\ne the body’s soft \ntissues and are licensed by \nthe appropriate provincial \nor territorial licensing body \nNo additional medical \ndocumenta\ntion is required \nNaturopath $500 per calendar year Naturopaths are \nmembers of the Canadian \nNa\nturopathic Association \nor any affiliated provincial \nor territorial association \nor, in the absence of such \nassociation, a person with \ncomparable qualifications \nas determined by \nCanada Life \nNo additional medical \ndocumenta\ntion is required \nPSHCP Member booklet 40 \nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nNurse (nursing services) $20,000 per calendar year Medically necessary \npriva\nte duty and visiting \nnursing services provided \nby a nurse graduated \nfrom a recognized school \nof nursing where such \nservices are prescribed \nby a physician or nurse \npractitioner and are \nrendered in the patient’s \nprivate residence. The \nprescription is valid for \n1 year unless otherwise \nadvised by Canada Life \nYes, additional medical \ndocumenta\ntion is required \nOccupational therapist $300 per calendar year Services covered by the \npro\nvince or territory \nof residence must be \nexhausted first \nNo additional medical \ndocumenta\ntion is required ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Physician’s services and laboratory services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-physician-s-services-and-laboratory-serv-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "physician-s-services-and-laboratory-serv-3", + "marginal_note": "Physician’s services and laboratory services (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Osteopath $500 per calendar year \nfor all it\nems and services \ncombined \nIncluding radiographs \nperformed b\ny an osteopath \nNo additional medical \ndocumenta\ntion is required \nPhysiotherapist $1,500 per calendar year Physiotherapists specialize \nin tre\nating injuries and \nconditions that impact \nmovement \nNo additional medical \ndocumenta\ntion is required \nPodiatrist $500 per calendar year \nfor all it\nems and services \nby these practitioners \ncombined \nIncluding radiographs \nperformed b\ny a podiatrist \nNo additional medical \ndocumenta\ntion is required Chiropodist \nPublic health or \ncommunity nur\nses \nlocated in community \nnursing stations providing \nfootcare \nPsychological services $5,000 per calendar year \nfor all ser\nvices by these \npractitioners combined \nPsychologist, \npsycho\ntherapist, social \nworker, counsellor \n(as deemed qualified by \nCanada Life based on \nprovincial or territorial \naccreditation) \nNo additional medical \ndocumenta\ntion is required \nPSHCP Member booklet 41\nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nSpeech language \npathologist \n$750 per calendar year \nfor all services by these \npractitioners combined \nSpeech language \npathologists provide \nassessment and treatment \nof communication \nproblems and speech \ndisorders \nNo additional medical \ndocumentation is required \nAudiologist Audiologists are \nhearing healthcare \nprofessionals who perform \ncomprehensive hearing \nloss evaluations, diagnose \nhearing loss and prescribe \nhearing aids and other \ndevices to help people hear \nExclusions \nNo benefit is payable for: \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \n\n- expenses for surgical supplies and diagnostic aids \n", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Physician’s services and laboratory services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-physician-s-services-and-laboratory-serv-4", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "physician-s-services-and-laboratory-serv-4", + "marginal_note": "Physician’s services and laboratory services (part 4)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- the Prostatic Specific Antigen (PSA) test used for screening purposes, and Prostate Cancer Detection (PCA) \nPCA3 urine test \n\n- expenses incurred for nursing services provided by salaried employees of a facility where you or your \neligible dependant(s) resides in such facility", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Physician’s services and laboratory services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-miscellaneous-expense-benefit-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "miscellaneous-expense-benefit-1", + "marginal_note": "Miscellaneous Expense Benefit (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Miscellaneous Expense Benefit \nEligible expenses \nThe PSHCP covers the following miscellaneous expenses, with conditions and limits. To be eligible, the \nexpenses must be Reasonable and Customary Charges and must be prescribed by either a licensed \nphysician or a nurse practitioner working within their scope of practice unless otherwise specified. \nIn the tables below, where it is indicated that additional medical documentation is required, this may mean \njust a prescription is required. PSHCP Member booklet 42 \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \nat 80% Bene\nfit Details \nLicensed emergency \nground ambulance \nservices \nBased on provincial or \nterrit\norial coverage fees \nTo the nearest hospital \nequipped to pr\novide the \nrequired treatment when \nthe physical condition of \nthe patient prevents the \nuse of another means of \ntransportation, where \nmedically necessary \nNo additional medical \ndocumenta\ntion is required \nEmergency air ambulance \nservic\ne \nBased on provincial or \nterrit\norial coverage fees \nTo the nearest hospital \nequipped to pr\novide the \nrequired treatment when \nthe physical condition of \nthe patient prevents the \nuse of another means of \ntransportation \nYes, additional medical \ndocumenta\ntion is required \nOrthopedic shoes $250 per calendar year An integral part of a \nbrac\ne or are specially \nconstructed for the patient, \nincluding modifications \nto such shoes, provided \nthe shoes or modification \nare prescribed in writing \nby a physician, nurse \npractitioner (if authorized \nby provincial or territorial \nlegislation) or podiatrist \nYes, additional medical \ndocumenta\ntion is required \nA prescription is valid for \n1 ye\nar \nOrthotics 1 pair per calendar year Including repairs Yes, additional medical \ndocumenta", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Miscellaneous Expense Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-miscellaneous-expense-benefit-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "miscellaneous-expense-benefit-2", + "marginal_note": "Miscellaneous Expense Benefit (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "tion is required Prescribed in writing \nby a physician, nur\nse \npractitioner (if authorized \nby provincial or territorial \nlegislation) or podiatrist, \nand dispensed by an \neligible provider, as \ndetermined by Canada Life, \nand limited to 1 pair in a \ncalendar year \nA prescription is valid for \n3 ye\nars \nPSHCP Member booklet 43\nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nHearing aids $1,500 during a 60-month \nperiod \nLess any eligible hearing \naid expenses incurr\ned \nand claimed during the \nprevious 60 months \nYes, additional medical \ndocumenta\ntion is required \nIncludes purchase and \nrep\nairs. No limit if required \nas a direct result of \nsurgery or an accident \nand purchased within \n6 months of the event up \nto the Reasonable and \nCustomary Charges. \nBatteries for hearing aids $200 per calendar year Not applicable Yes, additional medical \ndocumenta\ntion is required \nTrusses, crutches, splints, \ncas\nts and cervical collars \nFor each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nNot applicable Yes, additional medical \ndocumenta\ntion is required \nBraces For each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nPurchase and repairs, \nwhich cont\nain either metal \nor hard plastic or other \nrigid materials that, in the \nopinion of Canada Life, \nprovide a comparable \nlevel of support, excluding \ndental braces and braces \nused primarily for athletic \nuse \nYes, additional medical \ndocumenta\ntion is required \nOrthopaedic brassieres $200 per calendar year Not applicable Yes, additional medical \ndocumenta\ntion is required \nBreast prosthesis For each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Miscellaneous Expense Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-miscellaneous-expense-benefit-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "miscellaneous-expense-benefit-3", + "marginal_note": "Miscellaneous Expense Benefit (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Following mastectomy and \nas a replac\nement where 24 \nmonths have elapsed since \nthe last purchase \nYes, additional medical \ndocumenta\ntion is required \nWigs $1,500 during a 60-month \nperiod \nWhen the patient is \nsuffering fr\nom total hair \nloss as the result of an \nillness \nYes, additional medical \ndocumenta\ntion is required \nPSHCP Member booklet 44 \nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nColostomy, ileostomy and \ntracheostomy supplies \nFor each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nNot applicable Yes, additional medical \ndocumenta\ntion is required \nCatheters and drainage \nbags \nF\nor each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nFor incontinent, paraplegic \nor quadriplegic p\natients \nYes, additional medical \ndocumenta\ntion is required \nTemporary artificial limbs For each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nIntended for short-term \nuse, usually for 2 t\no 4 \nmonths \nYes, additional medical \ndocumenta\ntion is required \nPermanent artificial limbs Once every 60 months \nfor a member or eligible \ndependant(s) o\nver 21 years \nof age \nTo replace temporary \nartificial limbs \nYes, additional medical \ndocumenta\ntion is required \nThe frequency maximum \nmay not apply if \nmedic\nally proven that \ngrowth or shrinkage of \nsurrounding tissue requires \nreplacement of the existing \nprosthesis \nOnce every 12 months \nfor eligible dependant(s) \n21 y\nears of age and under \nOxygen Oxygen concentrators are \nco\nvered once every 60 \nmonths \nLess any eligible repair \nexpenses incurr\ned and \nclaimed during the \nprevious 60 months \nYes, additional medical \ndocumenta\ntion is required \nOxygen and equipment ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Miscellaneous Expense Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-miscellaneous-expense-benefit-4", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "miscellaneous-expense-benefit-4", + "marginal_note": "Miscellaneous Expense Benefit (part 4)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "needed for it\ns \nadministration are covered \nwhen required for home \nuse \nHyperbaric oxygen therapy \nis co\nvered for approved \nconditions \nDiabetic testing supplies $3,000 per calendar year Used for the treatment \nof diabet\nes, including \nneedles, syringes and \nchemical diagnostic aids. \nYes, additional medical \ndocumenta\ntion is required \nNeedles and syringes are \nnot eligible f\nor the \n36-month period following \nthe date of purchase of an \ninsulin jet injector device \nPSHCP Member booklet 45\nIs additional medical PSHCP reimburses Benefit Details documentation at 80% required? \nInsulin jet injector device $1,000 during a 36-month \nperiod \nNot applicable Yes, additional medical \ndocumenta\ntion is required \nInsulin pumps Once every 60 months Excluding repair or \nreplac\nement during the \n60-month period following \nthe date of purchase. \nYes, additional medical \ndocumenta\ntion is required \nDiabetic monitors $700 during a 60-month \nperiod, on a combined \nb\nasis \nExcluding repair or \nreplac\nement during the \n60-month period following \nthe dat\ne of purchase \nContinuous glucose \nmonitor\ns are covered for \npeople with Type I diabetes \nonly \nYes, additional medical \ndocumenta\ntion is required \nContinuous glucose \nmonitor supplies \n$3,000 per c\nalendar year Only covered for people \nwith Type I diabe\ntes \nYes, additional medical \ndocumenta\ntion is required \nBandages and surgical \ndressings \nF\nor each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nRequired for the treatment \nof an open wound or ulc\ner \nYes, additional medical \ndocumenta\ntion is required \nElasticized support \nst\nockings \nFor each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nManufactured to individual \npa\ntient specifications ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Miscellaneous Expense Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-miscellaneous-expense-benefit-5", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "miscellaneous-expense-benefit-5", + "marginal_note": "Miscellaneous Expense Benefit (part 5)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "or has a minimum \ncompression of 30 \nmillimeters \nYes, additional medical \ndocumenta\ntion is required \nElasticized apparel For each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nFor burn victims Yes, additional medical \ndocumenta\ntion is required \nPenile prosthesis implants For each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nExcluding those eligible \nunder the Gender \nAffirma\ntion Surgery Benefit \nYes, additional medical \ndocumenta\ntion is required \nNeedles and syringes $200 per calendar year For the administration of \ninject\nable prescription \ndrugs \nA prescription is valid for \n3 ye\nars \nYes, additional medical \ndocumenta\ntion is required \nPSHCP Member booklet 46 \nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nInjectable lubricants $600 per calendar year For joint pain and arthritis \n(viscosupplement \ninjec\ntions) \nA prescription is valid for \n3 ye\nars \nYes, additional medical \ndocumenta\ntion is required \nGender affirming care $75,000 per lifetime Includes coverage to \nsupport and affirm an \nindividual’s g\nender \nidentity. This benefit \nincludes gender affirming \ncare that is not covered by \nthe individual’s provincial \nor territorial health care \nplan. For members with \nSupplementary Coverage, \nthe care must be provided \nin Canada. For members \nwith Comprehensive \nCoverage, services must be \nprovided in the patient’s \ncountry of residence. \nTo be considered for \nco\nverage, a member or \ntheir eligible dependant(s) \nmust: \n\n- be aged 18 or older \n\n- be under the care of a \nphysician for g\nender \naffirmation \n\n- have all care considered \nmedically nec\nessary by \nthe attending physician \nor nurse practitioner \n\n- obtain prior approval \nby c", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Miscellaneous Expense Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-miscellaneous-expense-benefit-6", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "miscellaneous-expense-benefit-6", + "marginal_note": "Miscellaneous Expense Benefit (part 6)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "ompleting a \nGender Affirming Care \nApplication Form to be \ncompleted by both the \ncovered person and the \nattending physician or \nnurse practitioner and \nsubmitted to Canada Life \nfor review \nYes, additional medical \ndocumenta\ntion is required \nGender Affirming Care \nApplica\ntion Form (M7508) \nPSHCP Member booklet 47", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Miscellaneous Expense Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-additional-information-about-gender-affi-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "additional-information-about-gender-affi-1", + "marginal_note": "Additional information about gender affirming care (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Additional information about gender affirming care \nThe PSHCP includes gender affirming care coverage to support and affirm gender identity by providing help \nwith expenses for treatments not covered by provincial/territorial health insurance plans. \nThe below information is to help you plan your gender affirming care journey. This information is \ncontinually ev\nolving and does not detail all services that you may be eligible for under the PSHCP as this \nvaries depending on your place of residence. \nHow does it work? \n\n- Coverage is available for you and any eligible dependants aged 18 or older. \n\n- A lifetime maximum of $75,000 per person, reimbursed at 80%. \n\n- Coverage applies for services provided in your country of residence only. \n\n- Before applying for coverage under the PSHCP , you must check for coverage through your provincial or \nterritorial government health care plans. \n\n- You must obtain prior approval by completing the Gender Affirming Care Application Form (M7508). You \ncan find this form on the \nYour forms page of the PSHCP Member Services website (welcome.canadalife.\ncom/pshcp/forms) or c\nontact Canada Life to request that the form be sent to you by mail. It is to be \ncomplet\ned by both the covered person and the referring attending physician or nurse practitioner, then \nsubmitted to Canada Life for review. \n\n- If you are approved for coverage that requires multiple sessions, such as vocal therapy, you do not need to \nreapply for approval ahead of each session. In such cases, subsequent claims can be submitted to Canada \nLife for reimbursement without seeking prior approval. \n\n- Examples of gender affirming care that may be eligible for reimbursement under the PSHCP can include ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Additional information about gender affirming care”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-additional-information-about-gender-affi-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "additional-information-about-gender-affi-2", + "marginal_note": "Additional information about gender affirming care (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "facial feminization/masculinization; laryngoplasty; vocal cord surgery; hair transplants; brow bone \nreconstruction. This is not an exhaustive list of gender affirming care and additional care to support an \nindividual may be available. \nNext steps \n1. If you have not already, speak with your physician or nurse practitioner to assess whether provincial \nor territorial he\nalth insurance plans are available to you. \n2. Once you are ready to apply for coverage under the PSHCP , follow the steps below for completing the \nGender Affirming Care Application Form (M7508). \n\n- In the case where provincial or territorial support is offered, proof of funding received should \naccompany your Gender Affirming Care Application Form. This documentation will be used in the \nassessment of your eligible coverage under the PSHCP . \n\n- In the case where provincial or territorial support is not offered, proof of denial should accompany \nyour Gender Affirmation Procedure Application Form. If this documentation is not available, you \ncan indicate in the corresponding field on the Gender Affirming Care Application Form, that no \nsupport is available. \n3. Once received, Canada Life will assess your application form and communicate with you once a \ndecision has been made. To avoid delays in pr\nocessing and to ensure a prompt response, make sure \nall required documentation is provided, complete, and legible. \nPSHCP Member booklet 48 \nHow to fill out the Gender Affirming Care Application Form \n1. Visit the Your Forms page of the PSHCP Member Services website (welcome.canadalife.com/pshcp/\nforms) or c\nontact Canada Life to request that a form be sent to you by mail. \n2. Select the Health care coverage request forms and choose the Gender Affirming Care Application \nForm (M7508) ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Additional information about gender affirming care”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-additional-information-about-gender-affi-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "additional-information-about-gender-affi-3", + "marginal_note": "Additional information about gender affirming care (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "from the drop-down list. \n3. Complete the form as per the instructions provided in Part 1 of the form. \n4. Send in your completed form: \n\n- by submitting a pre-approval or claim estimate online by signing in to your PSHCP Member \nServices account (canadalife.com/pshcp) \n\n- through the mail by sending your completed application to: \nWinnipeg Benefit Payments \nPO Box 99451 \nStn Main Winnipeg MB R3C 1E6 \nFor more information, contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Additional information about gender affirming care”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-durable-equipment", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "durable-equipment", + "marginal_note": "Durable equipment", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Durable equipment \nEligible expenses are the rental or purchase of cost-effective durable equipment: \n\n- manufactured specifically for medical use \n\n- for use in the patient’s private residence, unless otherwise specified \n\n- approved by Canada Life for cost effectiveness and clinical value \n\n- designated as medically necessary \nReimbursement related to durable equipment will be limited to the cost of non-motorized equipment \nunless medically pro\nven that the patient requires motorized equipment. \nIn the tables below, where it is indicated that additional medical documentation is required, this may mean \njust a prescrip\ntion is required.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Durable equipment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-durable-equipment-for-care-devices-for-p", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "durable-equipment-for-care-devices-for-p", + "marginal_note": "Durable equipment – For care – Devices for physical movement", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Durable equipment – For care – Devices for physical movement \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \nat 80% Benefit De\ntails \nLift/hoist Once per lifetime Less all eligible lift/hoist \nrepair\ns incurred prior to \npurchase \nYes, additional medical \ndocumentation is r\nequired \nWalker Once per 60 months Less all eligible walker \nrepair\ns incurred during the \nprevious 60 months \nYes, additional medical \ndocumentation is r\nequired \nNot limited to use in \npatient’\ns private residence \nPSHCP Member booklet 49\nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nWheelchair (purchase and \nrepairs) \nOnce per 60 months Less any wheelchair \nrepairs incurred during the \nprevious 60 months \nReplacement of \nwheelchairs within the \n60-month limit shall be \npermitted when a patient’s \nmedical condition changes \nand warrants a different \ntype of chair. \nReimbursement will be \nthe eligible amount of \nthe new chair less the \namount reimbursed for the \npreviously claimed chair. \nIn the case of an eligible \ndependant, the 60-month \nmaximum may not \napply based on medical \nnecessity. Not limited to \nuse in patient’s private \nresidence. \nYes, additional medical \ndocumentation is required", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Durable equipment – For care – Devices for physical movement”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-durable-equipment-for-care-devices-for-s", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "durable-equipment-for-care-devices-for-s", + "marginal_note": "Durable equipment – For care – Devices for support and resting", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Durable equipment – For care – Devices for support and resting \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \nat 80% \nBenefit Details \nHospital beds Once per lifetime Less all eligible hospital \nbed repairs incurred prior \nto purchase \nYes, additional medical \ndocumentation is required \nTherapeutic mattress Once per 60 months Less all eligible therapeutic \nmattress repairs incurred \nduring the previous 60 \nmonths \nYes, additional medical \ndocumentation is required \nWheelchair cushions Once per 12 months Less all eligible wheelchair \ncushion repairs incurred \nduring the previous 12 \nmonths \nYes, additional medical \ndocumentation is required \nPSHCP Member booklet 50", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Durable equipment – For care – Devices for support and resting”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-durable-equipment-for-care-devices-for-m", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "durable-equipment-for-care-devices-for-m", + "marginal_note": "Durable equipment – For care – Devices for monitoring", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Durable equipment – For care – Devices for monitoring \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses at \n80% \nBenefit Details \nApnea monitors \nNote: This does not apply \nto CPAP or BiPAP monitors, \nwhich are eligible once per \n60 months. See Devices for \naerotherapeutic support. \nOnce per lifetime Less all eligible apnea \nmonitor repairs incurred \nprior to purchase \nYes, additional medical \ndocumentation is required \nBlood pressure monitor Once per 60 months Less all eligible blood \npressure monitor repairs \nincurred during the \nprevious 60 months \nYes, additional medical \ndocumentation is required \nEnuresis monitors Once per lifetime Less all eligible enuresis \nmonitor repairs incurred \nprior to purchase \nYes, additional medical \ndocumentation is required \nOxygen saturation meter Once per 60 months Less all eligible oxygen \nsaturation meter repairs \nincurred during the \nprevious 60 months \nYes, additional medical \ndocumentation is required \nPulse oximeter Once per 60 months Less all eligible pulse \noximeter repairs incurred \nduring the previous 60 \nmonths \nYes, additional medical \ndocumentation is required \nSaturometer Once per 60 months Less all eligible \nsaturometer repairs \nincurred during the \nprevious 60 months \nYes, additional medical \ndocumentation is required \nCoagulation monitor Once per 60 months Less all eligible coagulation \nmonitor repairs incurred \nduring the previous 60 \nmonths \nYes, additional medical \ndocumentation is required \nHeart monitor Once per 60 months Less all eligible heart \nmonitor repairs incurred \nduring the previous 60 \nmonths \nYes, additional medical \ndocumentation is required \nPSHCP Member booklet 51", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Durable equipment – For care – Devices for monitoring”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-durable-equipment-for-treatment-devices-", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "durable-equipment-for-treatment-devices-", + "marginal_note": "Durable equipment – For treatment - Devices for mechanical and therapeutic support", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Durable equipment – For treatment - Devices for mechanical and therapeutic support \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses at \n80% \nBenefit Details \nExtremity pump \n(lymphapress) \nOnce per lifetime Less all eligible extremity \npump repairs incurred \nprior to purchase \nYes, additional medical \ndocumentation is required \nInfusion pump Once per 60 months Less all eligible infusion \npump repairs incurred \nduring the previous 60 \nmonths \nYes, additional medical \ndocumentation is required \nTraction kit Once per lifetime Less all eligible traction kit \nrepairs incurred prior to \npurchase \nYes, additional medical \ndocumentation is required \nTranscutaneous electrical \nnerve stimulator (TENS) \nmachines \nOnce per 120 months Must be used for the \ncontrol of chronic pain \nLess all eligible TENS \nrepairs incurred during the \nprevious 120 months \nYes, additional medical \ndocumentation is required", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Durable equipment – For treatment - Devices for mechanical and therapeutic support”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-durable-equipment-for-treatment-devices--2-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "durable-equipment-for-treatment-devices--2-1", + "marginal_note": "Durable equipment – For treatment - Devices for aerotherapeutic support (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Durable equipment – For treatment - Devices for aerotherapeutic support \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \nat 80% \nBenefit Details \nCPAP , BiPAP or related \ndental appliance \nOnce per 60 months Less all eligible rentals and \npurchases of CPAP , BiPAP \nand dental appliances \nincurred during the \nprevious 60 months \nDental appliance only \neligible where a CPAP or \nBiPAP cannot be tolerated \nYes, additional medical \ndocumentation is required \nRepairs, servicing and \nreplacement parts for \neligible aerotherapeutic \ndevices (CPAP , BiPAP) \n$500 per calendar year Includes tubing, filters, \ncushions and masks \nYes, additional medical \ndocumentation is required \nCompressor Once per 60 months Less all eligible compressor \nrepairs incurred during the \nprevious 60 months \nYes, additional medical \ndocumentation is required \nNebulizer Once per 60 months Less all eligible nebulizer \nrepairs incurred during the \nprevious 60 months \nYes, additional medical \ndocumentation is required \nPSHCP Member booklet 52 \nExclusions \nNo benefit is payable for: \n\n- expenses for items purchased primarily for athletic use \n\n- expenses for ambulance services for a medical evacuation which are eligible under the Out-of-Province \nBenefit \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \n\n- durable equipment that is: \n\n- an accessory to an eligible device \n\n- a modification to the patient’s home (for example, bar, ramp, mat, elevator, etc.) \n\n- used for diagnostic or monitoring purposes except as specifically provided under eligible expenses \n\n- an implant, except as specifically provided under eligible expenses, and those eligible under the \nGender Affirmation Benefit \n\n- bathroom safety equipment \n\n- an air conditioner \n", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Durable equipment – For treatment - Devices for aerotherapeutic support”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-durable-equipment-for-treatment-devices--2-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "durable-equipment-for-treatment-devices--2-2", + "marginal_note": "Durable equipment – For treatment - Devices for aerotherapeutic support (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- ongoing supplies associated with durable equipment, except as specifically provided under eligible \nexpenses \n\n- durable equipment that is used to prevent illness, disease or injury \n\n- the use of a device for a treatment which Canada Life considers to be clinically experimental \n\n- the portion of charges which are payable under a provincial or territorial health insurance plan, or any \nprovincially or territorially sponsored program regardless of whether you and your eligible dependant(s) \nare participating in that program", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Durable equipment – For treatment - Devices for aerotherapeutic support”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-dental-benefit", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "dental-benefit", + "marginal_note": "Dental Benefit", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Dental Benefit \nEligible expenses are Reasonable and Customary Charges for oral surgery procedures or treatment(s) \nrequired due to an accidental injury.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Dental Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-lower-cost-alternative", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "lower-cost-alternative", + "marginal_note": "Lower-cost alternative", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Lower-cost alternative \nWhen 2 or more courses of treatment for an oral procedure or", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Lower-cost alternative”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-accidental-injury", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "accidental-injury", + "marginal_note": "Accidental injury", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "accidental injury are considered appropriate, \nthe PSHCP will limit the covered expenses to the more Reasonable and Customary Charges of the 2 \ntreatments. \nEligible expenses are the Reasonable and Customary Charges for the following services and", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Accidental injury”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-oral-surgical-procedures-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "oral-surgical-procedures-1", + "marginal_note": "Oral surgical procedures (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "oral surgical \nprocedures performed by a dentist. \nAccidental injury \nFor the expenses of a dental surgeon’s services and charges for a dental prosthesis required for the \ntreatment of a fractured jaw or for the treatment of accidental injuries to natural teeth are reimbursable by \nthe PSHCP . The fracture or injury must have been caused by an external, violent and accidental injury or \nblow and not associated with normal acts such as cleaning, chewing and eating. \nPSHCP Member booklet 53\nTreatment must occur within 12 months following the accident. In the case of an eligible dependant child \nunder 17 years of age, treatment must occur before they reach 18 years of age. A physician’s prescription \nis not required. This time limit may be extended if, as determined by Canada Life, the treatment could not \nhave been provided within the time frame specified. \nIf you are covered under the Public Service Dental Care Plan (PSDCP), the Pensioners’ Dental Services Plan, \nthe RCMP Dependants ’ Dental Care Plan or the CAF Dependants’ Dental Care Plan or, claims for expenses for \naccidental injury should first be submitted to the PSHCP . \nOral surgical procedures \nIf you are covered under the Public Service Dental Care Plan (PSDCP), the Pensioners’ Dental Services Plan, \nthe RCMP Dependants’ Dental Care Plan or the CAF Dependants’ Dental Care Plan, claims for expenses for \noral surgery should first be submitted to that plan. Any amount not covered by that plan may be submitted \nto the PSHCP . \nIn the tables below, where it is indicated that additional medical documentation is required, this may mean \njust a prescription is required. \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \nat 80% \nBenefit Details \nCysts, lesions and \nabscesses \nFor each member and their ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Oral surgical procedures”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-oral-surgical-procedures-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "oral-surgical-procedures-2", + "marginal_note": "Oral surgical procedures (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "eligible dependant(s) up \nto the Reasonable and \nCustomary Charges \n\n- Biopsy (incision, \nexcision) \n\n- Soft tissue lesion \n\n- Hard tissue lesion \n\n- Excision of cysts, benign \nlesions and ranulas \n\n- Incision and dr ainage of: \n\n- soft tissue (intra \noral) \n\n- bone (intra osseous) \n\n- periodontal abscess \nNo additional medical \ndocumentation is required \nGingival and alveolar \nprocedures \nFor each member and \ntheir eligible dependant(s) \nup to Reasonable and \nCustomary Charges \n\n- Alveoloplasty \n\n- Flap approach with: \n\n- curettage \n\n- osteoplasty \n\n- curettage and \nosteoplasty \n\n- Gingival curettage \n\n- Gingivectomy with or \nwithout cure ttage \n\n- Gingivoplasty \nNo additional medical \ndocumentation is required \nPSHCP Member booklet 54 \nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? \nRemoval of teeth or roots For each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \nRemoval of: \n\n- impacted teeth \n\n- root or foreign body from \nmaxillary antrum \n\n- r\noot resection \n(apicoec\ntomy) \n\n- anterior teeth \n\n- bicuspids \n\n- molars \nNo additional medical \ndocumenta\ntion is required \nFractures and dislocations For each member and their \neligible dependant(s) up \nto the \nReasonable and \nCustomary Charges \n\n- Open or closed reduction \nof a disloca\nted jaw \n(temporo-mandibular \njoint) \n\n- Treatment of mandible \nfrac\ntures using: \n\n- no reduction \n\n- closed reduction \n\n- open reduction \n\n- Treatment of maxillary or \nmalar frac\ntures using: \n\n- no reduction \n\n- closed reduction \n\n- open reduction \n\n- complicated open \nreduc\ntion \nNo additional medical \ndocumenta\ntion is required \nPSHCP Member booklet 55\nBenefit PSHCP reimburses \nat 80% Details \nIs additional medical \ndocumentation \nrequired? ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Oral surgical procedures”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-oral-surgical-procedures-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "oral-surgical-procedures-3", + "marginal_note": "Oral surgical procedures (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Other procedures For each member and their \neligible dependant(s) up \nto the Reasonable and \nCustomary Charges \n\n- Avulsion of nerve – supra \nor infra-orbital \n\n- Frenectomy of lip or \ncheek (labial or bucc al) \n\n- Tongue (lingual) \n\n- Repair of antro - oral \nfistula \n\n- Simple or complicated \nsialolithotomy \n\n- Sulcus deepening and \nridge reconstruction \n\n- Treatment of traumatic \ninjuries by: \n\n- repairing soft tissue \nlacerations \n\n- debridement, repair \nand suturing \n\n- Bone biopsy (torus) \nNo additional medical \ndocumentation is required \nExclusions \nNo benefit is payable for: \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \n\n- dental expenses, except those specifically provided under eligible expenses for treatment of accidental \ninjuries to natural teeth and oral surgical procedures", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Oral surgical procedures”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-out-of-province-benefit", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "out-of-province-benefit", + "marginal_note": "Out-of-Province Benefit", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Out-of-Province Benefit \nThe Out-of-Province Benefit consists of: \n\n-", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Out-of-Province Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-emergency-travel-assistance-services", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "emergency-travel-assistance-services", + "marginal_note": "Emergency Travel Assistance Services", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Emergency Travel Assistance Services \n\n- Referral Benefit \nThis benefit is for Supplementary Coverage only. Coverage is intended for you and your eligible \ndependant(s) if you live in Canada and are covered under a provincial or territorial health insurance plan. \nThe Emergency Benefit While Travelling and the Emergency Travel Assistance Services are managed by \nMSH International (MSH). MSH is a full-service travel assistance and Out-of-Province claims management \ncompany and provides the following services: \n\n- case management while in the hospital \n\n- air ambulance arrangement \nPSHCP Member booklet 56 \n\n- arrangement of billing and bill settlement \n\n- family assistance \n\n- return transportation \n\n- legal referrals \n\n- repatriation of remains \nThe Referral Benefit is managed by Canada Life. \nIf you have an eligible Out-of-Province claim, you must submit your claim to MSH through the MSH PSHCP \nMember Port\nal (pshcp-msh.ca) or by mail (see How to submit Comprehensive Coverage and Emergency \nTr\navel Assistance claims). \nEmergency Benefit While Travelling \nThe PSHCP covers you and your eligible dependant(s) for up to $1,000,000 (Canadian), reimbursed at 100%, \nin eligible medical expenses incurred due to an emergency while travelling on vacation or on business. \nReimbursement is based on Reasonable and Customary Charges in excess of the amount payable by a \npro\nvincial or territorial health insurance plan, if they are required for emergency treatment of an injury or \ndisease which occurs within 40 days from the date of departure from the province or territory of residence, \nexcluding any time out of the province for", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Emergency Travel Assistance Services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-official-travel-status-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "official-travel-status-1", + "marginal_note": "Official travel status (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "official travel status. \nEligible expenses \nEligible expenses are charges for: \n1. Public ward accommodation and auxiliary hospital services in a general hospital. \n2. Services of a physician. \n3. One-way economy airfare, or other means of transportation when air travel is not possible, for \nthe pa\ntient’s return to their province or territory of residence. Airfare for a professional attendant \naccompanying the member and their eligible dependant(s) is also included where medically \nrequired. \n4. Medical evaluation, which may include ambulance services, when suitable care, determined by MSH, \nis not av\nailable in the area where the emergency occurred. \n5. Family assistance benefits to a combined maximum of $5,000, reimbursed at 100%, for any one travel \nemerg\nency as follows: \n\n- The maximum payable for eligible dependant(s) under 16 years of age who are left unattended \nbecause you or your covered spouse or common-law partner is hospitalized, and an escort (if \nnecessary) is the cost of economy fare for return transportation. \n\n- Return transportation if a family member is hospitalized and as a result the family members are \nunable to return home on the originally scheduled travel and must purchase new return tickets. \nThe extra cost of the return fare is payable to a maximum of the cost of economy fare. \n\n- A visit of a relative if the family member is hospitalized for more than 7 days while travelling alone. \nThis includes economy return fare, and meals and accommodations in commercial lodging to a \ncombined maximum of $200 per day, reimbursed at 100%, for a spouse or common-law partner, \nparent, child or sibling. This benefit also covers expenses incurred if it is necessary to identify a \ndeceased family member prior to release of the body. \nPSHCP Member booklet 57\n", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Official travel status”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-official-travel-status-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "official-travel-status-2", + "marginal_note": "Official travel status (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- Meals and accommodations in commercial lodging if you and your eligible dependant(s) or a \ncovered dependant’s trip is extended due to hospitalization of a family member or physician \nimposed flight restrictions. The additional expenses incurred by accompanying family members for \naccommodations and meals are provided to a maximum of $200 per day, reimbursed at 100%. \n6. Return of the deceased in the event of death of a family member. The necessary authorizations will \nbe obtained, and arrangements made for the return of the deceased to the province or territory \nof residence. The maximum payable for the preparation and return of the deceased is $3,000, \nreimbursed at 100%. \nEmergency Travel Assistance Services \nIf emergency assistance is required, you and your eligible dependant(s) can access the MSH world-wide \nnetwork any time, contact \nMSH International. \nMSH will assist with: \n\n- transportation arrangements to the nearest hospital that provides the appropriate care or back to Canada \n\n- medical referrals, consultation and monitoring \n\n- legal referrals \n\n- a telephone interpretation service \n\n- a message collection service for family and business associates (messages will be held for up to 15 days) \n\n- advance payment on behalf of you and your eligible dependant(s) or a covered dependant for the \npayment of hospital and medical expenses \nTo arrange for advance payment of hospital and medical expenses, you must sign an authorization form \nallowing MSH to recover payment from the provincial or territorial health insurance plan. You must \nreimburse Canada Life for any payment made on your behalf which is more than the amount eligible for \nreimbursement under the provincial or territorial health insurance plan and the PSHCP . ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Official travel status”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-official-travel-status-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "official-travel-status-3", + "marginal_note": "Official travel status (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Assistance services are not available in countries of political unrest. The list of countries, maintained by \nCanada Life, will chang e according to world conditions. \nNeither Canada Life nor MSH is responsible for the availability, quality or result of the medical treatment \nreceived by you or your eligible dependant(s) or for the failure to obtain medical treatment. \nOfficial travel status \nMembers required to travel on official travel status for government business are covered under the \nEmergency Benefit While Travelling and the Emergency Travel Assistance Services during the entire period \nof their official travel status. Although there is no time limit to be on official travel status, the $1,000,000 \n(Canadian) benefit coverage limit still applies. \nIn addition to the supporting claim documentation outlined under the Emergency Out-of-Province Benefit, \nyou will be required to provide supporting information to establish official travel status where the date of \nservice is more than 40 days from the date of departure from the province or territory of residence. \nPSHCP Member booklet 58", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Official travel status”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-referral-benefit-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "referral-benefit-1", + "marginal_note": "Referral Benefit (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Referral Benefit \nThe Referral Benefit provides coverage for certain medical services that are not offered in your province or \nterritory of residence pending a written referral by your attending physician or nurse practitioner. \nThis means that you and your eligible dependants must physically leave your province or territory of \nresidenc\ne to obtain these services. Under this benefit, eligible expenses mean the Reasonable and \nCustomary Charges in excess of the amount payable by a provincial or territorial health insurance plan. \nIn the table below, where it is indicated that additional medical documentation is required, this may mean \njust a pr\nescription is required. You may also visit the Your forms page of the PSHCP Member Services \nwebsite (welcome.canadalife.com/pshcp/forms) \nor contact Canada Life to request that a form be sent to \nyou b\ny mail. \nIs additional medical \ndocumentation \nrequired? \nPSHCP reimburses \nat 80% Bene\nfit Details \nPublic ward \naccommodation and \nauxiliary hospital services \nin a general hospital \nUp to $25,000 combined \nfor e\nach illness or injury \nThe PSHCP pays for \nmedical tr\neatment not \navailable in your or your \neligible dependant(s)’ \nhome province or territory \nand performed when \nyou or your eligible \ndependant(s) physically \nleave the province or \nterritory of residence, \nwhen referred by a licensed \nattending physician or \nnurse practitioner \nYes, additional medical \ndocumenta\ntion is required \nPhysician or surgeon \nservic\nes \nLaboratory services \nExclusions \nNo benefit is payable for: \n\n- expenses incurred outside your or your eligible dependant(s)’ province or territory of residence if they \nare required for the emergency treatment of an injury or disease that occurred more than 40 days after ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Referral Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-referral-benefit-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "referral-benefit-2", + "marginal_note": "Referral Benefit (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "the date of departure from the province or territory of residence, except as provided for those who are on \nofficial travel status \n\n- expenses incurred by you or your eligible dependant(s) if you are temporarily or permanently residing \noutside Canada \n\n- expenses for the regular treatment of an injury or disease that existed prior to your or your eligible \ndependant(s’) departure from your province or territory of residence \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \nPSHCP Member booklet 59", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Referral Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-supplementary-hospital-provision-in-cana", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "supplementary-hospital-provision-in-cana", + "marginal_note": "Supplementary Hospital Provision (in Canada)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Supplementary Hospital Provision (in Canada) \nThis provision provides reimbursement for Reasonable and Customary Charges, up to specified amounts, \nfor hospital room and board charges in excess of standard ward charges for each day of hospitalization. The \nlevel of coverage chosen will determine the maximum amount that may be reimbursed and will also have \nan impact on your monthly PSHCP contributions. \nLevel I \nIncluded for all members \nLevel II \nOptional upgrade \nLevel III \nOptional upgrade \nUp to $90 a day, reimbursed at 100% Up to $170 a day, reimbursed at \n100% \nUp to $250 a day, reimbursed at \n100% \nExclusions \nNo benefit is payable for: \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \n\n- co-insurance charges or similar charges for hospital care that go above charges payable by a provincial or \nterritorial government health or hospital insurance plan \n\n- personal charges such as televisions and telephones \n\n- expenses incurred when a patient is occupying an acute care hospital bed but has been medically \ndischarged and no longer requires acute care", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Supplementary Hospital Provision (in Canada)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-comprehensive-hospital-provision-outside", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "comprehensive-hospital-provision-outside", + "marginal_note": "Comprehensive Hospital Provision (outside Canada)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Comprehensive Hospital Provision (outside Canada) \nCoverage under this provision forms part of Comprehensive Coverage and is mandatory for employees \ndeployed or posted outside Canada, including members of the Canadian Armed Forces (CAF) and Royal \nCanadian Mounted Police (RCMP). \nCoverage under this provision is not available to pensioners living outside Canada. \nIts purpose is to provide equivalent hospital coverage protection, as much as possible, to that available to \nmembers living in Canada with provincial or territorial hospital health care. \nEligible expenses \nEligible expenses are the Reasonable and Customary Charges for each day of hospitalization in a general \nhospital, a hospital of the CAF or the armed forces of a foreign country. Reasonable and Customary Charges \nare reimbursed at 100% for the following eligible expenses: \n\n- standard ward accommodation \n\n- nursing services when provided by the hospital \n\n- diagnostic radiographs, lab services and other diagnostic procedures \n\n- drugs prescribed and administered in hospital by any attending physician \n\n- use of operating and delivery rooms, anesthetic and surgical supplies \nPSHCP Member booklet 60 \n\n- services by any person paid by the hospital \n\n- use of speech therapy facilities \n\n- diet counselling services \n\n- out-patient drugs, items and services provided by a hospital \nExclusions \nNo benefit is payable for: \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \n\n- co-insurance charges or similar charges for hospital care that go above charges payable by a provincial or \nterritorial government health or hospital insurance plan \n\n- a person insured under a non-government group hospital insurance plan administered in a foreign \ncountry that provides hospital expense benefits similar to those provided under the Ontario Health \nInsurance Act, 1972, as amended from time to time", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Comprehensive Hospital Provision (outside Canada)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-basic-health-care-provision-for-all-memb", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "basic-health-care-provision-for-all-memb", + "marginal_note": "Basic Health Care Provision (for all members with Comprehensive Coverage)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Basic Health Care Provision (for all members \nwith Comprehensive Coverage) \nThe provision is available only if you reside outside Canada and are not covered under a provincial or \nterritorial health insurance plan. \nIts purpose is to provide coverage for services, reimbursed at 100%, as close as possible to coverage \nindividuals residing in Canada r eceive under a provinciar territorial health insurance plan. Hospital services \nare excluded. \nThe maximum eligible expense for these services is equal to three times the amount payable based on the \ncurrent fee schedule under the Health Insurance Act 1972 of Ontario. \nEligible expenses \nThe eligible expenses include: \n\n- services of a physician including: \n\n- physician’s services in the participant’s home, the physician’s office, clinic or in a hospital \n\n- diagnosis and treatment of illness and injury \n\n- 1 annual health examination \n\n- treatment of fractures and dislocations \n\n- surgery, including surgery performed by a Doctor of Podiatric Medicine (DPM) when performed in the \nUnited States of America \n\n- administration of anaesthetics \nPSHCP Member booklet 61\n\n- X-rays for diagnostic and treatment purposes \n\n- obstetrical care, including prenatal and postnatal care \n\n- laboratory services and clinical pathology when ordered by and performed under the direction of a \nphysician \n\n- optometrist services \n\n- physiotherapist services \n\n- ambulance services \n\n- chiropractor, osteopath or podiatrist services \nExclusions \nNo benefit is payable for: \n\n- expenses incurred under any of the conditions listed under General exclusions and limitations \n\n- physical services provided by a salaried employee of a hospital. An employee posted outside Canada may \nbe reimbursed for these expenses under the Hospital (outside Canada) Provision", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Basic Health Care Provision (for all members with Comprehensive Coverage)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-how-to-submit-a-supplementary-coverage-c-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "how-to-submit-a-supplementary-coverage-c-1", + "marginal_note": "How to submit a Supplementary Coverage claim (excluding Emergency Travel Assistance claims) (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to submit a Supplementary Coverage claim (excluding \nEmergency Travel Assistance claims) \nThere are 4 ways to submit your claims to Canada Life: \n\n- directly through a registered pharmacy or paramedical provider \n\n- online through your PSHCP Member Services Account \n\n- through your My Canada Life at Work TM mobile app \n\n- by mail using a paper claim form \nHow to submit a claim through your pharmacy or provider \nSubmitting claims through your pharmacist \nWhen submitting a prescription for prescription drugs, prescription drug supplies and eligible medical \nsupplies t\no your pharmacy in Canada, present your PSHCP benefit card so that the pharmacy may submit \nthe claim directly to Canada Life on your behalf and your claim will be processed in real-time. You will \nremain responsible to pay any ineligible expenses and the co-payment, unless you and your spouse/ \ncommon-law partner are both eligible and have coordinated your benefits with the same plan, or another \nplan (see Co-payment an Co-ordination of benefits). \nNote that if the PSHCP benefit card is not used at the pharmacy when purchasing prescription drugs, you \nmay p\nay a higher price than is eligible under the PSHCP . \nSubmitting claims through your provider (paramedical) \nRegistered providers with access to online Provider eClaims may submit claims on your behalf to Canada \nLif\ne through electronic transfer. This means Canada Life will pay providers directly, which helps reduce \nyour immediate out-of-pocket expenses as you are only responsible for the co-payment and the ineligible \nexpenses the PSHCP does not reimburse (see Co-payment). \nPSHCP Member booklet 62 \nIf your provider is eligible and registered for eClaims, present your PSHCP benefit card to them to submit \nyour claim in real time. ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “How to submit a Supplementary Coverage claim (excluding Emergency Travel Assistance claims)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-how-to-submit-a-supplementary-coverage-c-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "how-to-submit-a-supplementary-coverage-c-2", + "marginal_note": "How to submit a Supplementary Coverage claim (excluding Emergency Travel Assistance claims) (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "For the full list of providers registered for eClaims, sign in to your PSHCP Member Services account \n(canadalife.com/pshcp) and select Find a Provider. \nIf your provider is not registered for eClaims, you can still submit your claim digitally through your PSHCP \nMember Servic\nes account (canadalife.com/pshcp) or send it by paper, in the mail. Details for both are below. \nHow to submit a claim digitally (for expenses incurred in Canada) \nOnce you have completed positive enrolment and registered for a PSHCP Member Services account \n(canadalife.com/pshcp), you can submit claims digitally through the PSHCP Member Services website or \nMy Canada Life a\nt Work app. \nTo submit a claim digitally: \n1. Sign in to your PSHCP Member Services account ( canadalife.com/pshcp) or the My Canada Life at \nWork app. \n2. Selec\nt Submit a claim (or select Make a claim if you are using the mobile app). \n3. Choose the appropriate claim type and follow the steps to complete the claim. \nHow to submit a paper claim (for expenses incurred in Canada) \nTo submit a paper claim: \n1. Print, complete legibly, and sign the In-Canada Expenses Claim Form (M635D) or the Non-\nEmerg\nency Out of Country Expenses Claim Form M7518 found on the Your forms page of the PSHCP \nMember Services website at (welcome.canadalife.com/pshcp/forms) \nor call Canada Life to request \nthat a f\norm be sent to you by mail. If your form was incomplete or illegible, your form will be returned \nto you by mail, within 3 weeks, and a new form will need to be resubmitted to Canada Life. \n2. Mail the form to the address indicated on the form along with the originals of the supporting \ndocumenta\ntion (original receipts, bills, invoices, physician or practitioner statements, and/or ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “How to submit a Supplementary Coverage claim (excluding Emergency Travel Assistance claims)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-how-to-submit-a-supplementary-coverage-c-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "how-to-submit-a-supplementary-coverage-c-3", + "marginal_note": "How to submit a Supplementary Coverage claim (excluding Emergency Travel Assistance claims) (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "questionnaires, etc.). Keep a copy for your own files, Canada Life will not return original receipts after \nclaims are processed. \nWhen filing a claim under the coordination of benefits provision you must also include any claim statements \nrec\neived from another benefit plan(s). \nIf you require a paper copy of a blank claim form, contact Canada Life to request that one be sent to you by \nmail. A blank claim form is also included with y\nour mailed explanation of benefits statement.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “How to submit a Supplementary Coverage claim (excluding Emergency Travel Assistance claims)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-how-to-submit-comprehensive-coverage-and-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "how-to-submit-comprehensive-coverage-and-1", + "marginal_note": "How to submit Comprehensive Coverage and Emergency Travel Assistance claims (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to submit Comprehensive Coverage and Emergency Travel Assistance claims \nThere are 2 ways to submit your claims to MSH \n\n- online through your MSH PSHCP Member Portal \n\n- by mail using a paper claim form \nPSHCP Member booklet 63\nHow to submit a claim online (for expenses incurred outside Canada) \nTo submit a claim to MSH, you must first complete positive enrolment with Canada Life and provide \nconsent for the use of y\nour personal information to process your claims. This information will be securely \ntransferred to MSH on your behalf so that you may set up your MSH PSHCP Member Portal account. \nNote, non-urgent claims incurred within Canada, as well as claims under the Referral Benefit, will be \nprocessed b\ny Canada Life. See How to submit a Supplementary Coverage claim (excluding Emergency \nTrav\nel Assistance claims). \nHow to submit a claim online (for expenses incurred outside Canada) \n1. Ensure you have completed your registration for your MSH PSHCP Member Portal ( pshcp-msh.ca). \n\n- Note: This is a separate registration from your PSHCP Member Services account ( canadalife.com/\npshcp). See \nHow to create an MSH PSHCP Member Portal account. \n2. Sign in to your account through the MSH PSHCP Member Portal ( pshcp-msh.ca). \n3. Select New Claim in the Submit Claim area. \n4. Follow the prompts to submit the claim ensuring that you complete the payment preference form \nand upload all requir\ned documentation; receipts and proof of payment. \nHow to submit a paper claim (for expenses incurred outside Canada) \nTo submit a paper claim: \n1. Download, complete legibly, and sign either the Comprehensive Claims Incurred Outside of Canada \nClaim Form M7517 \nor the Emergency Benefit While Travelling Claim Form M7519 found on the ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “How to submit Comprehensive Coverage and Emergency Travel Assistance claims”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-how-to-submit-comprehensive-coverage-and-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "how-to-submit-comprehensive-coverage-and-2", + "marginal_note": "How to submit Comprehensive Coverage and Emergency Travel Assistance claims (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Your forms page of the PSHCP Member Services website at (welcome.canadalife.com/pshcp/\nforms) or c\nontact MSH to request a form by mail. If your form was incomplete or illegible, your form \nwill be returned t\no you by mail, within 3 weeks of receipt by MSH, and a new form will need to be \nresubmitted to Canada Life. \n2. Mail the form to the address indicated on the form along with the originals of the supporting documentation \n(original receip\nts, bills, invoices, physician or practitioner statements, and/or questionnaires, etc.). Keep a \ncopy for your own files, MSH will not return original receipts after claims are processed.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “How to submit Comprehensive Coverage and Emergency Travel Assistance claims”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-which-claims-to-submit-to-canada-life-or", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "which-claims-to-submit-to-canada-life-or", + "marginal_note": "Which claims to submit to Canada Life or to MSH", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Which claims to submit to Canada Life or to MSH \nSubmit the following claims to Canada Life Submit the following claims to MSH \nNon-emergency claims for expenses incurred within \nCanada for all PSHCP members. \nEmergency Travel Assistance claims for members \nwith Supplementary Coverage ( pshcp.ca/coverage/\nsupplementary-coverage). These ar\ne the eligible \nmedical expenses incurr\ned as a result of an emergency \nwhile travelling on vacation or on business while outside \nthe province or territory of residence. \nNon-emergency claims for expenses incurred outside \nof Canada for members with \nSupplementary Coverage \n(pshcp.ca/coverage/supplementary-coverage). \nAll claims for expenses incurred outside of Canada for \nmembers with Compr\nehensive Coverage ( pshcp.ca/\ncoverage/comprehensive-coverage). \nPSHCP Member booklet 64", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Which claims to submit to Canada Life or to MSH”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-claim-submission-deadline", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "claim-submission-deadline", + "marginal_note": "Claim submission deadline", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Claim submission deadline \nClaims must be received by Canada Life and MSH no later than December 31 of the year following the \ncalendar year in which the expenses were incurred. For example, if you incurred expenses in July 2024, you \nhave until December 31, 2025, to submit your claim. Some exceptions may apply, see the PSHCP Directive \n(njc-cnm.gc.ca/directive/d9/en).", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Claim submission deadline”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-co-ordination-of-benefits-information-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "co-ordination-of-benefits-information-1", + "marginal_note": "Co-ordination of benefits information (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Co-ordination of benefits information \nCo-ordination of benefits \nIf you are covered under more than one health care plan, either as a member or a dependant, co-ordination \nof benefits allows you to make a claim under all your plans to receive up to 100% in reimbursement. \nHow reimbursements are calculated \nBased on a set of rules established by the Canadian Life and Health Insurance Association, the first plan \ncalculates your reimbursement based on its rules. You may then submit a claim to the second plan. See \nOrder matters when coordinating a claim. \nIf your claim is eligible under the second plan, you will be reimbursed for the lesser of the following: \n\n- The amount it would have paid if it had been the first payer. \n\n- 100% of the eligible expenses less the amount reimbursed by the first payer. \nThe total reimbursement cannot exceed 100% of the eligible expenses. \nExample: You pay $150 for expenses eligible under both plans. \nNote: For the examples, assume that the $150 is within the Reasonable and Customary Charges and the \nmaximum has no\nt been reached. \nExample: You pay $150 for expenses not eligible under the first plan but the expenses are eligible under the \nsec\nond plan. \nPSHCP Member booklet 65\nEligible \nexpenses \nReimbursement \nper\ncentage Your plans Calculation Your reimbursement \nFirst plan $150 80% $150 X 80% = $120 $120 \nSecond plan $150 80% ($150 - $0) X 80% = $120 $ 30 \n(lesser of the 2) $150 - $120 = $30 \nTotal reimbursement $150 \nEligible \nexpenses \nReimbursement \nper\ncentage Your plans Calculation Your reimbursement \nFirst plan $0 80% $0 X 80% = $0 $0 \nSecond plan $150 80% $150 X 80% = $120 $ 120 (lesser of the 2) \n$150 - $0 = $150 \nTotal reimbursement $120 \nOrder matters when coordinating your claims ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Co-ordination of benefits information”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-co-ordination-of-benefits-information-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "co-ordination-of-benefits-information-2", + "marginal_note": "Co-ordination of benefits information (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "To help you determine in which order to submit your claims, follow the steps found in the scenario that \nmatches your current situation. If multiple scenarios match your situation, please start with the scenario \nthat appears first in the list below. If there is any unpaid amount, submit a claim to the next plan on the list. \nWork your way down the list as applicable. \nI am married or have a common-law partner and we each have a workplace benefit plan \n1. Your own benefits plan. \n2. Your spouse or common-law partner’s plan. \nNote: Your spouse or common-law partner’s claims should be submitted to their own plan first. \nI am married or have a common-law partner and we are submitting a claim for our child \n1. Plan of the parent whose birth month and day falls earlier in the calendar year. \n2. Other parent’s plan. \nI have joint custody of my children. My ex and I are each remarried or have a common-law partner. \n1. Plan of parent whose birth month and day falls earlier in the calendar year \n2. Plan of the second parent. \n3. Plan of the spouse or common-law partner of the parent whose birthday comes first. \n4. Plan of the spouse or common-law partner of the second parent. \nI have sole custody of my children. My ex and I are each remarried or have a common-law partner. \n1. Plan of the parent with sole custody. \n2. Plan of the spouse or common-law partner of the parent with sole custody. \n3. Plan of the second parent. \n4. Plan of the spouse or common-law partner of the second parent. \nI am a full-time student with coverage through my school and through my job. I am also considered an \neligible dependant under my par\nent’s plan. \n1. Your student or work plan, whichever one you received coverage with first. ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Co-ordination of benefits information”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-co-ordination-of-benefits-information-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "co-ordination-of-benefits-information-3", + "marginal_note": "Co-ordination of benefits information (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "2. Your student or work plan, whichever one you received coverage with second. \n3. Your parent’s plan. \nException: If you are a Quebec resident submitting a prescription drug claim, submit to your student plan \nlast\n. \nI have 2 jobs and have health benefits coverage with both \n1. Plan of the full-time job. \n2. Plan of the part-time job. \nNote: If you work the same type of hours at both jobs, or have 2 part-time jobs, submit to the plan of the job \nwhere y\nou started working first. \nPSHCP Member booklet 66 \nI have a retiree plan and a plan at my new job \n1. Plan of your new job. \n2. Retiree plan. \nIMPORTANT \nDuring positive enrolment, you must inform Canada Life about any other health benefit plans that you and \nyour spouse or common-law partner may have (for example, through another employer). \nIf the other coverage is with Canada Life, you will need the other plan’s details (i.e. plan number and \ncertifica\nte/ID number). \nIf you wish to add, amend or remove coordination of benefits information after you have completed \npositive enrolment, you may update your information through your PSHCP Member Services account \n(canadalife.com/pshcp). To learn more about coordination of benefits Co-ordination of benefits (pshcp.ca/\nclaims/coordination-of-benefits).", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Co-ordination of benefits information”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-explanation-of-benefits-statement", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "explanation-of-benefits-statement", + "marginal_note": "Explanation of benefits statement", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Explanation of benefits statement \nOnce your claim is processed, your explanation of benefits statement from Canada Life or MSH will be \navailable online in your PSHCP Member Services account or will be sent to you by mail, based on your \ncommunication preferences. \nThe explanation of benefits statement provides details on how your claim was processed and what you are \nreimbursed f\nor under the PSHCP .", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Explanation of benefits statement”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-overpayments", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "overpayments", + "marginal_note": "Overpayments", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Overpayments \nAdministrative error: In situations where you were reimbursed more than what was eligible under the \nPSHCP , Canada Life is authorized to recover the overpayment. You will be advised of the overpayment and \nasked how you would like to reimburse the amount. \nYou may choose one of the following: \n\n- by cheque for the amount of the overpayment \n\n- by deduction from future claims \nIf you do not acknowledge the overpayment and inform Canada Life of what you would like to do within 30 \ndays, Canada Life will automa\ntically deduct the overpayment from future claim reimbursements. \nAdjudication Error: In situations where an adjudication error is made or an adjudication decision is \nrev\nersed based on additional information, the Plan Administrator will not recover the overpayment from \nthe member, but will advise the member in writing that these expenses will no longer be reimbursed.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Overpayments”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-canada-life-claim-related-escalation", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "canada-life-claim-related-escalation", + "marginal_note": "Canada Life claim-related escalation", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Canada Life claim-related escalation \nYou have the right to escalate a denial of all or part of your claim if you submit a request within 12 months \nfrom the date Canada Life completed the initial assessment of your claim or estimate or predetermination. \nCanada Life prefers that escalations are submitted in writing. However, if you wish to submit an escalation \nover the phone, supporting document\ns or medical information must be provided for the review. \nPSHCP Member booklet 67\nEach request must include why you: \n\n- disagree with the claim decision \n\n- believe the claim is eligible \nIf you are not satisfied with the decision of this initial escalation, you may escalate your request a second \ntime in writing by sending Canada Life all the claim de\ntails and any additional information for review.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Canada Life claim-related escalation”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-appeals", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "appeals", + "marginal_note": "Appeals", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Appeals \nThe appeals process is available to you if you do not agree with a decision regarding your claim or coverage. \nA submission can be made to the Appeals Committee of the PSHCP Administration Authority within 12 \nmonths of the date seen on your explanation of benefits statement, which informed you that your claim was \ndenied. \nHowever, prior to submitting an appeal to the PSHCP Administration Authority ( pshcp.ca/appeals), you \nshould first e\nxhaust all avenues of review and escalation with Canada Life, if your appeal is claim-related, \nor with your departmental compensation office, Pay Centre or Pension Centre, if your appeal is coverage-\nrelated, to attempt to resolve the issue. In addition, review the PSHCP Directive ( njc-cnm.gc.ca/directive/\nd9/en) t\no determine if your claim is eligible under the PSHCP . \nPSHCP Administration Authority appeals \nIf you wish to request an appeal by the PSHCP Administration Authority, you may send a written submission \nto: \nPSHCP Adminis\ntration Authority \nPO Box 2245 Station “D” \nOttawa ON K1P 5W4", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Appeals”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-canada-life", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "canada-life", + "marginal_note": "Canada Life", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Canada Life \nCall the PSHCP Member Contact Centre \n\n- North America (toll-free): 1-855-415-4414, Monday to Friday from 8 am to 5 pm, your local time \n\n- International (collect): 1-431-489-4064 \nDeaf or hard of hearing access to a telecommunications relay service \n\n- TTY to Voice: 771 \n\n- Voice to TTY: 1-800-855-0511 \nSecure online chat \nSign in to your PSHCP Member Services account through My Canada Life at Work TM (canadalife.com/pshcp) \nand go to the Contact Us page. \nPSHCP Member booklet 68 \nSecure email \nSign in to your PSHCP Member Services account through My Canada Life at Work TM (canadalife.com/pshcp) \nand go to the Contact Us page to email Canada Life.", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Canada Life”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-msh-international", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "msh-international", + "marginal_note": "MSH International", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "MSH International \nPhone the Emergency Travel Assistance Services and Comprehensive \nCoverage Contact Centre (24 hours a day, 7 days a week) \n\n- North America (toll-free): 1-833-774-2700 \n\n- International (collect): 1-365-337-7427 \nOnline: \nVisit the MSH PSHCP Member Portal ( pshcp-msh.ca). \nKnow your PSHCP representation \nAs the PSHCP is a negotiated plan at the PSHCP Partners Committee, should you wish to provide your views, \ncomment\ns and suggestions to your representative, contact your respective Bargaining Agent or the National \nAssocia\ntion of Federal Retirees ( federalretirees.ca/en/at-a-glance/contact-us).", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “MSH International”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-government-of-canada-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "government-of-canada-1", + "marginal_note": "Government of Canada (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Government of Canada \nFor current employees \nFor more information on registration, eligibility coverage, benefits and pay deductions for Hospital Level II \nand III, contact your departmental compensation office, Pay Centre or Pension Centre. The Pay Centre can \nassist with redirecting your inquiry to the appropriate compensation unit. \nTelephone numbers for the Public Service Pay Centre \n\n- In Canada or the United States: 1-855-686-4729 \n\n- Outside of Canada and the United States: 1-506-424-4330 \n\n- Hours of operation: Monday to Friday, 7 am to 7 pm Eastern Time \nFor Pensioners \nFor more information on registration, monthly contributions, pension deductions, eligibility requirements \nand making changes to your level of coverage, contact your departmental compensation office, Pay Centre \nor Pension Centre. \nPSHCP Member booklet 69\nPublic Service \npensioners and \nretired members of \nParliament \nAddress: \nGovernment of Canada \nPension Centre - Mail \nFacility \nPO Box 8000 \nMatane, QC G4W 4T6 \nOffice hours for telephone \ninquiries: \nIn Canada: \nMonday to Friday 8 am to \n4 pm (your local time) \nCalls from outside Canada: \nMonday to F\nriday 8 am to \n5 pm (Atlantic Time) \nTelephone numbers: \nIn Canada and the Unit\ned \nStates\n: \n1-800-561-7930 (toll-free) \nLocal calls: \n506-533-5800 \nOutside North America: \n506-533-5800 (collect calls \nac\ncepted) \nTDD services for the deaf: \nCollect calls accepted for \nTDD calls only: \n1-506-533-5990 \nF\nax: \n418-566-6298 \nEmail: \nPWGSC.PensionCentre-\nCentredespensions. \nTPSGC@pwgsc\n-tpsgc. \ngc.ca \nRoyal Canadian \nMounted Police \n(RCMP) retired \nmembers \nAddress: \nRCMP – Specialized \nServices Division \nMain Building – 2nd floor, \nwing 2200 \n120 Parkdale Avenue \nOttawa, ON K1A 9Z9 \nOffice hours for telephone \nenquiries: \nMonday to Friday 8 am to ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Government of Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-government-of-canada-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "government-of-canada-2", + "marginal_note": "Government of Canada (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "4 pm (your local time) \nTelephone number\ns: \n1-855-502-7090 (toll-free) \nOutside Canada: \n506-533-5800 (collect calls \nac\ncepted) \nTDD services for the deaf: \nCollect calls accepted for \nTDD calls only: \n1-506-533-5990 \nEmail: \nsheenc\nadreurassurance-\nshecoachinsuranc\ne. \nPWGSC@tpsgc-pwgsc. \ngc.ca \nCanadian Armed \nForces retired \nmembers \nAddress: \nPSHCP Canadian Forces \nOffice \nDirector, Accounts \nProcessing, Pay and \nPensions \nNational Defense \nHe\nadquarters \n101 Colonel By Drive \nOttawa, ON K1A 0K2 \nOffice hours for telephone \ninquiries: \nIn Canada: \nMonday to Friday 8 am to \n4 pm (Eas\ntern Time) \nTelephone numbers: \nIn Canada: \n1-800-267-0325 \nLocal calls (National \nCapital Region): \n613-946-1093 \nOut\nside Canada: \n613-946-1093 (collect calls \nac\ncepted) \nTDD services for the deaf: \nCollect calls accepted for \nTDD c\nalls only: \n1-506-533-5990 \nTelephone teletype (TTY): \n1-855-255-9935 \nEmail: \npensioncentrecaf. \ncentredespensionsfac@ \ntp\nsgc-pwgsc.gc.ca \nJudges Act retired \nmembers \nAddress: \nOffice of the Commissioner \nfor Federal Judicial A\nffairs \n99 Metcalfe Street \n8th Floor \nOttawa, ON K1A 1E3 \nOffice hours for telephone \ninquiries: \nIn Canada: \nMonday to Friday 8:30 am \nto 5 pm (Eas\ntern Time) \nTelephone numbers: \nLocal calls (National \nCapital Region): \n613-995-5140 \nT\noll-free: \n1-877-583-4266 \nTDD services for the deaf: \nCollect calls accepted for \nTDD c\nalls only: \n1-506-533-5990 \nPSHCP Member booklet 70", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Government of Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-1", + "marginal_note": "Definitions (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Definitions \nAcupuncturist ( acupunct eur): A person licenced or certified as an acupuncturist in the province or territory \nwher\ne they render services or a person with comparable qualifications as determined by Canada Life. \nAdministrative Services Only Contract ( c ontrat de services administratifs seulement): The contract between \nthe Go\nvernment of Canada and Canada Life setting out the services to be provided by Canada Life in respect \nof the PSHCP , as amended from time to time. \nAudiologist ( audiologist e): A person who is a member or is qualified to be a member of the provincial or \nt\nerritorial college or association, or in the absence of such registry, a person with comparable qualifications \nas determined by Canada Life. \nBiologic drug ( médic\nament biologique): A prescription drug made from living organisms or its products and \nis used in the pr\nevention, diagnosis or treatment of a medical condition and approved by Health Canada. \nBiosimilar drug ( médic ament biosimilaire): A prescription drug that has been approved by Health Canada \nwhich is highly similar t\no its reference biologic counterpart drug. \nCalendar year ( année civile ): January 1 to December 31. \nCAF\n(FAC): Canadian Armed Forces. \nChildr\nen’s Benefit (prestation pour enfants): An ongoing benefit payable pursuant to any of the relevant acts \nlis\nted in Schedule IV of the Plan Directive. \nChiropodist ( chir opodiste): A person licensed by the appropriate provincial or territorial licensing authority \nor in those pr\novinces or territories where there is no licensing authority, members of the Canadian \nAssociation of Foot Professionals, or in the absence of such association, a person with comparable \nqualifications as determined by Canada Life. ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-2", + "marginal_note": "Definitions (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Chiropractor (chir opraticien): A member of the Canadian Chiropractic Association or of a provincial or \nt\nerritorial association affiliated with it, or in the absence of such association, a person with comparable \nqualifications as determined by Canada Life. \nChronic disease (maladie chronique): A condition that exists beyond the usual course of an acute disease or \nbe\nyond a reasonable time for tissue damage to heal. Any condition that lasts longer than 6 months may be \nconsidered chronic. \nCommon-law partner ( c\nonjoint de fait): A person with whom a member is cohabiting in a conjugal \nr\nelationship for a period of at least 1 year. \nCommunity nursing station (poste de soins infirmiers communautaire): An outpatient clinic, centre or \nf\nacility which offers the services of a nurse who provides health care. \nCompendium of Pharmaceuticals and Specialties (CPS) ( Compendium des pr oduits et spécialités \npharmaceutiques [CPS]): The reference manual, as amended from time to time, containing information \nabout pr\noducts intended for human use, which is compiled annually and produced by the Canadian \nPharmacists Association for the benefit of health professionals. \nPSHCP Member booklet 71\nCoordination of benefits (COB) ( c oordination des prestations [CoP]): A provision designed to eliminate \nduplic\nate payments and to provide the sequence in which coverage will apply when a plan member is \ncovered under 2 or more benefit plans. The Canadian Life and Health Insurance Association (CLHIA) benefit \ncoordination guidelines, as amended from time to time, which are recognized by the majority of insurance \ncompanies, have been adopted for the Public Service Health Care Plan (PSHCP), if unresolved by such \nguidelines, in accordance with the rules made by the PSHCP Administration. ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-3", + "marginal_note": "Definitions (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Co-p\nayment (c o-assurance): The proportion of eligible expenses not reimbursed by the PSHCP , which \nr\nemains the responsibility of the plan member. \nDentist\n(dentiste): A person licensed to practice dentistry by the provincial or territorial licensing authority, \nor in the absenc\ne of such authority, a person with comparable qualifications as determined by Canada Life. \nDependant (personne à charge): A plan member’s spouse or common-law partner, a dependant child of a \nmember or the dependant child of the member\n’s spouse or common-law partner. \nDependant child (enfant à charge): A person who is a child of a plan member or the member’s spouse \nor c\nommon-law partner, including a child for whom the member, the member’s spouse or common-law \npartner stands in loco parentis, provided such person is one of the following: \n\n- under 21 years of age \n\n- under 25 years of age and attending an accredited school, college or university on a full-time basis \n\n- a person over 20 or 24 years of age who was a dependant child as defined above when they became \nincapable of engaging in self-sustaining employment by reason of mental or physical impairment, and is \nprimarily dependent upon the member for support and maintenance \nDeputy Head (administrateur général): Has the meaning given that expression in the Public Service \nEmplo\nyment Act and includes the Commissioner of the Royal Canadian Mounted Police (RCMP). \nDesignat\ned Officer (agent désigné ): Compensation or pension officer or advisor responsible for receiving \nand ac\ntioning application requests upon verification of eligibility. \nDietitian\n(diététiste): A person who is an expert in identifying and treating or preventing disease-related \nmalnutrition c", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-4", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-4", + "marginal_note": "Definitions (part 4)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "onditions and/or conducting medical nutrition therapy including the provision of consultative \nnutritional services and who is professionally licensed or certified in the province or territory where they \nrender services or a person with comparable qualifications as determined by Canada Life. \nDurable equipment ( appar\neil durable): An eligible device that does not achieve any of its primary intended \nhe\nalth purposes by chemical action or by being metabolized. \nElectr\nologist (électr olyste): A person who, as determined by Canada Life, qualifies as a certified \nelec\ntrologist. \nEmploy\nee (employé): An employee is one of the following: \n\n- A person who holds an office or position, or performs services for which the remuneration is payable out \nof the Consolidated Revenue Fund of Canada or by an agent of His Majesty in right of Canada. \n\n- A person designated by the Treasury Board of Canada as being eligible to join the Public Service Health \nCare Plan (PSHCP) as listed in Schedule III of the Plan Directive, as amended from time to time by the \nTreasury Board of Canada. \nPSHCP Member booklet 72 \n\n- A person who is an employee of a participating employer as listed in Schedule I of the Plan Directive, as \namended from time to time by the Treasury Board of Canada. \n\n- A person who is a member of a civilian component of the forces of a state that is a party to the North \nAtlantic Treaty Status of Forces Agreement, 1949 who is serving in Canada. \nEmployer (employeur): The Treasury Board of Canada. \nExplanation of benefits (EOB) (relevé des prestations): Also referred to as the “Claim Statement” , Canada \nLif\ne’s written explanation which provides details about a health care insurance claim that has been ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-5", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-5", + "marginal_note": "Definitions (part 5)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "processed. The EOB details the services and/or products that were submitted, and it explains what portion \nwas paid by the PSHCP and what portion of the payment, if any, is the plan member’s responsibility. In the \ncase of a point-of-sale transaction at the pharmacy, the pharmacy receipt is considered the EOB. \nFamily member\n(membre de la f amille): A plan member or a covered eligible dependant(s). \nFee guide\n(guide des tarifs): For services provided by dentists, refers to charges established by the provincial \nor t\nerritorial dental association in the province or territory in which the expense is incurred or, in the \nabsence of such association, comparable considering Reasonable and Customary Charges, as determined \nby Canada Life. \nGeneric drug (médicament générique): A prescription drug that has the same active-ingredient formula, \namount and in a similar dosag\ne as a brand name drug. \nHospit\nal (hôpital): A legally licensed hospital which provides facilities for diagnosis, major surgery, and the \nc\nare and treatment of a person suffering from disease or injury on an in-patient basis, with 24-hour services \nby nurses and physicians. A hospital also is a legally licensed hospital providing specialized treatment for \nmental illness, drug and alcohol addiction, cancer, arthritis, and convalescing or chronically ill persons. This \ndoes not include nursing homes, homes for the aged, rest homes or other places providing similar care. \nHospit\nalized/hospitalization (hospitalisé/hospitalisation): Admitted to a hospital for in-patient treatment. \nLactation consultant (consultant en lactation): A person who specializes in breastfeeding/chestfeeding \nand tr\nained to recognize and prevent or solve breastfeeding/chestfeeding difficulties with a recognized ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-6", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-6", + "marginal_note": "Definitions (part 6)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "certification or a person with comparable qualifications as determined by Canada Life. \nLife\ntime maximum ( maximum r emboursable à vie): The maximum dollar amount the PSHCP agrees to pay \non behalf of a p\narticipant for an identified covered service or product during the participant’s lifetime. \nLo\nwest cost alternative (médicament de substitution le moins coûteux): The lowest priced drug that has \nbeen pr\noven to provide effective treatment for a specific disease. \nMaintenanc\ne drug (médicament d’entretien): Prescription medications commonly used to treat conditions \ntha\nt are considered chronic or long-term. These conditions usually require regular use of medications. \nMassage ther\napist (massothérapeute): A person licensed by the appropriate provincial or territorial \nlic\nensing body or, in the absence of a provincial or territorial licensing body, a person with comparable \nqualifications as determined by Canada Life. \nMember (participant): A member is one of the following: \n\n- An employee or a pensioner who has applied for and has been granted coverage under the PSHCP by a \ndesignated officer \nPSHCP Member booklet 73\n\n- A member of the CAF or the RCMP who has applied for and has been granted coverage for their eligible \ndependant(s) under the PSHCP \n\n- An individual who is a member of the VAC client group as defined in Schedule III of the Plan Directive who \nhas applied for and has been granted coverage under the PSHCP \nMember of the Canadian Armed Forces (CAF) (membre des Forces armées canadiennes [FAC]): A person who \nis one of the f\nollowing: \n\n- A member of the regular armed force of the CAF \n\n- A member of the CAF, other than a member of the regular force, and as an individual or as a member of a ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-7", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-7", + "marginal_note": "Definitions (part 7)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "class, has been designated by the Treasury Board of Canada as a member of the forces for the purposes of \nthis Plan Document \n\n- A member of the forces of a state that is a party to the North Atlantic Treaty Status of Forces Agreement, \n1949 who is serving in Canada \nMinister (Ministre): The President of the Treasury Board of Canada. \nMonth (mois): The period of time from a date in 1 calendar month to the same date in the following \nc\nalendar month. \nNational Associa\ntion of Federal Retirees (Association nationale des retraités fédéraux): An association of \nf\nederal retirees representing all pensioner members of the PSHCP at the Partners Committee. \nNational Joint Council (NJC)\n(Conseil national mixte [CNM]): National Joint Council, a consultative body \nes\ntablished pursuant to Treasury Board Minute T .272382B of March 1945, providing regular consultation \nbetween the government and employee organizations certified as bargaining agents on common employee \nissues. \nNatur\nopath (naturopathe): A member of the Canadian Naturopathic Association or any provincial or \nt\nerritorial association affiliated with it, or in the absence of such association, a person with comparable \nqualifications as determined by Canada Life. \nNurse\n(infirmier): A registered nurse, registered nursing assistant, registered practical nurse, licensed \npr\nactical nurse or certified nursing assistant who is listed on the appropriate provincial or territorial registry \nand, in the absence of such registry, a nurse with comparable qualifications as determined by Canada Life. \nNurse pr\nactitioner ( infirmier pr acticien): A registered nurse who has additional education and nursing \ne\nxperience, who is listed on the appropriate provincial or territorial registry and, in the absence of such ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-8", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-8", + "marginal_note": "Definitions (part 8)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "registry, a nurse with comparable qualifications as determined by Canada Life. \nOccup\national therapist ( er gothérapeute): A person who is a member or is qualified to be a member of the \nr\nelevant provincial or territorial college or association, or in the absence of such registry, a person with \ncomparable qualifications as determined by Canada Life. \nOphthalmologist\n(ophtalmologiste): A person licensed to practice ophthalmology and registered with the \nappr\nopriate provincial or territorial association or registry, or in the absence of such association, a person \nwith comparable qualifications as determined by Canada Life. \nPSHCP Member booklet 74 \nOptometrist (optométriste): A member of the Canadian Association of Optometrists or of a provincial or \nt\nerritorial association associated with it, or in the absence of such association, a person with comparable \nqualifications as determined by Canada Life. \nOst\neopath (ostéopathe): A person licensed to practice osteopathic medicine by the appropriate provincial \nor t\nerritorial body, or in the absence of a provincial or territorial licensing body, a person with comparable \nqualifications as determined by Canada Life. \nParticip\nant (per sonne protégée): A person covered under the PSHCP . \nParticip\nating employer (employeur participant): A Board, commission, corporation or other portion of the \nf\nederal public administration, which is specified in Schedule I of the Plan Directive, as amended from time \nto time by the Treasury Board of Canada. \nPa\ntient Support Program (programme de soutien aux patients): A program that may be available that aids \na P\nSHCP member to get coverage for a drug, service or supply listed on Canada Life’s list of drugs, services \nand supplies for which prior authorization is or is not necessary. ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-9", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-9", + "marginal_note": "Definitions (part 9)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Partner\ns Committee ( Comit é des partenaires): The committee established by the President of the Treasury \nBo\nard of Canada, comprised of representatives of the Employer, that portion of the National Joint Council \nof the Public Service that represents the employees, and an individual appointed by the National Joint \nCouncil who represents the pensioners. \nPension\n(pension): A recognized ongoing pension benefit, an eligible dependant(s)’s benefit or a children’s \nbenefit pur\nsuant to any Acts listed in Schedule IV of the Plan Directive, as amended from time to time by the \nTreasury Board of Canada. \nPensioner\n(retraité): A person who is in receipt of a recognized ongoing benefit, an eligible dependant(s)’s \nbenefit or a childr\nen’s benefit pursuant to any Acts listed in Schedule IV of this Plan Document, as amended \nfrom time to time by the Treasury Board of Canada. \nPharmacist\n(pharmacien): A person who is licensed to practice pharmacy and whose name is listed on the \npharmacis\nts’ registry of the licensing body for the jurisdiction in which such person is practicing. \nPhysician (médecin): A Doctor of Medicine (M.D.) legally licensed to practice medicine. \nPhysiother\napist (physiothér apeute): A member of the Canadian Physiotherapy Association or of a provincial \nor t\nerritorial association affiliated with it, or in the absence of such association, a person with comparable \nqualifications as determined by Canada Life. \nPlan (Régime): The Public Service Health Care Plan. \nPlan Administr\nator (Administrateur du Régime): For the purposes of this Plan Directive, the organization \nc\nontracted to adjudicate and pay claims under an Administrative Services Only Contract with the \nGovernment of Canada in accordance with the Plan Directive and/or direction from the PSHCP ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-10", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-10", + "marginal_note": "Definitions (part 10)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Administration Authority. \nPodia\ntrist (podiatr e): A person licensed by the appropriate provincial or territorial licensing authority or in \nthose pr\novinces or territories where there is no licensing authority, members of the Canadian Association \nof Foot Professionals, or in the absence of such association, a person with comparable qualifications as \ndetermined by Canada Life. \nPSHCP Member booklet 75\nPSHCP Administration Authority or Administration Authority (Administration du RSSFP ou Administration): \nThe corporation without share capital whose mandate is to oversee the administration of the PSHCP . \nThe P\nSHCP Administration Authority ensures that Canada Life delivers benefits efficiently and effectively \nto PSHCP members in accordance with the Plan provisions. The PSHCP Administration Authority is \naccountable to the Partners Committee. \nPsy\nchologist (psychologue): A permanently certified psychologist who is listed on the appropriate \npr\novincial or territorial registry in the province or territory where the service is rendered, or in the absence \nof such registry, a person with comparable qualifications as determined by Canada Life. \nPsy\nchotherapist/registered counsellor (psychothérapeute/ conseiller autorisé): A person licensed by the \nappr\nopriate provincial or territorial licensing authority, or in the absence of such association, a person with \ncomparable qualifications as determined by Canada Life who specializes in the use of counselling or an in-\ndepth form of talk therapy. \nPSHCP\n(RSSFP): Public Service Health Care Plan. \nReasonable and Customary Charges (frais habituels et raisonnables [H&R]): That amount which is usually \nchar\nged to a person without coverage, and which does not exceed the general level of charges for the ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-definitions-11", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "definitions-11", + "marginal_note": "Definitions (part 11)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "specific service or product in the geographic location where the expense is incurred, as determined by \nCanada Life. Published Fee Guides of national, provincial or territorial associations of practitioners will be \nconsulted for this purpose where applicable. \nRe\nasonable treatment (traitement raisonnable): A treatment that is accepted by the Canadian medical \npr\nofession, proven to be effective; and, of a form, intensity, frequency, and/or duration essential to the \ndiagnosis or management of the disease or injury. \nRemuner\nation (rémunération): Includes salary, wages, pay and allowances, pension, annual allowance, \nsessional allo\nwance and annuity. \nRCMP (GRC ): Royal Canadian Mounted Police. \nSocial work\ner (travailleur/travailleuse social): A person who is listed on the appropriate provincial or \nt\nerritorial registry in the province or territory where the service is rendered, or in the absence of such \nregistry, a person with comparable qualifications as determined by Canada Life. \nSpeech language p\nathologist (orthophoniste): A person who is a member or is qualified to be a member of \nthe Canadian Speech and He\naring Association or any provincial or territorial association affiliated with it, or \nin the absence of such registry, a person with comparable qualifications as determined by Canada Life. \nSurviv\nor Benefit (prestation de survivant): An ongoing pension benefit payable pursuant to any of the \nr\nelevant acts listed in Schedule IV of the Plan Directive. \nPSHCP Member booklet 76", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-summary-of-maximum-eligible-expenses-1", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "summary-of-maximum-eligible-expenses-1", + "marginal_note": "Summary of maximum eligible expenses (part 1)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Summary of maximum eligible expenses \nMaximum eligible expense per \nparticipant \nMaximum \nreimbur\nsement Reimbursement \nExtended Health Provision as indicated below \nDrug Benefit \nCatastrophic Drug \nCov\nerage \nEligible drug expenses in excess of \n$3,500 out-of\n-pocket drug expense \nincurred in a given calendar year \n100% \nSmoking cessation aids $2,000 in a lifetime 80% $1,600 ($2,000 x 80%) \nErectile dysfunction drugs $500 every calendar year 80% $400 ($500 x 80%) \nDispensing fee Maximum of $8 for the pharmacy \ndispensing fee \nThe f\nee cap does not apply to biologic \nor compound drugs. \n80% -\nDispensing F\nee Frequency \nLimit \nPharmacist dispensing fees will \nbe limited t\no 5 times per year for \nmaintenance drugs. \n- 5 refills \nExceptions shall be granted if \na. the drug is a controlled substance, \nb. the drug has a manufacturer \nrec\nommended storage limitation, or \nc. the prescribed drug’s three-month \nsupply co\n-pay is more than $100. \nVision Care Benefit \nEyeglasses/contact lenses \n(purchase and r\nepairs) \n$400 every 2 calendar years \ncommencing e\nvery odd year \nNo limit if required as a result of \nsurg\nery or accident and purchased \nwithin 6 months of the event \n80% $320 ($400 x 80%) \nEye examination 1 examination every 2 calendar years, \ncommencing e\nvery odd year \n80% R&C[1] x 80% \nArtificial eye Once in 60 months 80% R&C[1] x 80% \nIn case of dependant children 21 years \nof age or less, 12 months of the las\nt \npurchase \nCorrective laser eye \nsurg\nery \n$2,000 per lifetime 80% $1,600 ($2,000 x 80%) \nPSHCP Member booklet 77\nMedical Practitioners Benefit \nServices of a(n): \nAcupuncturist $500 in a calendar year 80% $400 ($500 x 80%) \nChiropractor $500 in a calendar year 80% $400 ($500 x 80%) \nDietitian $300 in a calendar year 80% $240 ($300 x 80%) ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Summary of maximum eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-summary-of-maximum-eligible-expenses-2", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "summary-of-maximum-eligible-expenses-2", + "marginal_note": "Summary of maximum eligible expenses (part 2)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Electrologist (including \ntreatment when performed \nb\ny a physician) \n$1,200 in a calendar year 80% $960 ($1,200 x 80%) \nLactation consultant $300 in a calendar year 80% $240 ($300 x 80%) \nMassage therapist $500 in a calendar year 80% $400 ($500 x 80%) \nNaturopath $500 in a calendar year 80% $400 ($500 x 80%) \nNursing services $20,000 in a calendar year 80% $16,000 ($20,000 x \n80%) \nOccupational therapist $300 in a calendar year 80% $240 ($300 x 80%) \nOsteopath $500 in a calendar year 80% $400 ($500 x 80%) \nPhysiotherapist $1,500 in a calendar year 80% $1,200 ($1,500 x 80%) \nPodiatrist and chiropodist \n(including foot care \nr\nendered by a nurse in \na community nursing \nstation) \n$500 in a calendar year (combined) 80% $400 ($500 x 80%) \nPsychological services \n(including the services \nof psychologist\ns, \npsychotherapists, social \nworkers, and counsellors) \n$5,000 in a calendar year (combined) 80% $4,000 ($5,000 x 80%) \nSpeech language \npathologist and audiologist \n$750 in a c\nalendar year (combined) 80% $600 ($750 x 80%) \nMiscellaneous Expense Benefit \nOrthopaedic shoes $250 in a calendar year 80% $200 ($250 x 80%) \nOrthotics (including \nrepairs) \n1 pair in a c alendar year 80% R&C[1] x 80% \nHearing aids (purchase/ \nrepairs) \n$1,500 less any eligible hearing aid \ne\nxpenses incurred and claimed during \nthe previous 60 months \nNo limit if r\nequired as a result of \nsurgery or accident and pur\nchased \nwithin 6 months of the event \n80% $1,200 ($1,500 x 80%) \nMaximum eligible expense per \nparticipant Reimbursement Maximum \nreimbursement \nExtended Health Provision as indicated below \nPSHCP Member booklet 78 \nMaximum eligible expense per \nparticipant Reimbursement Maximum \nreimbursement \nExtended Health Provision as indicated below ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Summary of maximum eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-summary-of-maximum-eligible-expenses-3", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "summary-of-maximum-eligible-expenses-3", + "marginal_note": "Summary of maximum eligible expenses (part 3)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Batteries for hearing aids $200 in a calendar year 80% $160 ($200 x 80%) \nOrthopaedic brassieres $200 in a calendar year 80% $160 ($200 x 80%) \nWigs $1,500 during a 60-month period 80% $1,200 ($1,500 x 80%) \nPermanent artificial limbs \n(to replace temporar\ny \nartificial limbs) \nOnce in 60 months for a member or \ndependant over 21 years of ag\ne \nThe frequency maximum may not \napply if medically proven that gr\nowth \nor shrinkage of surrounding tissue \nrequires replacement of the existing \nprosthesis \n80% R&C\n[1] x 80% \nDiabetic testing supplies $3,000 in a calendar year 80% $2,400 ($3,000 x 80%) \nExcept needles and syringes are not \neligible for the 36-month period \nfollowing the date of pur\nchase of an \ninsulin jet injector device \nInsulin Jet Injector Device $1,000 during a 36-month period 80% $800 ($1,000 x 80%) \nInsulin pumps Once in 60 months 80% R&C[1] x 80% \nExcluding repair or replacement during \nthe 60-month period following the \ndate of purchase \nDiabe\ntic monitors $700 during a 60-month period, on a \ncombined basis \n80% $560 ($700 x 80%) \nExcluding rep\nair or replacement during \nthe 60-month period following the \ndate of purchase \nContinuous gluc\nose \nmonitor supplies \n$3,000 in a calendar year 80% $2,400 ($3,000 x 80%) \nNeedles and syringes \n(f\nor the administration of \ninject\nable drugs) \n$200 in a calendar year 80% $160 ($200 x 80%) \nInjectable lubricants (for \njoint pain) \n$600 in a calendar year 80% $480 ($600 x 80%) \nGender affirming car\ne $75,000 in a lifetime 80% $60,000 ($75,000 x \n80%) PSHCP Member booklet 79\nMaximum eligible expense per \nparticipant Reimbursement Maximum \nreimbursement \nExtended Health Provision as indicated below \nDurable equipment \nA. For care \nDevices for physical movement \nLift/hoist Once in a lifetime ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Summary of maximum eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-summary-of-maximum-eligible-expenses-4", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "summary-of-maximum-eligible-expenses-4", + "marginal_note": "Summary of maximum eligible expenses (part 4)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Less all eligible lift/hoist repairs \nincurred prior to purchase \n80% R&C\n[1] x 80% \nWalker Once in 60 months \nLess all eligible walker repair expenses \nincurred during the previous 60 \nmonths \n80% R&C\n[1] x 80% \nWheelchair (purchase or \nrepairs) \nOnce in 60 months \nLess any wheelchair e\nxpenses claimed \nfor repairs during the pre\nvious \n60 months \nIn case of dependant children, the \n60-month maximum may not apply for \nmedical necessity \nReplac\nement of wheelchairs within \nthe 60 month limit shall be permitted \nwhen a patient’s medic\nal condition \nchanges and warrants a different \ntype of chair. Reimbursement will be \nthe eligible amount of the new chair \nless the amount reimbursed for the \npreviously claimed chair. \n80% R&C\n[1] x 80% \nDevices for support and resting \nHospital bed Once in a lifetime \nLess all eligible hospital bed repairs \nincurred prior to purchase \n80% R&C[1] x 80% \nTherapeutic mattress Once in 60 months \nLess all eligible therapeutic mattress \nrepairs incurred during the pre\nvious 60 \nmonths \n80% R&C[1] x 80% \nWheelchair cushion Once in 12 months \nLess all eligible wheelchair cushion \nrepairs incurred during the pre\nvious \n12 months \n80% R&C[1] x 80% \nPSHCP Member booklet 80 \nMaximum eligible expense per \nparticipant Reimbursement Maximum \nreimbursement \nExtended Health Provision as indicated below \nDevices for monitoring \nApnea monitor Once in a lifetime \nLess all eligible apnea monitor repairs \nincurred prior to purchase \n80% R&C[1] x 80% \nBlood pressure monitor Once in 60 months \nLess all eligible blood pressure \nmonitor repairs incurred during the \npre\nvious 60 months \n80% R&C[1] x 80% \nEnuresis monitor Once in a lifetime \nLess all eligible enuresis monitor \nrepairs incurred prior to purchase \n80% R&C[1] x 80% ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Summary of maximum eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-summary-of-maximum-eligible-expenses-5", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "summary-of-maximum-eligible-expenses-5", + "marginal_note": "Summary of maximum eligible expenses (part 5)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Oxygen saturation meter Once in 60 months \nLess all eligible oxygen saturation \nmeter repairs incurred during the \npr\nevious 60 months \n80% R&C[1] x 80% \nPulse oximeter Once in 60 months \nLess all eligible pulse oximeter repairs \nincurred during the previous 60 \nmonths \n80% R&C\n[1] x 80% \nSaturometer Once in 60 months \nLess all eligible saturometer repairs \nincurred during the previous 60 \nmonths\n80% R&C\n[1] x 80% \nCoagulation monitor Once in 60 months \nLess all eligible coagulation monitor \nrepairs incurred during the previous 60 \nmonths \n80% R&C\n[1] x 80% \nHeart monitor Once in 60 months \nLess all eligible heart monitor repairs \nincurred during the previous 60 \nmonths \n80% R&C\n[1] x 80% \nB. For treatment \nDevices for mechanical and therapeutic support \nExtremity pump \n(Lymphapress) \nOnce in a lifetime \nLess all eligible e\nxtremity pump repairs \nincurred prior to purchase \n80% R&C[1] x 80% \nInfusion pump Once in 60 months \nLess all eligible infusion pump repairs \nincurred during the previous 60 months \n80% R&C\n[1] x 80% \nPSHCP Member booklet 81\nMaximum eligible expense per \nparticipant Reimbursement Maximum \nreimbursement \nExtended Health Provision as indicated below \nTraction kit Once in a lifetime \nLess all eligible traction kit repairs \nincurred prior to purchase \n80% R&C[1] x 80% \nTranscutaneous Electric \nStimulator (TENS) \nOnce in 120 months \nL\ness all eligible TENS repairs incurred \nduring the previous 120 months \n80% R&C[1] x 80% \nDevices for aerotherapeutic support \nCPAP , BiPAP , or related \ndental appliance \nOnce in 60 months \nLess all eligible r\nentals and purchases \nof CPAP , BiPAP and dental applianc\ne \nincurred during the previous 60 \nmonths \n80% R&C[1] x 80% \nRepairs, servicing, and \nreplacement parts f\nor \neligible aerotherapeutic ", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Summary of maximum eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-summary-of-maximum-eligible-expenses-6", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "summary-of-maximum-eligible-expenses-6", + "marginal_note": "Summary of maximum eligible expenses (part 6)", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "devices (CPAP , BiPAP) \n$500 in a calendar year 80% $400 ($500 x 80%) \nCompressor Once in 60 months \nLess all eligible compressor repairs \nincurred during the previous 60 \nmonths \n80% R&C\n[1] x 80% \nNebulizer Once in 60 months \nLess all eligible nebulizer repairs \nincurred during the previous 60 \nmonths \n80% R&C\n[1] x 80% \nOut-of-Province Benefit \nEmergency Benefit While \nTravelling/ Emer\ngency \nTravel Assistance Services \n$1,000,000 per period of travel (not \nexceeding 40 consecutiv\ne days, \nexcluding any time out of the province \nfor official travel status) \n100% $1,000,000 (CAD) \nFamily Assistance Benefit $5,000 for any one travel emergency 100% $5,000 \nMeals and \naccommodations \n$200 per day (for all c\nombined costs) 100% $200 \nPreparation and return of \nthe deceased \n$3,000 100% $3,000 \nReferr\nal Benefit $25,000 per illness or injury 80% $20,000 ($25,000 x \n80%) \nHospital Provision \nLevel I $90 per day 100% $90 \nPSHCP Member booklet 82 \nLevel II $170 per day 100% $170 \nLevel III $250 per day 100% $250 \nBasic Health Care Provision 3 times the amount otherwise payable \nunder the current fee schedule of \nthe Health Insurance Act 1972 of Ontario \n100% \nMaximum eligible expense per \nparticipant Reimbursement Maximum \nreimbursement \nExtended Health Provision as indicated below \n[1] Reasonable and Customary", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Summary of maximum eligible expenses”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSHCP-length-of-time-a-prescription-is-valid", + "doc_type": "benefits", + "act_code": "PSHCP", + "act_short": "PSHCP", + "act_name": "Public Service Health Care Plan — Member Booklet", + "section": "length-of-time-a-prescription-is-valid", + "marginal_note": "Length of time a prescription is valid", + "part": "Public Service Health Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Length of time a prescription is valid \nBenefit Duration of prescription \nServices of a nurse 1 year, unless otherwise advised by the Plan \nAdministrator \nServices of an electrologist 3 years \nA prescription is not required if electrolysis is required as \na gender affirming care procedure. \nOrthotics 3 years \nOrthopaedic shoes 1 year \nInjectable lubricants for joint pain and arthritis 3 years \nNeedles and syringes (for the administration of \ninjectable drugs) \n3 years \nNote: Unless otherwise requested by the Plan Administrator, all other prescriptions do not have a time limit. \nPSHCP Member booklet 83\n79-02396-06/24 June 2024", + "history": "", + "last_amended": "", + "current_to": "June 2024", + "citation": "PSHCP Member Booklet (June 2024), “Length of time a prescription is valid”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/pshcp/PSHCP-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-the-public-service-dental-care-plan-psdc", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "the-public-service-dental-care-plan-psdc", + "marginal_note": "The Public Service Dental Care Plan (PSDCP)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "The Public Service Dental Care Plan (PSDCP) is an employer-paid \ndental plan for eligible employees of the federal public service, \nincluding the eligible dependant(s) of the Royal Canadian Mounted \nPolice (RCMP), the eligible dependant(s) of the Canadian Armed Forces \n(CAF), participating employers, members of certain designated groups \nand their eligible dependant(s).\nThe purpose of this PSDCP Member Booklet is to provide you and \nyour eligible dependant(s) with information about joining the PSDCP , \nyour PSDCP membership, benefits, exclusions and limitations, claims \nmanagement and contact information.\nThis booklet is not a substitute for the PSDCP Rules (canada.ca/en/\ntreasury-board-secretariat/topics/benefit-plans/plans/dental-care-\nplan/rules-dental-care-plan-public-service-canada ), which provides \nthe complete terms and conditions of the PSDCP . Where there is a \ndiscrepancy between this booklet and the PSDCP Rules, the PSDCP \nRules will apply.\nThe Public Service Dental Care Plan (PSDCP)\nThe PSDCP provides reimbursement for certain dental services \nnecessary to prevent or correct dental disease or defect if the services \nare consistent with generally accepted dental practices. The services \nmust be performed by a dental provider licensed or otherwise \nauthorized in accordance with the applicable law to practice in the \njurisdiction in which the services are received.\nThe PSDCP reimburses eligible expenses on a Reasonable and \nCustomary basis, subject to limitations identified in the PSDCP Rules \n(canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/\ndental-care-plan/rules-dental-care-plan-public-service-canada ).\n6 \nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “The Public Service Dental Care Plan (PSDCP)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-governance-of-the-psdcp-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "governance-of-the-psdcp-1", + "marginal_note": "Governance of the PSDCP (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Governance of the PSDCP\nThe governance framework of the PSDCP is made up of the following entities. Each plays a role in ensuring \nthe proper administration of the PSDCP .\nGovernment of Canada\nThe Government of Canada, as plan sponsor, is responsible for the oversight and management of the \nPSDCP . The Government of Canada assumes full liability for the payment of all expenses related to the \noperation of the PSDCP and the payment of eligible claims. The cost of the PSDCP is fully paid by the \nEmployer except in certain Leave Without Pay (LWOP) situations.\nThe Boards of Management\nThe Boards of Management are mandated to resolve member appeals related to claims and eligibility, \nmonitor the performance of the plan administration, oversee the plan’s financial information and provide \nfeedback on plan design.\nThe PSDCP has 4 boards of management representing their respective members. Each board is comprised \nof Employer and bargaining agent/member representatives.\nThe Public Service Dental Care Plan Boards of Management are:\n\n- National Joint Council (NJC) Component for employees represented by the bargaining agents of the NJC, \nall unrepresented and excluded employees except employees represented by Public Service Alliance of \nCanada (PSAC)\n\n- PSAC Component for employees represented by PSAC\n\n- Canadian Armed Forces (CAF) Component for the dependants of the Regular Force members and the \nReserve Force members\n\n- Royal Canadian Mounted Police (RCMP) Component for dependants of the RCMP and Civilian Members \nCanada Life\nThe PSDCP is administered by The Canada Life Assurance Company (Canada Life). On behalf of the \nGovernment of Canada, the administrator’s role is to process claims, answer benefit inquiries in accordance ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Governance of the PSDCP”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-governance-of-the-psdcp-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "governance-of-the-psdcp-2", + "marginal_note": "Governance of the PSDCP (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "with the PSDCP Rules (canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/dental-\ncare-plan/rules-dental-care-plan-public-service-canada ), and provide services as specified in the PSDCP \nAdministrative Services Only Contract.\nDepartmental compensation office or Public Service Pay Centre\nThe departmental compensation office or Public Service Pay Centre (Pay Centre) is responsible for \nconfirming member eligibility to the PSDCP and informing Canada Life of the effective date of coverage for \nall new and existing employees. Your departmental compensation office or Pay Centre will also provide \ninstructions, collect contributions and process payments related to Leave Without Pay (LWOP).\n7\nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Governance of the PSDCP”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-eligibility-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "eligibility-1", + "marginal_note": "Eligibility (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Eligibility\nTo become a member of the PSDCP , you must meet the eligibility requirements described in the PSDCP \nRules (canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/dental-care-plan/rules-\ndental-care-plan-public-service-canada ).\nEligible employee\n\n- an indeterminate employee\n\n- seasonal employee\n\n- full-time term employee appointed for more than 6 months or who has completed 6 months of \ncontinuous employment\n\n- part-time employee whose assigned work week is more than 1/3 of the normal work week for a full-\ntime employee of the same occupational group\n\n- an excluded or unrepresented employee\n\n- an executive\n\n- an employee of a number of participating employers\n\n- a member of the Royal Canadian Mounted Police (RCMP) (only eligible dependant(s) are covered)\n\n- a civilian member of the RCMP\n\n- a member of the Canadian Armed Forces (CAF) (only eligible dependant(s) are covered)\n\n- a member of the Canadian Armed Forces (CAF) Primary Reserve (consult your unit orderly room)\n\n- members of Parliament, Senators and their staff\n\n- the Governor General and Lieutenant Governors\nEligible dependants\n\n- your spouse\n\n- your common-law partner, the person you are cohabiting with in a conjugal relationship for a period of at \nleast 1 calendar year (12 months)\nNote: If you have both a legal spouse and a common-law partner, you can cover only one. The PSDCP \nwill only cover the person you include in your positive enrolment . During separation, a married spouse \nmay remain on the PSDCP . A divorced spouse cannot be covered under the PSDCP . Upon divorce or the \nend of a common-law partnership, it is your responsibility to notify the plan administrator and your \ndepartmental compensation officer or the Pay Centre to avoid risk of overpayments.\n", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Eligibility”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-eligibility-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "eligibility-2", + "marginal_note": "Eligibility (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- your or your spouse’s or common-law partner’s unmarried children including a natural child, adopted \nchild, or stepchild or a child for whom you stand in place of a parent (conditions apply, see Public Service \nDental Care Plan (PSDCP) Appeal Checklist (canada.ca/en/treasury-board-secretariat/topics/benefit-\nplans/plans/dental-care-plan/public-service-dental-care-plan-appeal-checklist )), if:\n8 \nPSDCP Member Booklet\n\n- the child is under 21 years of age\n\n- the child is between 21 and 25 years of age and attending an accredited school, college or university \non a full-time basis\n\n- the child is over 21 or 25 years of age who was an eligible dependant child under the PSDCP when \nbecoming incapable of self-sustaining employment by reason of mental or physical impairment \n(to apply for coverage of a dependant child with a disability, complete and submit the PSDCP \nApplication for Dependant with a Disability Coverage Form (welcome.canadalife.com/content/\ndam/rfp/psdcp/M7450(PSDCP).pdf ) to Canada Life within 31 days of the child turning 21 years of age \nor 25 years of age if the child is a full-time student).\nNote: If you have a child between 21 and 25 years of age in school, college or university, coverage \nis suspended at the end of each academic year and reinstated when Canada Life receives proof of \nre-enrolment. For example, if your child’s school term is from September to April, claims cannot be \nsubmitted from May to August. Once coverage is reinstated, any dental work completed during the \nsummer months can be submitted for reimbursement under the PSDCP . \nNote about how a child is defined: A child who does not meet the definition of child for the purposes \nof the PSDCP , but for whom you stand in place of a parent, may be eligible for coverage with the ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Eligibility”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-eligibility-3", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "eligibility-3", + "marginal_note": "Eligibility (part 3)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "approval of a Board of Management. To obtain coverage for such a child, you must provide the Board \nof Management responsible for your component with supporting documentation such as one of the \nfollowing:\n\n- a permanent guardianship (court) order\n\n- a custodial (court) order\n\n- a notarized private guardianship agreement, caregiving agreement or a notarized voluntary \nsurrender of custody and guardianship that indicates that the parent or parents relinquish their \nparental responsibility to you\nThe Board of Management will also consider:\n\n- the extent to which you are financially responsible for the child\n\n- whether your relationship is that of parent and child\n\n- the expected duration of this relationship", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Eligibility”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coverage-start-date", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coverage-start-date", + "marginal_note": "Coverage start date", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage start date\nPSDCP coverage starts exactly 3 months from the date you become an eligible employee. This period is \ncommonly known as the 3-month waiting period.\nExample:\n\n- You were hired as an indeterminate employee, appointed on a continuous basis with no preset end date, \non May 3, 2024. Your PSDCP coverage start date will be August 3, 2024.\n\n- You were hired as a term employee for a period of 3 months on May 3, 2024, and then you were hired for \na 1-year term with no break in service. Your PSDCP coverage start date will be February 3, 2025. This is \nbased on the first 3 months term employment (not eligible), followed by 6 months of continuous service, \nfollowed by the 3-month waiting period.\nPSDCP coverage for new eligible dependant(s) starts on the dependant(s) coverage start date.\n9\nPSDCP Member Booklet\nExample:\n\n- You get married on May 3, 2024. Your spouse’s coverage start date will be May 3, 2024, if your coverage was \neffective on that date.\n\n- Your child is born on May 3, 2024. Your child’s coverage start date will be May 3, 2024, if your coverage was \neffective on that date.\nIf you are on Leave Without Pay (LWOP) or on a seasonal layoff on the day that you would normally \nhave become a member of the PSDCP , your dental benefits coverage and the coverage for your eligible \ndependant(s) will begin on the first day of the month after the month you resume paid work. For example, if \nyou resumed paid work on October 15, your coverage would begin on November 1.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coverage start date”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-positive-enrolment-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "positive-enrolment-1", + "marginal_note": "Positive enrolment (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Positive enrolment\nPositive enrolment is the process where you provide Canada Life with information about you and your \neligible dependant(s) to ensure your claims can be processed accurately. Through positive enrolment, you \nmust provide consent for the use of your personal information. See Protecting your private information . If \nyou do not complete positive enrolment and provide consent, Canada Life cannot process your claims.\nTo complete positive enrolment, you will need to provide the following information about you and your \neligible dependant(s), if applicable:\n\n- first and last name\n\n- date of birth\n\n- gender – male, female, other or prefer not to answer\n\n- certificate number\n\n- contact information, including complete address\n\n- bank account information (required only if you wish to set up direct deposit for faster claim payments)\n\n- your plan number which is determined by your birth month:\n\n- January to March 72111\n\n- April to June 72112\n\n- July to September 72113\n\n- October to December 72114\nFor example, if you are an employee born in the month of November, your plan number is 72114.\nIf you need to make any updates to your personal information such as last name or date of birth, contact \nyour departmental compensation office or Pay Centre .\nIf you need to make any updates to your banking information, you can choose one of the following methods:\n\n- print, complete and sign a PSDCP Direct Deposit form, which you can find on the Forms page of the \nPSDCP Member Services website ( welcome.canadalife.com/psdcp/forms )\n\n- sign in to your PSDCP Member Services account through My Canada Life at Work TM (canadalife.com/\npsdcp) or the My Canada Life at Work mobile app, go to the icon in the top right corner (top left corner for ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Positive enrolment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-positive-enrolment-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "positive-enrolment-2", + "marginal_note": "Positive enrolment (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "mobile app) of the screen, select Your profile, then select Banking\n\n- contact Canada Life to request that a PSDCP Direct Deposit form be sent to you by mail\n10 \nPSDCP Member Booklet\nHow to complete your initial positive enrolment online\n1. Visit Positive enrolment (welcome.canadalife.com/psdcp/positive-enrolment ) and select Complete \npositive enrolment . This will bring you to the PSDCP positive enrolment page. This page is only to be \nused for initial positive enrolment. See Keeping your positive enrolment information up to date for \ninstructions on how to update your positive enrolment information.\n2. On the PSDCP positive enrolment page, enter your last name, date of birth and PSDCP certificate \nnumber, then select Continue.\n3. You will need to complete the steps outlined on the screens, provide consent and submit your \npositive enrolment information. You will immediately receive a confirmation email and you will be \nable to view, download and print a PDF copy of your PSDCP benefit card.\n4. Once positive enrolment is completed, create your PSDCP Member Services account through \nMy Canada Life at Work TM (canadalife.com/psdcp ) (see Benefits of a PSDCP Member Services \naccount).\nNote: If you are also a Public Service Health Care Plan (PSHCP) member and have a PSHCP Member \nServices account, use the same email address and password to sign in to your PSDCP Member \nServices account. \nHow to complete your initial positive enrolment by mail\nThere are 2 ways to get a paper PSDCP Positive Enrolment Form:\n1. Visit the PSDCP Member Services website (canadalife.com/psdcp ):\ni. Select Forms.\nii. Find, download and print the Positive Enrolment Form .\n2. Contact Canada Life to request that a PSDCP Positive Enrolment Form be sent to you by mail.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Positive enrolment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-positive-enrolment-3", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "positive-enrolment-3", + "marginal_note": "Positive enrolment (part 3)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Once you have your paper PSDCP Positive Enrolment Form:\n1. Fill out the double-sided PSDCP Positive Enrolment Form legibly.\n2. Double check the form to make sure your information is complete and accurate.\n3. Sign and date the form.\n4. Mail your Positive Enrolment Form to the address indicated on the form.\nYou will receive a letter in approximately 3 weeks from the date Canada Life receives your completed PSDCP \nPositive Enrolment Form, that includes a confirmation statement and a paper PSDCP benefit card.\nIf your form was incomplete or illegible, your form will be returned to you by mail, within 3 weeks, and you \nwill need to resubmit a new form to Canada Life. If you submit a claim before your positive enrolment is \ncompleted, the claim will not be assessed or retained, and you will need to resubmit the claim after you \ncomplete positive enrolment.\nOnce you have completed positive enrolment, you may submit claims under the PSDCP (see Claims \nmanagement).\n11\nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Positive enrolment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-psdcp-benefit-card-plan-number-and-certi", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "psdcp-benefit-card-plan-number-and-certi", + "marginal_note": "PSDCP benefit card (plan number and certificate number)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "PSDCP benefit card (plan number and certificate number)\nYour PSDCP benefit card includes your plan number and your certificate number\n\n- You and your eligible dependant(s) must provide your plan number and your certificate number to \nCanada Life when submitting a claim either online or by mail and to your dental provider, if they can \nsubmit claims on your behalf.\nNote: Eligible dependants will not receive their own PSDCP benefit card and must provide the \nplan number and the certificate number seen on the plan member’s PSDCP benefit card to dental \nproviders.\n\n- Your plan number and your certificate number are needed:\n\n- on all claims submitted for yourself and your eligible dependant(s)\n\n- in all correspondence with Canada Life\n\n- Your benefit card also includes Canada Life contact information\nShould you lose your benefit card, sign in to your PSDCP Member Services account (canadalife.com/psdcp ) \nto download and print one or contact Canada Life to request that a benefit card be sent to you by mail. You \ncan also contact your departmental compensation office or the Pay Centre to get your certificate number. \nYour plan number is determined by your birth month. See Positive enrolment .", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “PSDCP benefit card (plan number and certificate number)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-protecting-your-private-information-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "protecting-your-private-information-1", + "marginal_note": "Protecting your private information (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Protecting your private information\nCanada Life takes your privacy very seriously. It is a legal requirement to collect consent and indicate how \nand when Canada Life will use private information and who will not be able to access private information. \nThis includes providing consent to the Government of Canada, the PSDCP Boards of Management and \nCanada Life to access your personal information. Your consent allows Canada Life to collect, use and \ndisclose personal information about you and your eligible dependant(s) for the purpose of processing \nclaims in and out of Canada. Refer to the Privacy Statement (canada.ca/en/treasury-board-secretariat/\ntopics/benefit-plans/plans/dental-care-plan/public-service-dental-care-plan-privacy-statement ) for \nfurther information on how your privacy is protected. For a copy of the Privacy policy (canadalife.com/\nprivacy), or if there are any questions about Canada Life’s personal information policies and practices, \nincluding with respect to service providers, reach out to Canada Life’s Chief Compliance Officer by referring \nto Contact Us: Privacy rights request (canadalife.com/contact-us/corporate/privacy-rights-request ).\nProviding consent\nWhether completing positive enrolment online or by mail, you must carefully read the Authorization \nand Declaration (welcome.canadalife.com/psdcp/positive-enrolment/review-authorizations-and-\ndeclarations) section and provide consent. If you do not provide consent, Canada Life cannot process your \nclaims. If you submit a claim but have not completed positive enrolment or provided consent, your claim \nwill not be processed, and you will not receive payment.\nNote: Make sure to read the Authorization and Declaration (welcome.canadalife.com/psdcp/positive-", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Protecting your private information”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-protecting-your-private-information-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "protecting-your-private-information-2", + "marginal_note": "Protecting your private information (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "enrolment/review-authorizations-and-declarations ) section during online positive enrolment or on \nthe paper Positive Enrolment Form carefully before providing consent. For more information, please \nvisit Canada Life’s Privacy policy (canadalife.com/privacy ). \n12 \nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Protecting your private information”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-keep-your-positive-enrolment-information", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "keep-your-positive-enrolment-information", + "marginal_note": "Keep your positive enrolment information up to date", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Keep your positive enrolment information up to date\nYou can update or change your positive enrolment information at any time. To avoid any disruption of your \nclaims being processed, you are responsible for keeping your personal information up to date.\nImportant: If you need to make any updates to your personal information such as last name or date of birth, \ncontact your departmental compensation office or Pay Centre .\nIf you need to make any updates to your banking information, you can choose one of the following \nmethods:\n\n- print, complete and sign a PSDCP Direct Deposit form, which you can find on the Forms page of the \nPSDCP Member Services website ( welcome.canadalife.com/psdcp/forms )\n\n- sign in to your PSDCP Member Services account through My Canada Life at Work TM (canadalife.com/\npsdcp) or the My Canada Life at Work mobile app, go to the icon in the top right corner (top left corner for \nmobile app) of the screen, select Your profile, then select Banking\n\n- contact Canada Life to request that a PSDCP Direct Deposit form be sent to you by mail\nIt is important to note that the changes would also need to be updated separately for the Public Service \nHealth Care Plan (PSHCP) (canada.ca/en/treasury-board-secretariat/services/benefit-plans/contacts-\ngroup-insurance-benefit-plans ), where applicable.\nTo make changes to your positive enrolment information, you have 3 options:\n1. Sign in to your PSDCP Member Services account (canadalife.com/psdcp ) and go to the profile \nsection to update your information.\n2. Print and complete the PSDCP Positive Enrolment Form and submit it to Canada Life.\n3. Contact Canada Life to request that a PSDCP Positive Enrolment Form be sent to you by mail. \nComplete and return the form to Canada Life.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Keep your positive enrolment information up to date”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-registering-for-online-and-digital-tools", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "registering-for-online-and-digital-tools", + "marginal_note": "Registering for online and digital tools", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Registering for online and digital tools\nCommitment to the Environment\nThe Government of Canada and Canada Life are working to protect and preserve our planet for future \ngenerations. You can help reduce paper waste by managing your PSDCP correspondence, claims and \npersonal information online. Sign in to your", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Registering for online and digital tools”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-psdcp-member-services-account-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "psdcp-member-services-account-1", + "marginal_note": "PSDCP Member Services account (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "PSDCP Member Services account (canadalife.com/psdcp ), go \nto the profile icon in the top right corner (top left corner for mobile app) of the screen, select Your profile \nand then Communications preferences .\nPSDCP Member Services account\nBenefits of a PSDCP Member Services account\nBy creating a PSDCP Member Services account through My Canada Life at Work (online and mobile app) \n(canadalife.com/psdcp ), you can:\n\n- access your PSDCP benefit card and save it directly to your mobile device\n\n- view your plan number and your certificate number\n\n- provide your positive enrolment consent\n13\nPSDCP Member Booklet\n\n- update your positive enrolment information\n\n- view, edit or terminate dependant(s)\n\n- add or update your banking information\n\n- sign up for direct deposit for claim payments\n\n- submit claims online and access claims history\n\n- submit a treatment plan or estimate\n\n- get notified when claims have been processed\n\n- access the details of benefits, claim forms and other important information\n\n- find a provider\n\n- submit coordination of benefits claims between 2 Canada Life plans or submit the remaining balance of a \nclaim already processed through other insurance\n\n- submit photos of receipts for all dental claims\n\n- send supporting documentation requested by Canada Life\n\n- review your coverage and balances\n\n- submit a Canada Life appeal through the Contact us page\n\n- use biometrics (face recognition, touch or fingerprint ID) to sign in\n\n- access the Help Centre\n\n- contact Canada Life using the secure online chat or secure email from the Contact us page\nHow to create a PSDCP Member Services account\nPositive enrolment must be completed before you create a PSDCP Member Services account. Allow at ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “PSDCP Member Services account”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-psdcp-member-services-account-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "psdcp-member-services-account-2", + "marginal_note": "PSDCP Member Services account (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "least 48 hours after completing positive enrolment before creating your account. This will allow for your \ninformation to transfer through the system and appear in your account.\nTo create an account:\n1. You will need your plan number and your certificate number.\n2. Go to the PSDCP Member Services website (canadalife.com/psdcp ).\n3. If you already have a Canada Life account, select Sign in.\n4. If you do not have a Canada Life account, select Register.\n5. Select Start now.\n6. Follow the prompts on the screen.\nIf you already have an account with Canada Life for any of your benefit plans, please sign in to your PSDCP \nMember Services account (canadalife.com/psdcp ) using your existing login credentials. You will be \nprompted to view coverage information for each of your benefit plans and can switch between plans.\nIf you do not see one of your benefit plans online, please contact Canada Life.\nIf you have any questions, contact Canada Life.\n14 \nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “PSDCP Member Services account”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-my-canada-life-at-work-tm-online-and-mob-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "my-canada-life-at-work-tm-online-and-mob-1", + "marginal_note": "My Canada Life at Work TM (online and mobile app) (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "My Canada Life at Work TM (online and mobile app)\nHow to get started\n1. Create a PSDCP Member Services account (canadalife.com/psdcp ) if you have not already done so.\n2. Download the My Canada Life at Work mobile app from your app store (App Store or Google Play).\n3. Sign in using the same email address and password you use for your PSDCP Member Services \naccount.\nIf you are already a Public Service Health Care Plan member and have the Canada Life at Work \nmobile app\nIf you are a Public Service Health Care Plan (PSHCP) member and are already using the My Canada Life at \nWork mobile app, make sure your device is set up for automatic updates. Your app will automatically update \nto include coverage information for all your benefit plans. If your device is not set up for automatic updates, \nyou will need to manually update the app from the App Store or Google Play.\nOnce the app has updated, and you sign in, you will be prompted to view coverage information for each of \nyour benefit plans and you will be able to switch views between the plans.\nIf you use biometrics (face recognition, touch or fingerprint ID) to sign in to the app, you will need to use the \nSwitch Plan function, which you can access by selecting the profile icon located in the top left corner of the \nscreen.\nIf you have any questions, please contact Canada Life.\nImportant device settings\n\n- It is important to turn on your automatic updates to ensure fixes and updates download immediately to \nyour device.\n\n- The mobile app presents in the language set on your mobile device and may be different than the \nlanguage preference you indicated during positive enrolment with Canada Life. Be sure to set your mobile \ndevice to your language preference. \n", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “My Canada Life at Work TM (online and mobile app)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-my-canada-life-at-work-tm-online-and-mob-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "my-canada-life-at-work-tm-online-and-mob-2", + "marginal_note": "My Canada Life at Work TM (online and mobile app) (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- If you require Telephone Teletype (TTY), ensure the device setting for this option is on.\n2-step verification\nKeeping your information secure is important to us. That is why we have another layer of security to your \nPSDCP Member Services account (canadalife.com/psdcp ) for both online and mobile application. This \n2-step verification process is a fast and easy way to verify your identity when signing in to your account.\nFor more information on 2-step verification, please review the 2-step verification FAQ (welcome.\ncanadalife.com/psdcp/2-step-verification-faq ).", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “My Canada Life at Work TM (online and mobile app)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-contributions", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "contributions", + "marginal_note": "Contributions", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Contributions\nThe Government of Canada, as the Employer pays 100% of the PSDCP contributions for eligible members \nwith some exceptions (canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/dental-care-\nplan/rules-dental-care-plan-public-service-canada ).\n15\nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Contributions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-leave-without-pay-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "leave-without-pay-1", + "marginal_note": "Leave Without Pay (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Leave Without Pay\nSome types of Leave Without Pay (LWOP) do not require you to pay the full cost of your dental benefits \ncoverage to keep your coverage while on leave.\nBefore taking LWOP , contact your departmental compensation office or Pay Centre . You will be provided \nwith a letter that contains further information and instructions. If you wish to retain your PSDCP coverage \nwhile on LWOP , you must inform your departmental compensation office or Pay Centre or your coverage \nwill be suspended while on leave. See PSDCP contribution rates . If you need to change your category of \ncoverage, you can do so with your departmental compensation office or Pay Centre .\nImportant: It is your departmental compensation or Pay Centre’s responsibility to collect your contributions \nupon your return to work.\nIf you choose to not retain your PSDCP coverage before your LWOP begins, your coverage will be cancelled \non the first day of the following month of your LWOP start date.\nExample: If your LWOP begins on June 15, 2024 and you did not opt to retain your PSDCP while on leave, \nyour coverage will be cancelled on July 1, 2024.\nNo employee contributions are to be paid for the following types of LWOP:\n\n- maternity leave or parental leave (standard or extended)\n\n- caregiving leave\n\n- sick LWOP\n\n- disability or long-term disability leave\n\n- educational LWOP at the request of the employer\n\n- leave to serve in another organization if doing so is recognized as being to the advantage of the \ndepartment or to the Government of Canada\n\n- leave for training or other activities as part of service in the Canadian Armed Forces or Reserves\n\n- leave taken as part of leave with income averaging and pre-retirement transition leave", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Leave Without Pay”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-leave-without-pay-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "leave-without-pay-2", + "marginal_note": "Leave Without Pay (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Employee contributions must be paid for any other type of LWOP . The following will apply:\n\n- Your employer-paid coverage will continue during the first 3 consecutive calendar months of approved \nLW O P.\n\n- As of the fourth month of your leave of absence, if you wish to keep your dental benefits coverage, you \nmust pay your monthly contribution amount for the category of coverage you wish to retain (including \nthe applicable provincial sales tax) to the Receiver General of Canada. You can pay your contributions in \nadvance or when you return to work. If you choose to pay them when you return to work, you must make \npayments on a schedule that does not exceed the time you were on leave.\n\n- You cannot change your type of coverage during your LWOP .\nExample:\nYou take LWOP from February 21, 2024, to November 3, 2024, because your spouse needs to relocate, you \nreturn to work on November 5, 2024.\n16 \nPSDCP Member Booklet\nFirst 3 months\nYou have employer-paid coverage for the first 3 full months of your LWOP (March, April and May 2024). Your \ndental benefits coverage stops on May 31, 2024.\nBefore the end of the third month\nIf you wish to continue your dental benefits coverage for the rest of your LWOP , you can pay your \ncontributions in advance or when you return to work. If you choose to pay them when you return to work, \nyou must make payments on a schedule that does not exceed the time you were on leave or in this example, \n7 months following your return to work.\nConsult your departmental compensation office or Pay Centre about your options prior to beginning \nLW O P.\nReturn to work\nIf you chose to terminate your coverage for the period on LWOP , your employer-paid coverage will be \nreinstated on December 1, 2024 (the first of the month after you return to work). You cannot restart coverage \nwhile on LWOP .", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Leave Without Pay”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-suspension", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "suspension", + "marginal_note": "Suspension", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Suspension\nIf you are covered by the PSDCP and your employment is suspended, you can continue your dental benefits \ncoverage if you pay the required contributions (canada.ca/en/treasury-board-secretariat/services/\nbenefit-plans/dental-care-plan/contribution-rates ) quarterly, in advance, before the first of the month \nfollowing the month in which the suspension period began. Your employer-paid coverage will resume on \nthe first of the month following the date you return to duty. Your departmental compensation office or Pay \nCentre will provide reasonable notice to pay your contributions.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Suspension”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-layoff", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "layoff", + "marginal_note": "Layoff", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Layoff\nIf you are covered by the PSDCP and you are laid off, your dental benefits coverage may continue for a \nperiod of up to 12 months if you pay the appropriate monthly contribution amount in advance (canada.ca/\nen/treasury-board-secretariat/services/benefit-plans/dental-care-plan/contribution-rates ).", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Layoff”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-psdcp-contribution-rates", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "psdcp-contribution-rates", + "marginal_note": "PSDCP contribution rates", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "PSDCP contribution rates (not including applicable provincial or territorial sales tax)\nFor PSDCP contribution rates, please review Canada.ca/pension-benefits (canada.ca/en/treasury-board-\nsecretariat/services/benefit-plans/dental-care-plan/contribution-rates ).\nCategories of coverage:\n\n- Plan member only\n\n- Plan member and spouse/common-law partner or plan member with children\n\n- Plan member, spouse/common-law partner and children\n17\nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “PSDCP contribution rates”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coverage-termination-date", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coverage-termination-date", + "marginal_note": "Coverage termination date", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage termination date\nYour PSDCP coverage will terminate automatically on the earliest of the following:\n1. on the date when you are no longer an eligible employee\nFor example:\ni. the date you resign from the public service\nii. the date you become a part-time employee and work less than 1/3 of the normal work week\nYour dependant(s)’ PSDCP coverage will terminate on the earliest of the following:\n1. the date your coverage terminates\n2. the date your eligible dependant(s) no longer meet the definition of eligible spouse, common-law \npartner or child\nFor example:\ni. the date of a divorce\nii. the date the common-law partnership ends\niii. the date a child turns 21 years of age, if no longer in full-time attendance at an accredited school, \ncollege or university\niv. the date a child turns 25 years of age\nv. the last day of the month a child between 21 and 25 years is in full-time attendance at an \naccredited school, college or university\nvi. the date the dependant child marries\nvii. the date the dependant child becomes a member of the plan in their own right (as an eligible \nemployee as defined above)\nIt is your responsibility to promptly notify Canada Life and your departmental compensation office or Pay \nCentre of these changes.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coverage termination date”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-retirement", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "retirement", + "marginal_note": "Retirement", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Retirement\nDental benefits coverage ends on your last day of employment. However, if you are in receipt of a \nrecognized ongoing monthly public service pension benefit, which is based on a minimum of six years of \ncumulative pensionable service, you may be eligible to apply for coverage under the Pensioners’ Dental \nServices Plan (PDSP) (canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/pensioner-\ndental-services-plan ). If you apply for PDSP coverage before or within 60 days of the date your pension \nbenefit becomes payable, your dental benefits coverage, including coverage for your eligible dependants, \nwill begin on this same start date. Refer to the PDSP Member Booklet (canadalife.com/content/dam/rfp/\nwelcome-sites/pdsp/pdsp-member-booklet.pdf ) for more information.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Retirement”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-31-calendar-day-exception", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "31-calendar-day-exception", + "marginal_note": "31-calendar-day exception", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "31-calendar-day exception\nAn exception will be made if a dental service was started before your coverage end date. You or your eligible \ndependant(s) will be covered if that service is completed within 31 calendar days of your coverage end date.\n18 \nPSDCP Member Booklet\nFor example, this exception would apply if you were undergoing any of the following dental services:\n\n- root canal where the pulp chamber was opened before the coverage end date\n\n- a crown was being prepared and impressions had been taken before the coverage end date\n\n- ongoing orthodontic treatment where the initial appliance was inserted before the coverage end date", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “31-calendar-day exception”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-accessing-claim-summary-reports", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "accessing-claim-summary-reports", + "marginal_note": "Accessing claim summary reports", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Accessing claim summary reports\nTo access applicable claim summary reports, which can be used for income tax purposes:\n1. Sign in to your PSDCP Member Services account through My Canada Life at Work TM (canadalife.com/\npsdcp).\n2. From the lefthand navigation, Select Benefits, then Claim History.\n3. Select the option Create a claim summary .\nYou can also call Canada Life’s PSDCP Member Contact Centre for inquiries within North America (toll-\nfree) at 1-855-415-4414, Monday to Friday from 8 am to 5 pm, your local time, or for international inquiries \n(collect) at 1-431-489-4064, Monday to Friday from 8 am to 5 pm, ET .\nImportant: After termination you can only access your claim summary reports by calling the PSDCP Member \nContact Centre.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Accessing claim summary reports”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-before-incurring-an-expense", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "before-incurring-an-expense", + "marginal_note": "Before incurring an expense", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Before incurring an expense\nSome products and services may be costly. Before you incur dental expenses, know what your PSDCP will \nreimburse. For procedures that may exceed $300, submit an estimate to be certain of what is eligible for \nreimbursement. Plan members in discussion with their dental provider can decide on the most appropriate \ntreatment for their situation.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Before incurring an expense”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-reasonable-and-customary-charges", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "reasonable-and-customary-charges", + "marginal_note": "Reasonable and Customary Charges", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Reasonable and Customary Charges\nThe PSDCP provides reimbursement for eligible dental services based on the provincial or territorial dental \nassociation fee guides in effect the previous year . See Claim calculation example below.\nA dental fee guide is a listing of Reasonable and Customary Charges recommended by the respective \nprovincial or territorial dental association for specified services, provided by a specific practitioner type in a \nprovince or territory.\nIf services are provided by a qualified specialist in endodontics, prosthodontics, oral surgery, periodontics, \npedodontics or orthodontics (whose dental practice is limited to that specialty), then the fee guide \napproved by the provincial or territorial dental association for that specialist will be used.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Reasonable and Customary Charges”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-out-of-canada-benefit", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "out-of-canada-benefit", + "marginal_note": "Out-of-Canada Benefit", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Out-of-Canada Benefit\nIf you are temporarily outside of Canada and need dental services, the PSDCP will provide reimbursement \nbased on the previous year’s dental fee guide of your province or territory of residence.\nIf you live outside of Canada, the PSDCP provides reimbursement for eligible dental services based on the \nReasonable and Customary Charges in the location where the services are received. Reimbursement is paid \nin Canadian dollars. Members residing in the United States can choose to receive reimbursement in US \ndollars by cheque.\n19\nPSDCP Member Booklet\nForeign Service Directives: If a member who is deployed or posted outside Canada, incurs eligible dental \nexpenses outside of Canada that are higher than the fee for the same service as set out in the Ontario fee \nguide, they may be required to pay a higher co-payment amount as defined in the PSDCP . In such cases, \nthe member can submit a claim for payment under these Directives to cover the portion of the co-payment \namount that exceeds what they would have paid if the treatment had occurred in Ontario.\nCanadian Armed Forces members should refer to Chapter 10 - Foreign Services Instructions - Canada.ca .\nReimbursement is paid in Canadian dollars. Members residing in the United States can choose to receive \nreimbursement in US dollars by cheque.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Out-of-Canada Benefit”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-annual-deductible", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "annual-deductible", + "marginal_note": "Annual deductible", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Annual deductible\nThe annual deductible is the dollar amount you must pay out of pocket each calendar year. The annual \ndeductible amount is $25 for one covered person or $50 for more than one covered person and is deducted \nfrom your first claim(s) each calendar year. See Claim calculation example .\nThe annual deductible may be carried over\nIf the annual deductible is paid for a dental expense in the last 3 months of the calendar year (October 1 to \nDecember 31), a new annual deductible will not be charged in the following calendar year.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Annual deductible”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-co-payment", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "co-payment", + "marginal_note": "Co-payment", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Co-payment\nAfter the annual deductible amount has been paid, the PSDCP will reimburse you for a percentage of the \neligible expenses. The PSDCP covers 90% for eligible preventive and basic dental services, 65% for eligible \nmajor restorative services and 50% for eligible orthodontic services. You are required to pay the remaining \namount, which is therefore referred to as the co-payment amount.\nThe table below shows your co-payments depending on services received.\nEligible expense submitted PSDCP pays What you pay (co-payment)\nPreventive and basic dental services 90% 10%\nMajor restorative services 65% 35%\nOrthodontic services 50% 50%\nImportant: You are responsible for any amount not reimbursed by the PSDCP , including where the dental \nprovider charged more for a given service or procedure than the amount in the applicable dental fee guide \nfor the previous year.\n20 \nPSDCP Member Booklet\nClaim calculation example\nDental \nservice\nAmount \ncharged\nEligible \nexpense \n(based on \nReasonable \nand Customary \nCharges) (1)\nAnnual \ndeductible\nCovered \neligible \nexpense (%)\nPSDCP pays \n(2)\nWhat you \npay\nRecall exam $65 $60 $25 $35 \nreimbursed \nat 90%\n$31.50 $33.50\nCrown \nincluding lab \nfees\n$1,500 $1,300 Already paid $1,300 \nreimbursed \nat 65%\n$845 $655\n1. Up to the amount in the applicable dental fee guide in effect the previous year.\n2. Any amounts over the annual maximum are paid by the member.\nImportant: Plan members are responsible for all ineligible expenses in excess of the previous year’s dental \nfee guide or services not covered due to exceptions or plan limitations.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Co-payment”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-maximum-reimbursement-amounts", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "maximum-reimbursement-amounts", + "marginal_note": "Maximum reimbursement amounts", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Maximum reimbursement amounts\nPreventive, basic and major restorative dental services – annual maximum\nEach calendar year, the PSDCP will reimburse up to an annual maximum amount for each covered person \nfor preventive, basic and major restorative dental services. This excludes orthodontic services, which have a \nseparate lifetime maximum limit.\nThe yearly annual maximum reimbursement for dental services is:\n\n- $3,000 per year January 1, 2025 to December 31, 2026\n\n- $3,250 per year starting on January 1, 2027\nException: If your PSDCP coverage starts on or after July 1, the maximum amount that the PSDCP will \nreimburse for that calendar year will be 50% of the annual maximum. The full annual maximum will apply in \nthe next calendar year.\nOrthodontic services – lifetime maximum\nThe PSDCP will reimburse up to a lifetime maximum amount for each covered person for orthodontic \nservices.\nThe lifetime maximum reimbursement for orthodontic services is:\n\n- $3,000 per lifetime from January 1, 2025 until December 31, 2026\n\n- $3,250 per lifetime starting January 1, 2027\nImportant: Before January 1, 2025, the orthodontic lifetime maximum was $2,500. If you claimed $2,500 for \northodontic services, you may be eligible to claim the balance, up to the new lifetime maximum on services \nincurred after January 1, 2025.\n21\nPSDCP Member Booklet\nTo be eligible, the initial orthodontic appliance must not have been installed before the start of your PSDCP \ncoverage.\nWhen submitting a treatment plan, the dental provider must clearly indicate the cost, length of treatment \nand fee breakdown, any financial arrangement and the payment plan or interval. All claims will require the \nprovider’s signature or office stamp.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Maximum reimbursement amounts”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-estimate-of-reimbursement", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "estimate-of-reimbursement", + "marginal_note": "Estimate of reimbursement", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Estimate of reimbursement\nBefore you receive dental work or treatment that could be $300 or more (such as a crown or orthodontics), \nit is recommended that you or your dental provider send a treatment plan or estimate online or by mail to \nCanada Life . Canada Life will provide a predetermination of", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Estimate of reimbursement”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-benefits-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "benefits-1", + "marginal_note": "Benefits (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "benefits to confirm if the dental services are \neligible, how much of the expenses will be reimbursed, and how much you will have to pay out of pocket \n(your co-payment).\nImportant: Predeterminations are only valid for 180 days from the date requested. There may be limitations \nor time restrictions that apply. For example, a child graduates from post-secondary education or turns 25, or \nyou may reach the annual maximum amount during the 180 days.\nHow to submit a treatment plan or estimate online:\nIf your dental provider does not submit an estimate of reimbursement on your behalf, you can do \nso yourself. To submit a treatment plan/estimate through your PSDCP Member Services account on \nMy Canada Life at Work TM (canadalife.com/psdcp ), sign in and select Benefits, then Estimates, and follow \nthe instructions.\nYou can either:\n\n- upload the claim form (same form used for estimates) provided by your dental provider\n\n- access personalized claim forms by signing in to your PSDCP Member Services account (canadalife.com/\npsdcp),\n\n- select Info centre in the lefthand navigation, then View forms\n\n- select or search for the form you require and complete it with the information provided by your \ndental provider (indicate on the form that it is for an estimate)\n\n- upload the form along with any supporting documents\n\n- find blank claim forms on the Forms page of the PSDCP Member Services website ( welcome.canadalife.\ncom/psdcp/forms ) and complete it with the information provided by your dental provider (indicate on the \nform that it is for an estimate) and upload it along with any supporting documents\nA treatment plan or estimate does not need a dental provider signature.\nHow to submit a treatment plan or estimate by mail:", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Benefits”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-benefits-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "benefits-2", + "marginal_note": "Benefits (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Print, complete and sign a claim form with your personal information, include all available information \nfrom your dental provider and mail it to Canada Life.\nYou can either:\n\n- access personalized claim forms by signing in to your PSDCP Member Services account (canadalife.com/\npsdcp)\n22 \nPSDCP Member Booklet\n\n- select Info centre in the lefthand navigation, then View forms\n\n- select or search for the form you require\n\n- mail it to the following address\n\n- find blank claim forms on the Forms page of the PSDCP Member Services website ( welcome.canadalife.\ncom/psdcp/forms ) and mail it to the following address\nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7\nYou can also contact Canada Life to request that a claim form be sent to you by mail.\nCanada Life will send you a predetermination of benefits indicating what is covered using the method of \ncommunication indicated in your file. It will include:\n\n- a decision on whether the expense is covered by the PSDCP\n\n- an estimate of the dollar amount that is eligible for reimbursement when there is no coordination of \nbenefits (this may differ from the actual amount that is covered), see Coordination of benefits with other \nplans for more information\nBenefits", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Benefits”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-general", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "general", + "marginal_note": "General", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "General\nThe PSDCP provides reimbursement for specific dental services not covered under a provincial or territorial \nhealth or dental care plan. The plan provides reimbursement up to, but not exceeding, the amount shown in \nthe previous year’s dental fee guide.\nThe PSDCP will reimburse you for eligible expenses for dental services received by:\n\n- dentists or dental specialists\n\n- denturists\n\n- independent dental hygienists\n\n- anesthetists (in connection with oral surgery and drug injections)\nThe dental provider must be licensed to provide dental services in the province or territory where the \nservice is received.\nImportant: If you are a member of both the PSDCP and the Public Service Health Care Plan (PSHCP), you \nmay coordinate benefits between both plans for accidental dental injury or dental surgery. See Coverage \nunder the Public Service Health Care Plan (Accident/Surgery) .", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “General”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-eligible-expenses-exclusions-and-limitat", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "eligible-expenses-exclusions-and-limitat", + "marginal_note": "Eligible expenses, exclusions and limitations", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Eligible expenses, exclusions and limitations\nBelow are highlights of the covered services including most limitations. For complete information on the \nbenefits covered under the PSDCP , consult the PSDCP Rules (canada.ca/en/treasury-board-secretariat/\ntopics/benefit-plans/plans/dental-care-plan/rules-dental-care-plan-public-service-canada ) and look for:\n\n- the list of all eligible dental services (see Rule 6.(2) of the PSDCP Rules)\n23\nPSDCP Member Booklet\n\n- the list of exclusions and limitations (see Rules 6.(3) and 6.(12) of the PSDCP Rules)\n\n- the table of benefits (see Rule 6.(5) of the PSDCP Rules)", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Eligible expenses, exclusions and limitations”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-preventive-dental-services-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "preventive-dental-services-1", + "marginal_note": "Preventive dental services (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Preventive dental services \nDiagnostic services: reimbursed at 90% of the eligible expenses\nThe PSDCP covers services used to help prevent or correct dental diseases and defects. They are services \nthat dental providers perform regularly to help maintain good dental health.\nOral examinations Limitations \nComplete oral examination Once every 36 months (this limitation does not apply to a \nlimited new patient examination)\nRecall examination Once every 9 months or once every 6 months for eligible \ndependant children \nSpecific oral examination No limitations\nEmergency oral examination No limitations\nTreatment planning No limitations\nAnalysis of mixed dentition Covered when a complete examination is not performed \nin the previous 12-month period \nX-rays Limitations \nComplete series of periapical x-rays Once every 36 months \nOcclusal x-rays No limitations\nBitewing x-rays Once every 9 months or once every 6 months for eligible \ndependant children \nExtra-oral films No limitations\nSialography, use of dyes No limitations\nPanoramic x-ray Once every 36 months \nInterpretation of radiographs from another source No limitations\nTomography No limitations, including cone beam computed \ntomography\nOther services Limitations \nPolishing Once every 9 months or once every 6 months for eligible \ndependant children.\nA temporary suspension of the frequency limitation \nwill apply to those who will be or are undergoing \nchemotherapy to treat cancer*.\n24 \nPSDCP Member Booklet\nOther services Limitations \nTopical fluoride treatment Once every 9 months or once every 6 months for eligible \ndependant children.\nA temporary suspension of the frequency limitation \nwill apply to those who will be or are undergoing \nchemotherapy to treat cancer *. ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Preventive dental services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-preventive-dental-services-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "preventive-dental-services-2", + "marginal_note": "Preventive dental services (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Oral hygiene instruction Once per calendar year for eligible dependant children \nand once per lifetime for any other person\nPit and fissure sealants No age limitation \nSpace maintainers Not involving movement of teeth, service costs will \nnot be eligible if the service is in response to a needed \nadjustment that occurred within 31 days from the date \nthe space maintainer was originally inserted\nBiopsy of oral tissue and pulp vitality tests No limitations\nCaries control No limitations\nEnameloplasty No limitations\nHouse calls, hospital calls and special office visits No limitations\nEmergency services No limitations\nInjections, appliances and assessments For those with temporo-mandibular joint disorder\n*To ensure that claims for scaling/root planning, fluoride and polishing are not declined due to reaching the \nstandard frequency limitation, Canada Life must be informed by the member or provider that the claiming \npatient is going to receive or is receiving chemotherapy to treat cancer. Claims will be approved based on \nconfirmation from the member, provider or supporting medical documentation.\nContinued eligibility for this temporary suspension will be assessed 12 months after the initial approval.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Preventive dental services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-basic-dental-services-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "basic-dental-services-1", + "marginal_note": "Basic dental services (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Basic dental services\nBasic dental services: reimbursed at 90% of the eligible expenses\nThe PSDCP covers services used to treat basic dental diseases and defects. Below is a list of certain basic \ndental services that are covered.\nFillings Limitations \nFillings (amalgam, silicate, composite, acrylic) Replacement fillings for the same tooth and surface once \nevery 24 months or once every 12 months for eligible \ndependant children\nDenture services Limitations \nRepair or adjustment of dentures No limitations\nRebasing and relining of existing partial or complete \ndenture \nOnce every 36 months \n25\nPSDCP Member Booklet\nEndodontics Limitations \nRoot canal No limitations\nPulp capping \nPulpotomy/pulpectomy\nPeriapical services \nTooth isolation No limitations if there is a substantiated medical \ncondition\nPeriodontics Limitations \nScaling and root planing 6 time units every calendar year\nException: up to 6 additional time units can be pre-\napproved by Canada Life with evidence of gum disease \nfrom your dental provider. Pre-approvals are valid for \n3 years from the date of approval. When you apply for \nreimbursement of additional units of scaling and/or root \nplaning within 3 months of the treatment, you may be \nreimbursed for up to 2 time units.\nA temporary suspension of the frequency limitation \nwill apply to those who will be or are undergoing \nchemotherapy to treat cancer *.\nOcclusal equilibration 8 time units every calendar year \nNon-surgical, surgical and post-surgical treatment of \ngums and supporting tissue \nNo limitations\nOral surgery and related anaesthesia ** Limitations\nUncomplicated removal No limitations\nSurgical removal\nTooth repositioning\nAlveoloplasty (smooths and reshapes the jawbone after \nextraction)\nGingivoplasty (reshapes gum tissue)", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Basic dental services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-basic-dental-services-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "basic-dental-services-2", + "marginal_note": "Basic dental services (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Stomatoplasty (reconstructive mouth surgery)\nOsteoplasty (reshapes and recontouring of bone)\nTuberoplasty (reshapes or reduces the maxillary bone)\nRemoval of excess mucosa\nSurgical excision\nRemoval of cyst\nSurgical incision\nRemoval of impacted teeth \nRepair of soft tissue\nFrenectomy (correction of tongue tie or lip tie)\n26 \nPSDCP Member Booklet\n*To ensure that claims for scaling/root planning, fluoride and polishing are not declined due to reaching the \nstandard frequency limitation, Canada Life must be informed by the member or provider that the claiming \npatient is going to receive or is receiving chemotherapy to treat cancer. Claims will be approved based on \nconfirmation from the member, provider or supporting medical documentation.\nContinued eligibility for this temporary suspension will be assessed 12 months after the initial approval.\n**Excluding transplants and repositioning of the jaw.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Basic dental services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-major-dental-services", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "major-dental-services", + "marginal_note": "Major dental services", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Major dental services\nMajor dental services: reimbursed at 65% of the eligible expenses\nThe PSDCP covers services used to treat major dental diseases and defects. Below is a list of certain major \ndental services that are covered. \nMajor restorative Limitations \nGold foil Once every 60 months\nPorcelain veneers, metal and porcelain inlays, onlays Once every 60 months with certain conditions\nRetention pins, posts and cores No limitations\nMetal and porcelain crowns Once every 60 months, unless deemed necessary by the \ntreating dental provider and Canada Life approves\nServices and supplies for congenitally missing teeth Coverage under age 23 \nMajor prosthodontics Limitations \nDiagnostic services Replacements are only covered under certain conditions \n– see PSDCP Rule 6.(3)bComplete dentures\nAddition of a tooth to a removable denture\nPartial dentures\nFixed bridges (abutments/retainers, pontics) \nRetentive pins in abutments\nRepairs of fixed appliances\nImplants\nImportant: The PSDCP has an Alternate Benefit Clause for specific dental services. This means the PSDCP \nmay allow reimbursement towards an expense normally not covered or may limit reimbursement to the \ncost of a less expensive Reasonable and Customary dental service.\nIt is strongly advised that you ask Canada Life for a predetermination when a course of treatment is $300 \nor more. Canada Life will let you know how much will be covered and how much you will have to pay out of \npocket. Not all services are eligible for an alternate benefit. See Estimate of reimbursement .\n27\nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Major dental services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-orthodontic-services", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "orthodontic-services", + "marginal_note": "Orthodontic services", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Orthodontic services\nOrthodontic services: reimbursed at 50% of the eligible expenses\nThe PSDCP covers services used to treat misaligned or crooked teeth up to a lifetime maximum. See \nMaximum reimbursement amounts .\nThe PSDCP will reimburse at 90% of the diagnostic services related to orthodontics.\nOrthodontic Limitations \nExaminations No limitations\nX-rays\nDiagnostic casts\nThe PSDCP will reimburse at 50% of the appliances related to orthodontics.\nOrthodontic Limitations \nFixed or removable appliances, such as braces No orthodontic benefits will be paid if the initial \nappliance was installed before the person was covered \nunder the PSDCP .\nOrthodontic services purchased online from direct-\nto-consumer orthodontic treatment providers are not \neligible under the PSDCP . Unless with documented \nprofessional responsibility of a dental provider \ndemonstrated on the claim form.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Orthodontic services”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-third-party-products-and-appliances", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "third-party-products-and-appliances", + "marginal_note": "Third-party products and appliances", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Third-party products and appliances\nPurchasing devices from third-party service providers\nYou can purchase direct-to-consumer devices from third-party service providers when the use of the \nproduct/appliance covered under the PSDCP is under the regular supervision of a licensed dental provider. \nThis is done by ensuring that all related claim forms include the provider’s signature or approved office \nstamp.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Third-party products and appliances”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-submit-a-claim-for-dental-service-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-1", + "marginal_note": "How to submit a claim for dental services incurred in Canada (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to submit a claim for dental services incurred in Canada\nThere are 3 ways to submit a PSDCP claim to Canada Life:\n1. Have your dental provider submit a claim electronically on your behalf\n2. Submit a claim online (through your PSDCP Member Services account or through the My Canada Life \nat WorkTM mobile app)\n3. Submit a claim by mail\n28 \nPSDCP Member Booklet\n1. Have a claim submitted by your dental provider\nMost dental providers can submit dental claims online to Canada Life on your behalf. Present your PSDCP \nbenefit card with your plan number and your certificate number. Your claim will be processed in real time \nand your eligible expenses will be reimbursed by direct deposit or by cheque.\nNote: Eligible dependants will not receive their own PSDCP benefit card and must present the plan number \nand the certificate number seen on the plan member’s PSDCP benefit card to dental providers.\nIt is your responsibility to:\n\n- authorize your dental provider to submit claims\n\n- ensure that your personal information, including your plan number, your certificate number and address \nare correct and current in both your PSDCP Member Services account and with your dental provider\n\n- at time of claim, provide information to your dental provider about any other dental coverage you or your \neligible dependants may have for coordination of benefits\nNote: CAF Primary Reserve must complete paper claim forms, that includes the appropriate unit orderly \nroom stamp, and the Reservist submits it to Canada Life at:\nCanada Life \nWinnipeg Benefit Payments \nPO Box 6025 Station Main \nWinnipeg MB R3C 3C7\n2. Submit a claim online (through your PSDCP Member Services account or the My Canada Life at \nWork mobile app)", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to submit a claim for dental services incurred in Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-submit-a-claim-for-dental-service-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-2", + "marginal_note": "How to submit a claim for dental services incurred in Canada (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Once you have completed positive enrolment and registered for a PSDCP Member Services account \n(canadalife.com/psdcp ), you can submit claims digitally through your PSDCP Member Services account or \nthe My Canada Life at Work mobile app, if your dental provider has not already submitted the claim on your \nbehalf.\nTo submit a claim online:\ni. Sign in to your PSDCP Member Services account or the My Canada Life at Work mobile app.\nii. Select Make a claim.\niii. Choose the appropriate claim type and follow the steps to complete the claim. You will need to \nupload a claim form or a receipt signed by your dental provider to get your reimbursement.\n3. Submit a claim by mail\nTo submit a claim by mail using one of the following options:\ni. Print, complete and sign an authorized claim form.\nYou can either:\n\n- access personalized claim forms by signing in to your PSDCP Member Services account \n(canadalife.com/psdcp )\n\n- select Info centre in the lefthand navigation, then View forms\n\n- select or search for the form you require\n29\nPSDCP Member Booklet\n\n- find blank claim forms on the Forms page of the PSDCP Member Services website ( welcome.\ncanadalife.com/psdcp/forms )\n\n- contact Canada Life to request that a claim form be sent to you by mail\nComplete the claim form with the appropriate information, including:\n\n- your full name and address, including your postal code\n\n- your plan number and your certificate number\n\n- your spouse’s or common-law partner’s dental plan number and certificate number, if applicable\n\n- your signature\n\n- the dental provider’s signature or office stamp in Part I of the claim form\nAttach any invoices or receipts that you may have and ensure that they provide full details of the \nservices rendered or purchases made.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to submit a claim for dental services incurred in Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-submit-a-claim-for-dental-service-3", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-3", + "marginal_note": "How to submit a claim for dental services incurred in Canada (part 3)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Incomplete claim forms will be returned to you for completion.\nii. Mail a claim form from your dental provider to the following address, along with the originals of \nthe supporting documentation (original receipts, invoices, dental provider statements, and/or \nquestionnaires, etc.). Keep a copy for your own files, Canada Life will not return original receipts after \nclaims are processed.\nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7\nWhen submitting a claim under the coordination of benefits provision you must also include any claim \nstatements received from another benefit plan(s).", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to submit a claim for dental services incurred in Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-submit-a-claim-for-dental-service-2-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-2-1", + "marginal_note": "How to submit a claim for dental services incurred outside of Canada (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to submit a claim for dental services incurred outside of Canada\nClaims for dental services incurred outside of Canada can be submitted online or by mail.\nSubmit a claim online (through your PSDCP Member Services account or the My Canada Life at \nWork mobile app)\nOnce you have completed positive enrolment and registered for a PSDCP Member Services account \n(canadalife.com/psdcp ), you can submit claims online through your PSDCP Member Services account or \nthe My Canada Life at Work mobile app. Dental providers outside of Canada are not able to submit claims \non behalf of the member.\nTo submit a claim online:\n1. Sign in to your PSDCP Member Services account or the My Canada Life at Work mobile app.\n2. Select Make a claim.\n3. Select Start a claim.\n4. Select whom the claim is for, then select Continue.\n5. Select Out-of-Canada, then select Continue and follow the steps to complete the claim.\n6. You will need to upload a claim form or receipt signed by your dental provider.\n30 \nPSDCP Member Booklet\nTo submit a claim by mail using one of the following options:\n1. Print, complete and sign a claim form.\nYou can either:\n\n- access personalized claim forms by signing in to your PSDCP Member Services account \n(canadalife.com/psdcp )\n\n- select Info centre in the lefthand navigation, then View forms\n\n- select or search for the form you require\n\n- find blank claim forms on the Forms page of the PSDCP Member Services website ( welcome.\ncanadalife.com/psdcp/forms )\n\n- contact Canada Life to request that a claim form be sent to you by mail\nComplete the claim form with the appropriate information, including:\n\n- your full name and address, including your postal code\n\n- your plan number and your certificate number\n", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to submit a claim for dental services incurred outside of Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-submit-a-claim-for-dental-service-2-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-2-2", + "marginal_note": "How to submit a claim for dental services incurred outside of Canada (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- your spouse or common-law partner’s dental plan and certificate number, if applicable\n\n- your signature\n\n- the appropriate section of the claim form completed by your dental provider, including the dental \nprovider’s signature/stamp \nAttach any invoices or receipts that you may have and ensure that they provide full details of the \nservices rendered or purchases made.\nIncomplete claim forms will be returned to you for completion.\n2. Mail a claim form from your dental provider to the following address, along with the originals of \nthe supporting documentation (original receipts, invoices, dental provider statements, and/or \nquestionnaires, etc.). Keep a copy for your own files, Canada Life will not return original receipts after \nclaims are processed.\nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7\nWhen submitting a claim under the coordination of benefits provision you must also include any claim \nstatements received from another benefit plan(s).", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to submit a claim for dental services incurred outside of Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-deadline-to-submit-a-dental-claim", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "deadline-to-submit-a-dental-claim", + "marginal_note": "Deadline to submit a dental claim", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Deadline to submit a dental claim\nTo be eligible for reimbursement, Canada Life must receive your claims within 15 months of the date the \nexpenses were incurred.\nAn expense is incurred:\n\n- on the date of your single appointment for dental services\n31\nPSDCP Member Booklet\n\n- on the date of your last appointment for dental services that take more than one appointment, such as on \nthe date an appliance is installed\n\n- for orthodontic dental services, the date the appliance is installed and the date of each monthly visit\nClaims submitted after the 15-month period will not be paid unless you can demonstrate that it was \nimpossible for you to submit your claim within 15 months from the date you incurred the expense.\nImportant: Claims submitted more than 24 months after the expense was incurred will not be paid except in \nthe case of legal incapacity.\nIf a child between 21 and 25 years of age who is a full-time student receives dental services during an \nacademic break, claims for those services should not be sent to Canada Life until the student has returned \nto school full-time.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Deadline to submit a dental claim”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-explanation-of-benefits-statement", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "explanation-of-benefits-statement", + "marginal_note": "Explanation of benefits statement", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Explanation of benefits statement\nOnce your claim is processed, you will receive a notification by text, email or mail (depending on your \nnotification method of choice) informing you that an explanation of benefits from Canada Life can be \naccessed online through your PSDCP Member Services account (canadalife.com/psdcp ). The explanation \nof benefits provides details on how your claim was processed and the amount being reimbursed under the \nPSDCP .\nIf you have signed the Public Service Dental Care Plan (PSDCP) Authorization for Claims Submission and \nRedirection of Payment form, which can be found on the Forms page of the PSDCP Member Services \nwebsite (welcome.canadalife.com/psdcp/forms ), for your eligible dependant child(ren)’s claims, payment \nmay be issued to your spouse or common-law partner.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Explanation of benefits statement”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-overpayments", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "overpayments", + "marginal_note": "Overpayments", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Overpayments\nAdministrative error : In situations where you were reimbursed more than what was eligible under the \nPSDCP , Canada Life is authorized to recover the overpayment. You will be advised of the overpayment and \nprovided with different options on how you would like to repay the amount.\nYou can choose one of the following:\n\n- by cheque in the amount of the overpayment or\n\n- by deduction from future claims\nIf you do not acknowledge the overpayment and inform Canada Life of what you would like to do within 30 \ndays, Canada Life will automatically deduct the overpayment from future claim reimbursements.\nAdjudication Error: In situations where an adjudication error is made or an adjudication decision is \nreversed based on additional information, Canada Life will not recover the overpayment but will advise you \nin writing that these expenses will no longer be reimbursed.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Overpayments”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-appeal-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-appeal-1", + "marginal_note": "How to appeal (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to appeal\nAn appeal process is available if you do not agree with a decision regarding your claim or your coverage.\nYou may also wish to review the PSDCP Rules (canada.ca/en/treasury-board-secretariat/topics/benefit-\nplans/plans/dental-care-plan/rules-dental-care-plan-public-service-canada ) to determine if your claim is \neligible under the PSDCP .\n32 \nPSDCP Member Booklet\nBefore you submit a Board of Management Appeal, you must first try to resolve the issue with:\n\n- Canada Life, if your appeal is claim-related\n\n- your departmental compensation office or Pay Centre , if your appeal is coverage-related\nCanada Life claim-related appeal\nYou have the right to appeal a denial of all or part of your claim if you submit a request within 15 months \nfrom the date Canada Life completed the initial assessment of your claim or treatment plan.\nAppeals should be submitted to Canada Life in writing or can be submitted online. If you wish to submit \na Canada Life appeal over the phone, supporting documents (legible originals or copies) or dental \ninformation must be sent to Canada Life by mail for the review.\nEach request must include why you:\n\n- disagree with the claim decision\n\n- believe the claim is eligible\nIn writing:\nMail your supporting documents or dental information to:\nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7\nOnline:\nHow to submit a Canada Life appeal online through your PSDCP Member Services account\n1. Sign in to your PSDCP Member Services account (canadalife.com/psdcp ) and go to the Contact us \npage.\n2. Under Subject, select Benefits.\n3. Under Detailed subject, select Submit a Canada Life appeal .\n4. Complete all remaining fields and upload supporting documentation.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to appeal”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-appeal-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-appeal-2", + "marginal_note": "How to appeal (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "If you are not satisfied with the decision, you can appeal a second time. This can be done in writing through \nyour PSDCP Member Services account (canadalife.com/psdcp ) or by calling the PSDCP Member Contact \nCentre (contact Canada Life). In order to appeal a second time, you must send all the claim details, which \nmust include all additional information that was not previously submitted for review, and why you disagree \nwith the initial Canada Life claim decision.\nBoard of Management Appeal\nIf you have submitted a Canada Life appeal and are still not satisfied with the decision, you may submit an \nappeal to the Board of Management responsible for your component.\nNote: This appeal process is also used to apply for PSDCP coverage for a child from whom you stand in place \nof a parent such as custodial or guardianship situations. The relevant Board of Management will review your \ncase and issue a decision.\n33\nPSDCP Member Booklet\nSee Public Service Dental Care Plan (PSDCP) Appeal Checklist (canada.ca/en/treasury-board-secretariat/\ntopics/benefit-plans/plans/dental-care-plan/public-service-dental-care-plan-appeal-checklist ) for more \ninformation.\nWhat to include in an appeal\nIf you wish to ask the applicable PSDCP Board of Management to review your case, mail your appeal to \none of the following addresses. Your appeal should include why you disagree with the claim or coverage \ndecision and the following information:\n\n- the plan member’s name, address, telephone number and email address\n\n- if the appeal is for an eligible dependant, include their full name and date of birth, medical certificate, \nif referring to a medical condition, and any relevant documentation\n\n- the plan member’s PSDCP certificate number\n\n- the category of the appeal: coverage, enrolment or other\n", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to appeal”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-appeal-3", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-appeal-3", + "marginal_note": "How to appeal (part 3)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "- copies of supporting documents such as:\n\n- the explanation of benefits statement from Canada Life\n\n- correspondences with Canada Life or your departmental compensation office or Pay Centre related to \nthe appeal\n\n- documentation from the dental provider including a treatment plan, additional medical information \nor a rationale for the dental services\n\n- additional information may be requested by the applicable PSDCP Board of Management before an \nappeal decision is final\n\n- if applicable, the latest decision from the Canada Life process outlining their rationale for denial \n(which could include the explanation of benefits)\nThe Boards of Management may meet bi-monthly, quarterly or less frequently depending on the volume of \nappeals. The response to an appeal may take a few months.\nThe decision of the Board of Management is final unless an appellant can provide new information not \npreviously considered.\nWhere to send an appeal\nAppeal documentation should be mailed to the appropriate Board of Management. Medical and dental \nrecords as well as information on eligible dependant child(ren) custody are considered Protected B and \ncannot be emailed. \nIf you are represented by the Public Service Alliance of Canada (PSAC): \nBoard of Management \nDental Care Plan (PSAC) Component \n90 Elgin Street \n3rd Floor, Suite 3026 \nOttawa, Ontario \nK1A 0R5\n34 \nPSDCP Member Booklet\nIf you are a member of the Canadian Armed Forces (CAF) or the Primary Reserve:\nCanadian Armed Forces Dental Care Plan Board \nDirector General Compensation and Benefits \nDirectorate of Pensions and Social Programs \nMGen George R. Pearkes Building \n101 Colonel By Drive \nOttawa, Ontario \nK1A 0K2\nIf you are a member of the Royal Canadian Mounted Police (RCMP):\nRCMP Dental Care Plan Board of Management ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to appeal”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-how-to-appeal-4", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "how-to-appeal-4", + "marginal_note": "How to appeal (part 4)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "National Compensation Services: Insurance \n73 Leikin Drive, M5-4-101 \nMail stop 31 \nOttawa, Ontario \nK1A 0R2\nFor all other members:\nBoard of Management \nDental Care Plan National Joint Council (NJC) \nP .O. Box 1525, Station B \n240 Sparks Street West \n7th floor \nOttawa, Ontario \nK1P 5V2", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “How to appeal”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coordination-of-benefits-with-other-plan-1", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-1", + "marginal_note": "Coordination of benefits with other plans (part 1)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coordination of benefits with other plans\nIt is important to always keep your coordination of benefits information up to date with Canada Life and \nyour dental provider(s) to ensure that you and your eligible dependant(s) receive the benefits to which you \nare entitled. You must provide coordination of benefits information each time you submit a claim online or \nby mail.\nConsult with your dental provider to see if they can submit a coordination of benefit on your behalf at the \ntime of claim.\nIf you are a PSDCP member and you have dental benefits coverage under other insurance, such as your \nspouse’s or common-law partner’s plan, including if your spouse or common-law partner is also a PSDCP \nmember, you may be eligible to coordinate your benefits and receive up to 100% of the actual eligible \ndental expenses.\nThe combined reimbursement from your PSDCP and your spouse’s or common-law partner’s other \ninsurance cannot exceed the lesser of either of the following:\n\n- the expenses incurred\n\n- the amount specified in the previous year’s dental fee guide of the province or territory where the services \nwere rendered\n35\nPSDCP Member Booklet\nExclusions, frequency limitations and annual maximums for each calendar year apply separately under \neach plan.\nIf you and your spouse or common-law partner both have dental plans administered by Canada Life, review \nthe following guidelines to determine which plan you should submit your expenses to first. You do not need \nto submit a second claim for the unpaid balance if you provide the plan and certificate numbers of your \nspouse’s or common-law partner’s dental plan on the claim form or when submitting a claim in your PSDCP \nMember Services account. Canada Life will process the eligible claims under both memberships.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coordination of benefits with other plans”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coordination-of-benefits-with-other-plan-2", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-2", + "marginal_note": "Coordination of benefits with other plans (part 2)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Claims made under your spouse’s or common-law partner’s plan and certificate numbers will be paid to \nthem unless the benefits are assigned to the dental provider.\n\n- If you are a CAF member, consult the Dependants’ Dental Care Plan (DDCP) (canada.ca/en/department-\nnational-defence/services/benefits-military/pay-pension-benefits/benefits/medical-dental/\ndependant-dental-care-plan ).\n\n- If you are a CAF Primary Reservist, consult the Reserve Dental Care Plan Administrative Instructions \n(canada.ca/en/department-national-defence/services/benefits-military/pay-pension-benefits/\nbenefits/medical-dental/reserve-dental-care-plan ).\n\n- If you are covered under the PSDCP and the Pensioners’ Dental Services Plan (PDSP) you can coordinate \nbenefits between both plans. If you are a PSDCP member, your claim will first be paid through the \nPSDCP , followed by the PDSP (some exceptions apply). Please consult the PSDCP Rules (canada.ca/en/\ntreasury-board-secretariat/topics/benefit-plans/plans/dental-care-plan/rules-dental-care-plan-public-\nservice-canada ). The remaining amount, if applicable, would be paid by your spouse or common-law \npartner’s plan.\nIf you or your eligible dependant(s) have dental benefits coverage under other insurance, you must \nprovide this information to your dental provider at time of claim. If your dental provider does not \nprovide coordination of benefits services, you will need to submit the claim to Canada Life with the other \ninsurance’s information.\nCanada Life can help you determine which plan you should claim from first.\nCoordination of benefits guidelines\n\n- For dental services required due to an accidental injury to natural teeth covered under both the Public ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coordination of benefits with other plans”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coordination-of-benefits-with-other-plan-3", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-3", + "marginal_note": "Coordination of benefits with other plans (part 3)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Service Health Care Plan (PSHCP) and the PSDCP , the coverage will be determined under the PSHCP first. \nClaims should be submitted to the PSHCP first.\n\n- For specific oral surgical procedures covered under both the PSHCP and the PSDCP , the coverage will be \ndetermined under the PSDCP first.\n\n- If you are a member of the PSDCP and are also covered under your spouse’s or common-law partner’s \nplan as an eligible dependant, you should submit your claim to your PSDCP first.\n\n- If your spouse or common-law partner is covered under other insurance and is also covered as an eligible \ndependant under your PSDCP , your spouse or common-law partner should submit their expenses to their \nown plan first.\n\n- When your eligible dependant child(ren) are covered under both your PSDCP and your spouse’s or \ncommon-law partner’s plan as eligible dependant(s), the plan that pays first is determined by the \nCanadian Life and Health Insurance Association (clhia.ca/web/CLHIA_LP4W_LND_Webstation.nsf/\npage/28DE0F1EE2ACED4285257841005B27F8!OpenDocument ) for coordination of benefits. Under these \n36 \nPSDCP Member Booklet\nguidelines, the parent whose birthday falls earlier (month and day) in the year must claim the children’s \nexpenses first under their plan. For example, if your birthday is May 1 and your spouse’s or common-law \npartner’s birthday is June 5, you must claim under the PSDCP first.\n\n- The maximum amount that you can receive from all plans for eligible expenses is up to 100% of the actual \neligible expenses.\nHow to coordinate your claims after separation or divorce from your spouse or common-law \npartner\nIn case of divorce or separation, where both parents share custody of a child, the following order of ", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coordination of benefits with other plans”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coordination-of-benefits-with-other-plan-4", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-4", + "marginal_note": "Coordination of benefits with other plans (part 4)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "submission must be followed for the eligible dependant child(ren)’s expenses:\n1. the plan of the parent whose birthday falls earlier in the year\n2. the plan of the parent whose birthday comes later in the year\n3. the plan of the spouse or common-law partner of the parent whose birthday falls earlier in the year\n4. the plan of the spouse or common-law partner of the parent whose birthday comes later in the year\nIf one parent has custody of a child, the following order of submission must be followed for the child’s \nexpenses:\n1. the plan of the parent who has custody of the child\n2. the plan of the spouse or common-law partner of the parent who has custody of the child\n3. the plan of the parent who does not have custody of the child\n4. the plan of the spouse or common-law partner of the parent who does not have custody of the child\nIf you do not have care and custody of your child(ren), you can authorize the person who does have care \nand custody of the child(ren) to file claims and receive payment for the eligible dependant child(ren)’s \ndental services.\nTo authorize direct payment to the person who has custody of the child or children, complete and submit \nthe PSDCP Authorization for Claims Submission and Re-direction of Payment form, which can be found on \nthe Forms page of the PSDCP Member Services website ( welcome.canadalife.com/psdcp/forms ).\nShould you later wish to rescind this authorization, you can do so by writing to Canada Life .", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coordination of benefits with other plans”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coverage-under-a-provincial-or-territori", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coverage-under-a-provincial-or-territori", + "marginal_note": "Coverage under a provincial or territorial plan", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage under a provincial or territorial plan\nIf you are entitled to dental benefits under a provincial or territorial plan or any other third-party source \nof dental care assistance for which you have a legal right and are also covered under the PSDCP , you must \nsubmit to the other plan first as follows.\nProcess:\n1. Submit a claim to your provincial or territorial plan or any other third-party source of dental care \nassistance for which you have a legal right.\n2. Wait for the claim to be processed.\n3. Submit a claim for the remaining eligible expenses to the PSDCP with the explanation of benefits \nfrom the other plan.\n37\nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coverage under a provincial or territorial plan”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-coverage-under-the-public-service-health", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "coverage-under-the-public-service-health", + "marginal_note": "Coverage under the Public Service Health Care Plan (Accident/Surgery)", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage under the Public Service Health Care Plan (Accident/Surgery)\nIf you are a member of both the PSDCP and the Public Service Health Care Plan (PSHCP), you benefit from \ncombined coverage for:\n\n- dental services needed as a result of injury to natural teeth provided the treatment occurs within 12 \nmonths of the accident or, in the case of an eligible dependant child under 17 years of age, before \nattaining 18 years of age\n\n- certain types of surgical dental services \nReason for receiving a \ndental service\nSteps that you need to take to coordinate benefits under the PSDCP and \nPSHCP\nInjury 1. Send a claim to the PSHCP .\n2. If the claim is not fully reimbursed by the PSHCP , send a claim to the PSDCP with:\n\n- a copy of your PSHCP claim form\n\n- a copy of the PSHCP explanation of benefits.\nSurgical procedure 1. Send a claim to the PSDCP .\n2. If the claim is not fully reimbursed by the PSDCP , send a claim to the PSHCP with:\n\n- a copy of your PSDCP claim form\n\n- a copy of the PSDCP explanation of benefits.\nNote: Limitations for Accidental Injury and Oral Surgical Procedures can be found in \nthe PSHCP Directive, Section 6.6 Dental Benefit (njc-cnm.gc.ca/directive/d9/v283/\ns832/en#s832-tc-tm_6).", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Coverage under the Public Service Health Care Plan (Accident/Surgery)”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-prevent-fraud-and-abuse", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "prevent-fraud-and-abuse", + "marginal_note": "Prevent fraud and abuse", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Prevent fraud and abuse\nYou can help protect your dental benefits coverage by following these steps to reduce the incidence of fraud \nand abuse:\n\n- confirm that a service is necessary before you have it performed\n\n- check your invoice to make sure you were charged for:\n\n- the correct amount\n\n- the services or supplies that you received\n\n- review your explanation of benefits statement to ensure that the listed services are correct\n\n- refuse receipts for services or supplies that you did not receive\n\n- do not sign blank claim forms\n\n- check your claims history on your PSDCP Member services account through My Canada Life at Work TM \n(canadalife.com/psdcp ) to make sure that you are aware of all submitted claims\n\n- notify Canada Life if your spouse, common-law partner or eligible dependent child(ren) are no longer \ncovered under the PSDCP\n38 \nPSDCP Member Booklet\nIf you see something suspicious, report it to Canada Life:\n\n- Confidential tip line: 1-866-810-8477\n\n- Email: confide@canadalife.com", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Prevent fraud and abuse”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-dependant-eligibility-verification-progr", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "dependant-eligibility-verification-progr", + "marginal_note": "Dependant Eligibility Verification Program", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Dependant Eligibility Verification Program\nThe purpose of the Dependant Eligibility Verification Program (DEVP)\nThe purpose is to verify, with supporting documents, that dependant(s) who are enrolled under the PSDCP \nare eligible for dental benefits coverage according to the PSDCP Rules (canada.ca/en/treasury-board-\nsecretariat/topics/benefit-plans/plans/dental-care-plan/rules-dental-care-plan-public-service-canada ). \nIf Canada Life determines that a dependant is no longer eligible, their PSDCP coverage will be terminated, \nand you may be responsible to repay any claims that were reimbursed after the date the dependant was no \nlonger eligible.\nIf you do not respond to the request for documents supporting the eligibility of your enrolled dependant(s), \nthe processing of claims for your dependant(s) may be suspended or terminated until the required \ndocuments are received and the eligibility under the PSDCP is verified. You may be responsible to repay any \nclaims that were reimbursed for ineligible dependants.\nWhy you were selected\nThis program is based on a random selection of PSDCP members who have enrolled dependant(s). You will \nbe asked to provide supporting documents to verify your enrolled dependant(s) meet the eligibility criteria \nunder the PSDCP .\nIf you have any questions about the DEVP , contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Dependant Eligibility Verification Program”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-annual-student-eligibility-verification", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "annual-student-eligibility-verification", + "marginal_note": "Annual Student Eligibility Verification", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Annual Student Eligibility Verification\nThe purpose of the Annual Student Eligibility Verification (ASEV)\nThe purpose is to verify, with supporting documents, that the enrolled dependant(s) are eligible for dental \nbenefits coverage as a full-time student according to the PSDCP Rules (canada.ca/en/treasury-board-\nsecretariat/topics/benefit-plans/plans/dental-care-plan/rules-dental-care-plan-public-service-canada ). If \nCanada Life determines that a dependant is no longer eligible, their PSDCP coverage will be terminated, and \nyou may be responsible to repay any claims that were reimbursed after the student was no longer eligible.\nIf you do not respond to the request for documents supporting the full-time student eligibility of your \nenrolled dependant(s), the processing of claims for your dependant(s) may be suspended or terminated \nuntil the required documents are received and the eligibility under the PSDCP as a student is verified. You \nmay be responsible to repay any claims that were reimbursed for ineligible dependants not enrolled in full-\ntime studies.\nWhy you were selected\nIf you are selected to participate in the ASEV, it is because claims have been submitted over the last year \nfor your full-time dependant student(s). You will be asked to provide supporting documents to verify the \nstudent status every year that claims are submitted for your full-time student(s) until they are no longer \neligible for coverage under the PSDCP .\nIf you have any questions about the ASEV, you can contact Canada Life.\n39\nPSDCP Member Booklet", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Annual Student Eligibility Verification”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-canada-life", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "canada-life", + "marginal_note": "Canada Life", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Canada Life\nPSDCP Member Contact Centre\n\n- North America (toll-free): 1-855-415-4414, Monday to Friday from 8 am to 5 pm, your local time \n\n- International (collect): 1-431-489-4064, Monday to Friday from 8 am to 5 pm, ET\nDeaf or hard of hearing access to a telecommunications relay service\n\n- Telephone Teletype (TTY) to Voice: 771 \n\n- Voice to Telephone Teletype (TTY): 1-800-855-0511\nSecure online chat\nSign in to your PSDCP Member Services account through My Canada Life at Work TM (canadalife.com/psdcp ) \nand go to the Contact us page.\nSecure email\nSign in to your PSDCP Member Services account through My Canada Life at Work TM (canadalife.com/psdcp ) \nand go to the Contact us page to email Canada Life.\nMy Canada Life at Work mobile app\nSign in to your PSDCP Member Services account through the My Canada Life at Work TM mobile app and \nselect More to go to the Contact us page. Select Message us, Call us or Mail us.", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Canada Life”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-government-of-canada", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "government-of-canada", + "marginal_note": "Government of Canada", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Government of Canada\nFor more information on registration, eligibility of coverage, benefits and pay deductions while on Leave \nWithout Pay (LWOP), contact your departmental compensation office or Pay Centre . The Pay Centre can \nassist with redirecting your inquiry to the appropriate compensation unit.\nTelephone numbers for the Public Service Pay Centre\n\n- In Canada or the United States: 1-855-686-4729\n\n- Outside of Canada and the United States: 1-506-424-4330\n\n- Hours of operation: Monday to Friday, 7 am to 7 pm, ET", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Government of Canada”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PSDCP-definitions", + "doc_type": "benefits", + "act_code": "PSDCP", + "act_short": "PSDCP", + "act_name": "Public Service Dental Care Plan — Member Booklet", + "section": "definitions", + "marginal_note": "Definitions", + "part": "Public Service Dental Care Plan Member Booklet", + "division": "", + "heading": "", + "text": "Definitions\nFor a complete listing of PSDCP terminology definitions, please visit the PSDCP Rules (canada.ca/en/\ntreasury-board-secretariat/topics/benefit-plans/plans/dental-care-plan/rules-dental-care-plan-public-\nservice-canada ).\n70-0876-05/26 May 2026", + "history": "", + "last_amended": "", + "current_to": "May 2026", + "citation": "PSDCP Member Booklet (May 2026), “Definitions”", + "source_url": "https://www.welcome.canadalife.com/content/dam/rfp/welcome-sites/psdcp/psdcp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-the-pensioners-dental-services-plan-pdsp", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "the-pensioners-dental-services-plan-pdsp", + "marginal_note": "The Pensioners’ Dental Services Plan (PDSP)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "The Pensioners’ Dental Services Plan (PDSP) is a Government of \nCanada sponsored voluntary dental plan offered to eligible federal \npensioners (retired members) from the federal public service, the \nRoyal Canadian Mounted Police (RCMP), the Canadian Armed Forces \n(CAF), members of Parliament, federal judges, designated agencies \nand corporations in receipt of a pension, annuity or annual allowance, \nincluding a survivor pension under one of a number of federal \nsuperannuation acts, and their eligible dependant(s). \nThe purpose of this PDSP Member booklet is to provide you and your \neligible dependant(s) with information about joining the PDSP , your \nPDSP membership, benefits, exclusions and limitations, your claims \nmanagement and contact information. \nThis booklet is not a substitute for the PDSP Rules (canada.ca/en/ \ntreasury-board-secretariat/services/benefit-plans/pensioner-dental-\nservices-plan/pensioners-dental-services-plan-rules), which provides \nthe complete terms and conditions of the PDSP . Where there is a \ndiscrepancy between this booklet and the PDSP Rules, the PDSP Rules \nwill apply. \nThe Pensioners’ Dental Services Plan (PDSP) \nThe PDSP provides reimbursement for certain dental services \nnecessary to prevent or correct dental disease or defect if the services \nare consistent with generally accepted dental practices. The services \nmust be performed by a dental provider licensed or otherwise \nauthorized in accordance with the applicable law to practice in the \njurisdiction in which the services are received. \nPDSP Member booklet 5\nThe PDSP reimburses eligible expenses on a Reasonable and Customary basis, subject to limitations \nidentified in the PDSP Rules (canada.ca/en/treasury-board-secretariat/services/benefit-plans/pensioner-\ndental-services-plan/pensioners-dental-services-plan-rules).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “The Pensioners’ Dental Services Plan (PDSP)”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-governance-of-the-pdsp", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "governance-of-the-pdsp", + "marginal_note": "Governance of the PDSP", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Governance of the PDSP \nThe governance framework of the PDSP is made up of the following entities. Each plays a role in ensuring \nthe proper administration of the PDSP . \nGovernment of Canada \nThe Government of Canada, as plan sponsor, is responsible for the PDSP and establishes PDSP policy. The \nGovernment of Canada assumes full liability for the payment of all expenses related to the operation of the \nPDSP and the payment of eligible claims. The cost of the PDSP is equally shared between the Government \nof Canada and PDSP members (i.e., 50% paid by Employer and 50% paid by member). \nThe PDSP Board \nThe PDSP Board is comprised of Employer and pensioner representatives from the public service, Canadian \nArmed Forces (CAF) and Royal Canadian Mounted Police (RCMP). The PDSP Board is mandated to provide \nadvice to the President of the Treasury Board or designated officials on all aspects of the PDSP including \ncontribution rates, plan design, performance of the plan administrator, and the resolution of member \nappeals. \nCanada Life \nThe PDSP is administered by The Canada Life Assurance Company (Canada Life) on behalf of the \nGovernment of Canada. Canada Life’s role is to process claims, answer benefit inquiries in accordance with \nthe \nPDSP Rules (canada.ca/en/treasury-board-secretariat/services/benefit plans/pensioner-dental-\nservices-plan/pensioners-dental-services-plan-rules), and provide services as specified in the PDSP \nAdministrative Services Only Contract. \nThe Pension Centre \nThe Pension Centre is responsible for verifying eligibility requirements in accordance with the PDSP Rules, \nregistering eligible pensioners or survivors into the plan and collecting and adjusting contribution rates \nupon written requests from plan members. They are responsible for notifying \nCanada Life of the effective \ndate of coverage for all new and existing pensioners. \nPDSP Member booklet 6", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Governance of the PDSP”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-eligibility-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "eligibility-1", + "marginal_note": "Eligibility (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Eligibility \nTo become a member of the PDSP , you must meet the eligibility requirements described in the PDSP Rules \n(canada.ca/en/treasury-board-secretariat/services/benefit plans/pensioner-dental-services-plan/ \npensioner\ns-dental-services-plan-rules). \nEligible pensioner \n\n- You are a pensioner in receipt of an ongoing recognized monthly pension from the Canadian federal \ng\novernment (some exceptions apply, please consult the PDSP Rules to learn more) (canada.ca/en/ \ntreasury-board-secretariat/services/benefit-plans/pensioner-dental-services-plan/pensioners-dental-\nservices-plan-rules.html#Toc129481895). \n\n- You are an eligible surviving dependant of a pensioner who has died, and you are eligible for coverage \nunder the PDSP because you are in receipt of an ongoing recognized monthly pension from the Canadian \nf\nederal government (canada.ca/en/treasury-board-secretariat/services/benefit-plans/pensioner-\ndental-services-plan/pensioners-dental-services-plan-rules.html#Toc129481895). \nEligible dependant \n\n- Your spouse \n\n- Your common-law partner, the person you are cohabiting with in a conjugal relationship for a period of at \nleast 1 year (12 months) \nNote: If you have both a legal spouse and a common-law partner, you can cover only one. The PDSP will \nonly c\nover the person you include in your positive enrolment. Divorced spouses cannot be covered under \nthe PDSP\n. If you voluntarily terminate coverage of a dependant, they cannot be covered under the PDSP \nas your dependant again in the future. \n\n- Your or your spouse’s or common-law partner’s unmarried children including a natural child, adopted \nchild, stepchild or a child for whom you stand in place of a parent (conditions apply, see Pensioners’ \nDent", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Eligibility”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-eligibility-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "eligibility-2", + "marginal_note": "Eligibility (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "al Services Plan (PDSP) Appeal Checklist ( canada.ca/en/treasury-board-secretariat/services/ \nbene\nfit-plans/pensioner-dental-services-plan/appeal-checklist)) if: \n\n- the child is under 21 years of age \n\n- the child is between 21 and 25 years of age and attending an accredited school, college or university \non a full-time basis \n\n- the child is over 21 or 25 years of age who was an eligible dependant child under the PDSP or Public \nService Dental Care Plan (PSDCP) when becoming incapable of self-sustaining employment by reason \nof mental or physical impairment or on the date the pensioner is eligible for the PDSP . To apply \nfor coverage of a dependant child with a disability, complete and submit the PDSP Application for \nDependant with a Disability Co\nverage Form (welcome.canadalife.com/content/dam/rfp/welcome-\nsit\nes/pdsp/M7450(PDSP).pdf) to Canada Life within 31 days of the child turning 21 years of age or 25 \nyears of age if the child is a full-time student. \nPDSP Member booklet 7\nNote: If you have a child between 21 and 25 years of age in school, college or university, coverage \nis suspended at the end of each academic year and reinstated when Canada Life receives proof of \nre-enrolment. For example, if your child’s school term is from September to April, claims cannot be \nsubmitted from May to August. Once coverage is reinstated, any dental work completed during the \nsummer months can be submitted for reimbursement under the PDSP . \nNote about how a child is defined: A child who does not meet the definition of child for the purposes \nof the PDSP\n, but for whom you stand in place of a parent, may be eligible for coverage with the \napproval of the PDSP Board. To obtain coverage for such a child, you must provide supporting ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Eligibility”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-eligibility-3", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "eligibility-3", + "marginal_note": "Eligibility (part 3)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "documentation to the PDSP Board, such as one of the following: \n\n- a permanent guardianship (court) order \n\n- a custodial (court) order \n\n- a notarized private guardianship agreement, caregiving agreement or a notarized voluntary \nsurrender of custody and guardianship that indicates that the parent or parents relinquish their \nparental responsibility to you \nThe PDSP Board will also consider: \n\n- the extent to which you, your spouse or common-law partner are financially responsible for the \nsupport and maintenance of the child \n\n- whether your relationship is that of parent and child \n\n- the expected duration of this relationship", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Eligibility”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-apply-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-apply-1", + "marginal_note": "How to apply (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to apply \nThe Pensioners’ Dental Services Plan Form is a multipurpose form used to apply, amend or terminate PDSP \ncoverage. \nPensioner \nIf you are about to retire, you should receive the Pensioners’ Dental Services Plan Form in your retirement \npackage or you can contact the Pension Centre or your pension office to request that one be mailed to you. \nIf you are already retired, you can get the Pensioners’ Dental Services Plan Form mailed to you by contacting \nthe Pension Centre or your pension office. \nSurvivor \nIf you become entitled to a survivor pension, you may be eligible to apply to the PDSP as a member in your \nown right. To apply for survivor coverage under the PDSP , contact the Pension Centre or your pension \no\nffice of the deceased member and send the PDSP member’s death certificate. If you are eligible, a \nP\nensioners’ Dental Services Plan Form will be mailed to you. \nImportant: Once your initial PDSP application as a survivor is approved by the Pension Centre or your \npension offic\ne, you will receive your PDSP plan number (e.g. 92115) and your certificate number. Your \ncertificate number is your unique identification number under the PDSP . You must then complete positive \nenr\nolment with Canada Life before you submit claims. \nPDSP Member booklet 8 \nIf you complete positive enrolment online, you will immediately receive a confirmation email and you will \nbe able to view, download and print a PDF copy of your PDSP benefit card. You can also save your PDSP \nbenefit card directly to your phone through the My Canada Life at Work\nTM mobile app. \nIf you complete positive enrolment by mail, you will receive a letter in approximately 3 weeks from the date \nCanada Life receives your completed PDSP Positive Enrolment Form that includes a confirmation statement ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to apply”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-apply-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-apply-2", + "marginal_note": "How to apply (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "and a paper PDSP benefit card. \nYou and your eligible dependant(s) must provide your plan number and your certificate number to Canada \nLife when submitting a claim either online or by mail and to your dental provider, so that they can submit \nclaims on your behalf. Eligible dependants will not receive their own PDSP benefit card and must present the \nplan number and the certificate number seen on the plan member’s PDSP benefit card to dental providers.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to apply”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coverage-start-date", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coverage-start-date", + "marginal_note": "Coverage start date", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage start date \nIf you apply for PDSP coverage before or within 60 days of your pension eligibility date, your coverage, \nincluding coverage for eligible dependants, will start on the eligibility date. \nExample: If your pension eligibility date is April 2, 2024, and your application for coverage under the PDSP \nis received by the Pension Centre or your pension office on May 20, 2024 (within 60 days), your coverage \nstarts on April 2, 2024. \nIf you apply more than 60 days after your pension eligibility date, your coverage, including coverage for \neligible dependants, will start on the first day of the second month following the date your completed and \nsigned application form is received by the Pension Centre or your pension office. \nExample: If your pension eligibility date is May 1, 2024, and the Pension Centre or your pension office receives \nyour completed and signed form on October 25, 2024, your coverage will begin on December 1, 2024. \nImportant: Expenses incurred between your pension start date and your PDSP start date will not be \ncovered. \nImportant: If you and your spouse or common-law partner are eligible under the PDSP , you may both \nbecome a member in your own right or one of you may be covered as an eligible dependant of the other. \nThe same person cannot be covered as both a member and an eligible dependant. In addition, your eligible \ndependant children can only be covered under 1 PDSP member. Coordination of benefits is not allowed \nbetween 2 PDSP members.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coverage start date”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-mandatory-enrolment-period", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "mandatory-enrolment-period", + "marginal_note": "Mandatory enrolment period", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Mandatory enrolment period \nWhen you apply for PDSP coverage for you and your eligible dependant(s), you agree to participate in the \nPDSP for a minimum of 3 complete calendar years before you can voluntarily terminate coverage. \nExample: If you became a member (Category 1 - Pensioner only) on June 1, 2024, you cannot voluntarily \nterminate coverage until after December 31, 2027. \nIf you add an eligible dependant to your PDSP , the same 3 complete calendar year mandatory enrolment \nperiod applies, after you add the eligible dependant. \nExample: If you became a member on June 1, 2024, and add an eligible dependant on June 1, 2025, you \ncannot voluntarily terminate coverage until after December 31, 2028. \nPDSP Member booklet 9\nException to the mandatory enrolment period: You may voluntarily terminate coverage under the PDSP at \nany time if you become a member of the Public Service Dental Care Plan (PSDCP) or if you become eligible \nfor dental benefits with the Canadian Armed Forces or Royal Canadian Mounted Police. You may also \nvoluntarily terminate PDSP coverage for your eligible dependant(s) at any time due to certain life events \nsuch as dependant child’s graduation, death, divorce or separation from a common-law partner. Some \nexceptions apply. Contact the Pension Centre or your pension office for more information.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Mandatory enrolment period”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-positive-enrolment-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "positive-enrolment-1", + "marginal_note": "Positive enrolment (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Positive enrolment \nPositive enrolment is the process where you provide Canada Life with information about you and your \neligible dependant(s) to ensure your claims can be processed accurately. Through positive enrolment, you \nmust provide consent for the use of your personal information. See Protecting your private information. If \ny\nou do not complete positive enrolment and provide consent, Canada Life cannot process your claims. \nTo complete positive enrolment, you will need to provide the following information about you and your \neligible dependant(s), if applic\nable: \n\n- first and last name \n\n- date of birth \n\n- gender – male, female, other or prefer not to answer \n\n- certificate number \n\n- contact information, including complete address \n\n- bank account information (required, only if you wish to set up direct deposit for faster claim payments) \n\n- your plan number which is determined by your birth month or member status: \n\n- January to March 92111 \n\n- April to June 92112 \n\n- July to September 92113 \n\n- October to December 92114 \n\n- eligible surviving dependant \n(eligible spouse/common-law partner and children) 92115 \nFor example, if you are a pensioner born in the month of November, your plan number is 92114. If you are \nan eligible sur\nviving dependant, your plan number is 92115, regardless of your month of birth. \nIf you are new to the PDSP or you are unable to locate your certificate number, please call the Pension \nCentr\ne or your pension office. \nIf you need to make any updates to your personal information such as last name, date of birth, or change \ny\nour category of coverage I, II, III, which are all associated with your pension file, contact the Pension \nCentr\ne or your pension office. ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Positive enrolment”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-positive-enrolment-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "positive-enrolment-2", + "marginal_note": "Positive enrolment (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "If you need to make any updates to your banking information, you can choose one of the following \nme\nthods: \n\n- print, complete and sign a PDSP Direct Deposit form, which you can find on the Forms page of the PDSP \nMember Ser\nvices website (welcome.canadalife.com/pdsp/forms) \nPDSP Member booklet 10 \n\n- sign in to your PDSP Member Services account through My Canada Life at Work TM (canadalife.com/pdsp) \nor the My Canada Lif\ne at Work mobile app, go to the profile icon in the top right corner (top left corner for \nmobile app) of the screen, select Your profile, then select Banking \n\n- contact Canada Life to request that a PDSP Direct Deposit form be sent to you by mail \nHow to complete your initial positive enrolment online \n1. Visit Positive enrolment ( welcome.canadalife.com/pdsp/positive-enrolment) and select Complete \npo\nsitive enrolment. This will bring you to the PDSP positive enrolment page. This page is only to be \nused for initial positive enrolment. See Keep your positive enrolment information up to date for \nins\ntructions on how to update your positive enrolment information. \n2. On the PDSP positive enrolment page, enter your last name, date of birth and PDSP certificate \nnumber\n, then select Continue. \n3. You will need to complete the steps outlined on the screens, provide consent and submit your \npositiv\ne enrolment information. You will immediately receive a confirmation email and you will be \nable to view, download and print a PDF copy of your PDSP benefit card. \n4. Once positive enrolment is completed, create your PDSP Member Services account through My \nCanada Lif\ne at WorkTM (canadalife.com/pdsp) (see Benefits of a PDSP Member Services account). \n\n- Note: If you are also a Public Service Health Care Plan (PSHCP) member and have a PSHCP Member ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Positive enrolment”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-positive-enrolment-3", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "positive-enrolment-3", + "marginal_note": "Positive enrolment (part 3)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Services account, use the same email address and password to sign in to your PDSP Member \nServices account. \nHow to complete your initial positive enrolment by mail \nThere are 2 ways to get a paper PDSP Positive Enrolment Form: \n1. Visit the PDSP Member Services website ( canadalife.com/pdsp): \ni. Select Forms. \nii. Find, download and print the Positive Enrolment Form. \n2. Contact Canada Life to request that a PDSP Positive Enrolment Form be sent to you by mail. \nOnce you have your paper PDSP Positive Enrolment Form: \n1. Fill out the double-sided PDSP Positive Enrolment Form legibly. \n2. Double check the form to make sure your information is complete and accurate. \n3. Sign and date the form. \n4. Mail your Positive Enrolment Form to the address indicated on the form. \nYou will receive a letter, in approximately 3 weeks from the date Canada Life receives your completed PDSP \nP\nositive Enrolment Form, that includes a confirmation statement and a paper PDSP benefit card. \nIf your form was incomplete or illegible, your form will be returned to you by mail, within 3 weeks, and you \nwill need t\no resubmit a new form to Canada Life. If you submit a claim before your positive enrolment is \ncompleted, the claim will not be assessed or retained, and you will need to resubmit the claim after you \ncomplete positive enrolment. \nAdditionally, if your form does not match your PDSP positive enrolment information, your form will be \nr\neturned to you by mail with instructions to contact the Pension Centre or your pension office to update \ny\nour category of coverage. \nPDSP Member booklet 11\nOnce you have completed positive enrolment, you may submit claims under the PDSP (see Claims \nmanagement).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Positive enrolment”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-pdsp-benefit-card-plan-number-and-certif", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "pdsp-benefit-card-plan-number-and-certif", + "marginal_note": "PDSP benefit card (plan number and certificate number)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "PDSP benefit card (plan number and certificate number) \nYour PDSP benefit card includes your plan number and your certificate number \n\n- You and your eligible dependant(s) must provide your plan number and your certificate number to \nCanada Life when submitting a claim either online or by mail, and to your dental provider, if they can \nsubmit claims on your behalf. \n\n- Note: Eligible dependants will not receive their own PDSP benefit card and must present the plan \nnumber and the certificate number seen on the plan member’s PDSP benefit card to their dental \nproviders. \n\n- Your plan number and your certificate number are needed: \n\n- on all claims submitted for yourself and your eligible dependant(s) \n\n- in all correspondence with Canada Life \n\n- Your benefit card also includes Canada Life contact information. \nShould you lose your paper PDSP benefit card, sign in to your PDSP Member Services account (canadalife. \ncom/pdsp) to download and print one or contact Canada Life to request that a paper benefit card be sent to \nyou by mail. You can also contact the Pension Centre or your pension office to get your certificate number. \nYour plan number is determined by your birth month (see Positive enrolment).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “PDSP benefit card (plan number and certificate number)”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-protecting-your-private-information-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "protecting-your-private-information-1", + "marginal_note": "Protecting your private information (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Protecting your private information \nCanada Life takes your privacy very seriously. It is a legal requirement to collect consent and indicate how \nand when Canada Life will use private information and who will not be able to access private information. \nThis includes providing consent to the Government of Canada, the PDSP Board and Canada Life to \naccess your personal information. Your consent allows Canada Life to collect, use and disclose personal \ninformation about you and your eligible dependant(s) for the purpose of processing claims in and out of \nCanada. Refer to the \nPrivacy Statement (canada.ca/en/treasury-board-secretariat/topics/benefit-plans/ \nplans/pensioner-dental-services-plan/resources/pensioners-dental-services-plan-privacy-statement) \nfor further information on how your privacy is protected. For a copy of the \nPrivacy policy (canadalife.com/ \nprivacy), or if there are any questions about Canada Life’s personal information policies and practices, \nincluding with respect to service providers, reach out to Canada Life’s Chief Compliance Officer by referring \nto \nContact Us: Privacy rights request (canadalife.com). \nProviding consent \nWhether completing positive enrolment online or by mail, you must carefully read the Authorization \nand Declaration (welcome.canadalife.com/pdsp/positive-enrolment/review-authorizations-and-\ndeclarations) section and provide consent. If you do not provide consent, Canada Life cannot process your \nclaims. If you submit a claim but have not completed positive enrolment or provided consent, your claim \nwill not be processed. \nPDSP Member booklet 12 \nNote: Make sure to read the Authorization and Declaration (welcome.canadalife.com/pdsp/positive-\nenr", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Protecting your private information”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-protecting-your-private-information-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "protecting-your-private-information-2", + "marginal_note": "Protecting your private information (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "olment/review-authorizations-and-declarations) section during online positive enrolment or on \nthe paper Positive Enrolment Form carefully before providing consent. For more information, please \nvisit Canada Life’s Privacy policy ( canadalife.com/privacy).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Protecting your private information”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-keep-your-positive-enrolment-information", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "keep-your-positive-enrolment-information", + "marginal_note": "Keep your positive enrolment information up to date", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Keep your positive enrolment information up to date \nYou can update or change your positive enrolment information at any time. To avoid any disruption of your \nclaims being processed, you are responsible for keeping your personal information up to date. \nImportant: If you need to make any updates to your personal information such as last name, date of birth \nor chang\ne your category of coverage I, II, III, which are all associated with your pension file, contact the \nPension Centre or your pension office. \nIf you need to make any updates to your banking information, you can choose one of the following \nme\nthods: \n\n- print, complete and sign a PDSP Direct Deposit form, which you can find on the Forms page of the PDSP \nMember Ser\nvices website (welcome.canadalife.com/pdsp/forms) \n\n- sign in to your PDSP Member Services account through My Canada Life at Work TM (canadalife.com/pdsp) \nor the My Canada Lif\ne at Work mobile app, go to the profile icon in the top right corner (top left corner for \nmobile app) of the screen, select Your profile, then select Banking \n\n- contact Canada Life to request that a PDSP Direct Deposit form be sent to you by mail \nIt is important to note that the changes would also need to be updated separately for the Public Service \nHe\nalth Care Plan (PSHCP) ( canada.ca/en/treasury-board-secretariat/services/benefit-plans/contacts-\ngr\noup-insurance-benefit-plans), where applicable. \nTo make changes to your positive enrolment information, you have 3 options: \n1. Sign in to your PDSP Member Services account ( canadalife.com/pdsp) and go to the profile section \nt\no update your information. \n2. Print and complete the PDSP Positive Enrolment Form and submit it to Canada Life. \n3. Contact Canada Life to request that a PDSP Positive Enrolment Form be sent to you by mail. \nComple\nte and return the form to Canada Life.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Keep your positive enrolment information up to date”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-registering-for-online-and-digital-tools", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "registering-for-online-and-digital-tools", + "marginal_note": "Registering for online and digital tools", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Registering for online and digital tools \nCommitment to the Environment \nThe Government of Canada and Canada Life are working to protect and preserve our planet for future \ngenerations. You can help reduce paper waste by managing your PDSP correspondence, claims and \npersonal information online. Sign in to your", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Registering for online and digital tools”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-pdsp-member-services-account", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "pdsp-member-services-account", + "marginal_note": "PDSP Member Services account", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "PDSP Member Services account ( canadalife.com/pdsp), go to \nthe \nprofile icon in the top right corner (top left corner for mobile app) of the screen, select Your profile and \nthen Communications preferences. \nPDSP Member booklet 13\nPDSP Member Services account \nBenefits of a PDSP Member Services account \nBy creating a PDSP Member Services account through", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “PDSP Member Services account”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-my-canada-life-at-work-online-and-mobile-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "my-canada-life-at-work-online-and-mobile-1", + "marginal_note": "My Canada Life at Work (online and mobile app) (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "My Canada Life at Work (online and mobile app) \n(canadalife.com/pdsp), you can: \n\n- access your PDSP benefit card and save it directly to your mobile device \n\n- view your plan number and your certificate number \n\n- provide positive enrolment consent \n\n- update your positive enrolment information \n\n- view, edit or terminate dependant(s) \n\n- add or update your banking information \n\n- sign up for direct deposit for claim payments \n\n- submit claims online and access claims history \n\n- submit a treatment plan or estimate \n\n- get notified when claims have been processed \n\n- access the details of benefits, claim forms and other important information \n\n- find a provider \n\n- submit coordination of benefits claims (restrictions apply to coordinating benefits between 2 PDSP \nmembers) or submit the remaining balance of a claim already processed through other insurance \n\n- submit photos of receipts for all dental care expenses \n\n- send supporting documentation requested by Canada Life \n\n- review your coverage and balances \n\n- submit an appeal through the Contact us page \n\n- use biometrics (face recognition, touch or fingerprint ID) to sign in \n\n- access the Help Centre \n\n- contact Canada Life using the secure online chat or secure email from the Contact us page \nHow to create a PDSP Member Services account \nPositive enrolment must be completed before you create a PDSP Member Services account. Allow at least \n48 hours after completing positive enrolment to create your account. This will allow for your information to \ntransfer through the system and appear in your account. \nTo create an account: \n1. You will need your plan number and your certificate number. \n2. Go to the PDSP Member Services website (canadalife.com/pdsp). ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “My Canada Life at Work (online and mobile app)”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-my-canada-life-at-work-online-and-mobile-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "my-canada-life-at-work-online-and-mobile-2", + "marginal_note": "My Canada Life at Work (online and mobile app) (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "3. If you already have a Canada Life account, select Sign in. \n4. If you do not have a Canada Life account, select Register. \n5. Select Start now. \n6. Follow the prompts on the screen. \nPDSP Member booklet 14 \nIf you already have an account with Canada Life for any of your benefit plans, please sign in to your \nPDSP Member Services account (canadalife.com/pdsp) using your existing login credentials. You will be \nprompted to view coverage information for each of your benefit plans and can switch between the plans. \nIf you do not see one of your benefit plans online, please contact Canada Life. \nIf you have any questions, contact Canada Life. \nMy Canada Life at Work (online and mobile app) \nHow to get started \n1. Create a PDSP Member Services account (canadalife.com/pdsp) if you have not already done so. \n2. Download the My Canada Life at Work mobile app from your app store (App Store or Google Play). \n3. Sign in using the same email address and password you use for your PDSP Member Services account. \nIf you are already a Public Service Health Care Plan member and have the Canada Life at Work \nmobile app \nIf you are a Public Service Health Care Plan (PSHCP) or Public Service Dental Care Plan (PSDCP) member \nand are already using the My Canada Life at Work mobile app, make sure your device is set up for automatic \nupdates. Your app will automatically update to include coverage information for all your benefit plans. If \nyour device is not set up for automatic updates, you will need to manually update the app from the App \nStore or Google Play. \nOnce the app has updated, and you sign in, you will be prompted to view coverage information for each of \nyour benefit plans and you will be able to switch views between the plans. ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “My Canada Life at Work (online and mobile app)”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-my-canada-life-at-work-online-and-mobile-3", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "my-canada-life-at-work-online-and-mobile-3", + "marginal_note": "My Canada Life at Work (online and mobile app) (part 3)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "If you use biometrics (face recognition, touch or fingerprint ID) to sign in to the app, you will need to use \nthe Switch Plan function, which you can access by selecting the profile icon located in the top left corner of \nyour screen. \nIf you have any questions, please contact Canada Life. \nImportant device settings \n\n- It is important to turn on your automatic updates to ensure fixes and updates download immediately to \nyour device. \n\n- The mobile app presents in the language set on your mobile device and may be different than the \nlanguage preference you indicated during positive enrolment with Canada Life. Be sure to set your mobile \ndevice to your language preference. \n\n- If you require Telephone Teletype (TTY), ensure the device setting for this option is on. \n2-step verification \nKeeping your information secure is important to us. That is why we have another layer of security to your \nPDSP Member Services account (canadalife.com/pdsp) for both online and mobile application. This 2-step \nverification process is a fast and easy way to verify your identity when signing in to your account. \nFor more information on 2-step verification, please review the 2-step verification FAQ (welcome. \ncanadalife.com/pdsp/2-step-verification-faq). \nPDSP Member booklet 15", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “My Canada Life at Work (online and mobile app)”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-contributions", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "contributions", + "marginal_note": "Contributions", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Contributions \nThe PDSP costs are equally shared between the Government of Canada and the PDSP members (i.e., 50% \npaid by Employer and 50% paid by member).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Contributions”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-categories-of-coverage", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "categories-of-coverage", + "marginal_note": "Categories of coverage", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Categories of coverage \n\n- Category I Pensioner only \n\n- Category II Pensioner and one eligible dependant (family member) \n\n- Category III Pensioner and more than one eligible dependant (family members) \nFor contribution rates, see the PDSP Rules (canada.ca/en/treasury-board-secretariat/services/benefit-\nplans/pensioner-dental-services-plan/pensioners-dental-services-plan-rules.html#Toc129481952). \nIf your net pension is not enough to cover the monthly contribution amount, you may still be eligible to join \nthe PDSP . Contact the \nPension Centre or your pension office for more information. \nImportant: It is your responsibility to make sure your category of coverage is up to date.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Categories of coverage”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-when-and-how-to-report-changes-that-affe", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "when-and-how-to-report-changes-that-affe", + "marginal_note": "When and how to report changes that affect dental benefits coverage", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "When and how to report changes that affect dental benefits coverage \nFrom time to time, there may be circumstances that change your coverage needs. To ensure that your \ncategory of coverage, corresponding contribution rate and personal information are up to date, you are \nresponsible for informing the \nPension Centre or your pension office in writing about certain life changes \nthat could affect your coverage, such as: \n\n- a change of address \n\n- a change in marital status (common-law partnership, marriage, separation, divorce, widowed) \n\n- adding or removing an eligible dependant \n\n- a dependant child turning 21 and no longer in full-time attendance at a recognized school \n\n- a dependant child turning 25 \n\n- the death of an eligible dependant \nThe Pension Centre or your pension office can provide you with a multi-purpose form used to start, amend \nor terminate PDSP coverage. \nImportant: These changes should also be reported to the Pension Centre or your pension office. The PDSP \nand PSHCP each require separate forms to make changes. \nIn general, changes to your PDSP coverage will take effect on the first day of the second month following the \ndate the Pension Centre or your pension office receives your completed PDSP Form. \nExample: If the Pension Centre or your pension office receives your PDSP Form for coverage changes on \nJune 15, 2024, the changes will take effect on August 1, 2024. \nPDSP Member booklet 16", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “When and how to report changes that affect dental benefits coverage”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coverage-termination-date", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coverage-termination-date", + "marginal_note": "Coverage termination date", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage termination date \nYour PDSP coverage will terminate on the earliest of the following: \n\n- the date of your death \n\n- the first day of the second month following the date the Pension Centre or your pension office receives \nyour voluntary request to terminate your PDSP coverage, provided you and your eligible dependant(s), if \nany, have been covered under the PDSP for the \nmandatory enrolment period \nExample: If the Pension Centre or your pension office receives your voluntary request to terminate \nyour PDSP coverage on June 15, 2024, your PDSP coverage will terminate on August 1, 2024. \n\n- the first day of the second month following the month in which you cease to be an eligible pensioner \nExample: If you cease to be an eligible pensioner on June 15, 2024, your PDSP coverage will terminate \non August 1, 2024.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coverage termination date”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-voluntary-termination-of-coverage", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "voluntary-termination-of-coverage", + "marginal_note": "Voluntary termination of coverage", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Voluntary termination of coverage \nIf you voluntarily terminate PDSP coverage for you or your eligible dependant(s), you cannot register for \ncoverage under the plan again. Some exceptions apply. Please consult the \nPDSP Rules (canada.ca/en/ \ntreasury-board-secretariat/services/benefit-plans/pensioner-dental-services-plan/pensioners-dental-\nservices-plan-rules.html#Toc129481904) for more information.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Voluntary termination of coverage”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-31-calendar-day-exception", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "31-calendar-day-exception", + "marginal_note": "31-calendar-day exception", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "31-calendar-day exception \nAn exception will be made if a dental service was started before your coverage end date. You or your eligible \ndependant(s) will be covered if that service is completed within 31 calendar days of your coverage end date. \nFor example, this exception would apply for any of the following dental services: \n\n- root canal where the pulp chamber was opened before the coverage end date \n\n- a crown was being prepared and impressions had been taken before the coverage end date \n\n- ongoing orthodontic treatment where the initial appliance was inserted before the coverage end date", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “31-calendar-day exception”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-accessing-claim-summary-reports", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "accessing-claim-summary-reports", + "marginal_note": "Accessing claim summary reports", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Accessing claim summary reports \nTo access applicable claim summary reports, which can be used for income tax purposes: \n1. Sign in to your PDSP Member Services account through My Canada Life at Work TM (canadalife.com/ \npdsp). \n2. From the lefthand navigation, Select Benefits, then Claim History. \n3. Select the option Create a claim summary. \nYou can also call Canada Life’s PDSP Member Contact Centre for inquiries within North America (toll-free) at \n1-855-415-4414, Monday to Friday from 8 am to 5 pm, your local time, or for international inquiries (collect) \nat 1-431-489-4064, Monday to Friday from 8 am to 5 pm, ET . \nImportant: After termination you can only access your claim summary reports by calling the PDSP Member \nContact Centre. \nPDSP Member booklet 17\nThe annual deductible may be carried over", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Accessing claim summary reports”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-before-incurring-an-expense", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "before-incurring-an-expense", + "marginal_note": "Before incurring an expense", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Before incurring an expense \nSome products and services may be costly. Before you incur dental expenses, know your PDSP coverage \nand details and how they impact your reimbursements.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Before incurring an expense”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-reasonable-and-customary-charges", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "reasonable-and-customary-charges", + "marginal_note": "Reasonable and Customary Charges", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Reasonable and Customary Charges \nThe PDSP provides reimbursement for eligible dental services based on the provincial or territorial dental \nfee guides in effect the previous year. See \nClaim calculation example below. \nA dental fee guide is a listing of Reasonable and Customary Charges recommended by the respective \nprovincial or territorial dental association for specified services, provided by a specific practitioner type in a \nprovince or territory. \nIf services are provided by a qualified specialist in endodontics, prosthodontics, oral surgery, periodontics, \npedodontics or orthodontics (whose dental practice is limited to that specialty), then the fee guide \napproved by the provincial or territorial dental association for that specialist will be used.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Reasonable and Customary Charges���", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-out-of-canada-benefit", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "out-of-canada-benefit", + "marginal_note": "Out-of-Canada Benefit", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Out-of-Canada Benefit \nIf you are temporarily outside of Canada and need dental services, the PDSP will provide reimbursement \nbased on the previous year’s dental fee guide for your province or territory of residence. \nIf you live outside of Canada, the PDSP provides reimbursement for eligible dental services based on the \nReasonable and Customary Charges in the location where the services are rendered up to the previous \nyear’s Ontario dental fee guide. Reimbursement is paid in Canadian dollars. Members residing in the United \nStates can choose to receive reimbursement in US dollars by cheque.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Out-of-Canada Benefit”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-annual-deductible", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "annual-deductible", + "marginal_note": "Annual deductible", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Annual deductible \nThe annual deductible is the dollar amount you must pay each calendar year. The annual deductible \namount is $25 for one covered person or $50 for more than one covered person and is deducted from your \nfirst claim(s) each calendar year. See \nClaim calculation example. \nIf the annual deductible is paid for a dental expense in the last 3 months of the calendar year (October 1 to \nDecember 31), a new annual deductible will not be charged in the following calendar year.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Annual deductible”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-co-payment", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "co-payment", + "marginal_note": "Co-payment", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Co-payment \nAfter the annual deductible amount has been paid, the PDSP will reimburse you for a percentage of the \neligible expenses. The PDSP covers 90% for eligible preventive and basic dental services, and 50% for \neligible major restorative and orthodontic services. You are required to pay the remaining amount, which is \ntherefore referred to as the co-payment amount. \nThe table below shows your co-payments depending on services received. \nEligible expense submitted PDSP pays What you pay (co-payment) \nPreventive and basic dental services 90% 10% \nMajor restorative and orthodontic services 50% 50% \nPDSP Member booklet 18 \nImportant: You are responsible for any amount not reimbursed by the PDSP , even in cases where the dental \nprovider charged more for a given service or procedure than the amount in the applicable dental fee guide \nfor the previous year. \nClaim calculation example \nEligible \nexpense \n(based on \nReasonable \nand Customary \nCharges) \n(1) \nCovered \neligible \nexpense\n(%) \nDental \nservice \nAmount \ncharged \nAnnual \ndeductible \nWhat \nyou pay \nPDSP pays (2) \nRecall exam $65 $60 $25 $35 at 90% $31.50 $33.50 \nCrown \nincluding \nlab fees \n$1,500 $1,300 Already paid $1,300 at 50% $650 $850 \n1. Up to the amount in the applicable dental association fee guide in effect the previous year. \n2. Any amounts over the $1,500 annual maximum are paid by the member. \nImportant: Plan members are responsible for all ineligible expenses in excess of the previous year’s dental \nfee guide or services not covered due to exceptions or plan limitations.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Co-payment”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-maximum-reimbursement-amounts", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "maximum-reimbursement-amounts", + "marginal_note": "Maximum reimbursement amounts", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Maximum reimbursement amounts \nPreventive, basic and major restorative dental services – annual maximum \nEach calendar year, the PDSP will reimburse up to an annual maximum amount of $1,500 for each covered \nperson for preventive, basic and major restorative dental services. This excludes orthodontic services, \nwhich have a separate lifetime maximum limit. \nException: If your dental benefits coverage starts on or after July 1, the maximum amount that the PDSP will \nreimburse for that calendar year will be $750. The full annual maximum will apply in the next calendar year. \nOrthodontic services – lifetime maximum \nThe PDSP will reimburse up to a lifetime maximum amount of $2,500 for each covered person for \northodontic services. \nTo be eligible, the initial orthodontic appliance must not have been installed before the start of your PDSP \ncoverage unless the initial appliance was covered by the Public Service Dental Care Plan (PSDCP). \nWhen submitting a treatment plan, the dental provider must clearly indicate the cost, length of treatment \nand fee breakdown, any financial arrangement and the payment plan or interval.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Maximum reimbursement amounts”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-estimate-of-reimbursement", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "estimate-of-reimbursement", + "marginal_note": "Estimate of reimbursement", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Estimate of reimbursement \nBefore you receive dental work or treatment that could be $300 or more (such as a crown or orthodontics), \nit is recommended that you or your dental provider send a treatment plan or estimate online or by mail to \nCanada Life. Canada Life will provide a predetermination of benefits to confirm if the dental services are \neligible, how much of the expenses will be reimbursed, and how much you will have to pay out of pocket \n(your co-payment).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Estimate of reimbursement”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-pdsp-member-booklet", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "pdsp-member-booklet", + "marginal_note": "PDSP Member booklet", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "PDSP Member booklet 19\nImportant: Predeterminations are only valid for 180 days from the date requested. There may be limitations \nor time restrictions that apply. For example, a child may reach the age limit for pits and fissure sealants, or \nyou may reach the annual maximum amount during the 180 days. \nHow to submit a treatment plan or estimate online \nTo submit a treatment plan/estimate through your PDSP Member Services account on My Canada Life at \nWork\nTM (canadalife.com/pdsp), sign in and select", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “PDSP Member booklet”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-benefits-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "benefits-1", + "marginal_note": "Benefits (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Benefits, then Estimates, and follow the instructions. \nYou can either: \n\n- upload the claim form (same form used for estimates) provided by your dental provider \n\n- access personalized claim forms by signing in to your PDSP Member Services account (canadalife.com/\npdsp), \n\n- select Info centre in the lefthand navigation, then View forms \n\n- select or search for the form you require and complete it with the information provided by your \ndental provider (indicate on the form that it is for an estimate) \n\n- upload the form along with any supporting documents \n\n- find blank claim forms on the Forms page of the PDSP Member Services website (welcome.canadalife. \nc\nom/pdsp/forms) and complete it with the information provided by your dental provider (indicate on the \nform that it is for an estimate) and upload it along with any supporting documents \nA treatment plan/estimate does not need a dental provider signature. \nHow to submit a treatment plan or an estimate by mail \nPrint, complete and sign a claim form with your personal information, include all available information \nfrom your dental provider and mail it to Canada Life. \nYou can either: \n\n- access personalized claim forms by signing in to your PDSP Member Services account (canadalife.com/\npdsp) \n\n- select Info centre in the lefthand navigation, then View forms \n\n- select or search for the form you require \n\n- mail it to the following address \n\n- find blank claim forms on the Forms page of the PDSP Member Services website (welcome.canadalife. \nc\nom/pdsp/forms) and mail it to the following address: \nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7 \nYou can also contact Canada Life to request that a claim form be sent to you by mail. Canada Life will \nsend y", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Benefits”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-benefits-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "benefits-2", + "marginal_note": "Benefits (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "ou a predetermination of benefits indicating what is covered using the preferred method of \ncommunication indicated in your file. It will include: \n\n- a decision to determine if the expense is covered by the PDSP \nPDSP Member booklet 20 \n\n- an estimate of the dollar amount that is eligible for reimbursement when there is no coordination of \nbenefits (this may differ from the actual amount that is covered) \nBenefits", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Benefits”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-general", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "general", + "marginal_note": "General", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "General \nThe PDSP provides reimbursement for specific dental services not covered under a provincial or territorial \nhealth or dental care plan. The PDSP provides reimbursement up to, but not exceeding, the amount shown \nin the previous year’s dental fee guide. \nThe PDSP will reimburse you for eligible expenses for dental services received by: \n\n- dentists or dental specialists \n\n- denturists \n\n- independent dental hygienists \n\n- anesthetists (in connection with oral surgery and drug injections) \nThe dental provider must be licensed to provide dental services in the province or territory where the \nser\nvice is received. \nImportant: If you are a member of both the PDSP and the Public Service Health Care Plan (PSHCP), you may \nc\noordinate benefits between both plans for accidental injury or surgery. See Coverage under the Public \nSer\nvice Health Care Plan (Accident/Surgery).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “General”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-eligible-expenses-exclusions-and-limitat", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "eligible-expenses-exclusions-and-limitat", + "marginal_note": "Eligible expenses, exclusions and limitations", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Eligible expenses, exclusions and limitations \nBelow are highlights of the covered services including most limitations. For complete information on the \nbenefits covered under the PDSP , consult the PDSP Rules (canada.ca/en/treasury-board-secretariat/ \nser\nvices/benefit-plans/pensioner-dental-services-plan/pensioners-dental-services-plan-rules) and look for: \n\n- the list of all eligible dental services (See Schedule 2 of the PDSP Rules) \n\n- the list of exclusions and limitations (see Schedule 3 of the PDSP Rules) \n\n- the specific limitations with respect to major services (see Rule 6(2) of the PDSP Rules)", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Eligible expenses, exclusions and limitations”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-preventive-dental-services", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "preventive-dental-services", + "marginal_note": "Preventive dental services", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Preventive dental services \nDiagnostic Services: reimbursed at 90% of the eligible expenses \nThe PDSP covers services used to help prevent or correct dental diseases and defects. They are services that \ndental providers perform regularly to help maintain good dental health. \nOral examinations Limitations \nComplete oral examination No limitations \nRecall examination Once every 9 months \nSpecific oral examination No limitations \nEmergency oral examination No limitations \nTreatment planning No limitations \nPDSP Member booklet 21\nX-rays Limitations \nComplete series of periapical x-rays Once every 36 months \nOcclusal x-rays No limitations \nBitewing x-rays Once every 9 months \nExtra-oral films No limitations \nSialography, use of dyes No limitations \nPanoramic x-ray Once every 36 months \nInterpretation of radiographs from another source No limitations \nTomography Cone-beam computed tomography is not covered under \nthe PDSP \nOther services Limitations \nPolishing Once every 9 months \nTopical fluoride treatment Once every 9 months \nOral hygiene instruction Once every calendar year \nPit and fissure sealants Only eligible dependant children under the age of 15 \nSpace maintainers Not involving movement of teeth \nBiopsy of oral tissue and pulp vitality tests No limitations \nCaries control No limitations \nEnameloplasty No limitations \nHouse calls, hospital calls and special office visits No limitations \nEmergency services No limitations", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Preventive dental services”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-basic-dental-services", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "basic-dental-services", + "marginal_note": "Basic dental services", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Basic dental services \nBasic dental services: reimbursed at 90% of the eligible expenses \nThe PDSP covers services used to treat basic dental diseases and defects. Below is a list of certain basic \ndental services that are covered. \nFillings Limitations \nFillings (amalgam, silicate, composite, acrylic) Replacement fillings for the same tooth and the same \nsurface once every 24 months \nDenture services Limitations \nRepair or adjustment of dentures No limitations \nRebasing and relining of existing partial or complete \ndenture \nOnce every 36 months \nPDSP Member booklet 22 \nEndodontics Limitations \nRoot canal No limitations \nPulp capping \nPulpotomy/pulpectomy \nPeriapical services \nPeriodontics Limitations \nScaling and root planing 6 time units every calendar year \nException: up to 6 additional time units can be pre-\napproved by Canada Life with evidence of gum disease \nfrom your dental provider. Pre-approvals are valid for 3 \nfull calendar years from the date of approval. \nOcclusal equilibration 8 time units every calendar year \nNon-surgical, surgical and post-surgical treatment of \ngums and supporting tissue\nNo limitations \nOral surgery and related anaesthesia * Limitations \nUncomplicated removal No limitations \nSurgical removal \nTooth repositioning \nAlveoloplasty (smooths and reshapes the jawbone after \nan extraction) \nGingivoplasty (reshapes gum tissues) \nStomatoplasty (reconstructive mouth surgery) \nOsteoplasty (reshapes and recontouring of bone) \nTuberoplasty (reshapes or reduces the maxillary bone) \nRemoval of excess mucosa \nSurgical excision \nRemoval of cyst \nSurgical incision \nRemoval of impacted teeth \nRepair of soft tissue \nFrenectomy (correction of tongue-tie or lip tie) \n*Excluding transplants and repositioning of the jaw. \nPDSP Member booklet 23", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Basic dental services”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-major-dental-services", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "major-dental-services", + "marginal_note": "Major dental services", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Major dental services \nMajor dental services: reimbursed at 50% of the eligible expenses \nThe PDSP covers services used to treat major dental diseases and defects. Below is a list of certain major \ndental services that are covered. \nMajor restorative Limitations \nGold foil Once every 60 months \nPorcelain veneers, metal and porcelain inlays, onlays Once every 60 months with certain conditions \nRetention pins, posts and cores No limitations \nMetal and porcelain crowns Once every 60 months with certain conditions \nMajor prosthodontics Limitations \nDiagnostic services Replacements are only covered under certain conditions. \nSee PDSP Rule 6(2)b. Addition of a tooth to a removable denture \nComplete dentures \nPartial dentures \nFixed bridges (abutments/retainers, pontics) \nRetentive pins in abutments \nRepairs of fixed appliances \nImplants Implants are not covered under the PDSP . The Alternate \nBenefit Clause may apply. \nImportant: The PDSP has an Alternate Benefit Clause for specific dental services. This means the PDSP may \nallow reimbursement towards an expense normally not covered or may limit reimbursement to the cost of a \nless expensive Reasonable and Customary dental service. \nIt is strongly advised that you ask Canada Life for a predetermination when a course of treatment is $300 or \nmore. Canada Life will let you know how much may be covered and how much you will have to pay out of \npocket. Not all services are eligible for an alternate benefit. See \nEstimate of reimbursement.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Major dental services”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-orthodontic-services", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "orthodontic-services", + "marginal_note": "Orthodontic services", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Orthodontic services \nOrthodontic services: reimbursed at 50% of the eligible expenses \nThe PDSP covers services used to treat misaligned or crooked teeth up to a separate lifetime maximum of \n$2,500. \nThe PDSP will reimburse 90% of the diagnostic services related to orthodontics. \nPDSP Member booklet 24 \nOrthodontic Limitations \nExaminations No limitations \nX-rays \nDiagnostic casts \nThe PDSP will reimburse 50% of the appliances related to orthodontics. \nOrthodontic Limitations \nFixed or removable appliances, such as braces No orthodontic benefits will be paid if the initial \nappliance was installed before the person was covered \nunder the PDSP , unless that initial appliance was \ninstalled while the person was covered under the Public \nService Dental Care Plan (PSDCP). \nOrthodontic services purchased online from direct \nto-consumer orthodontic treatment providers are not \neligible under the PDSP .", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Orthodontic services”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-submit-a-claim-for-dental-service-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-1", + "marginal_note": "How to submit a claim for dental services incurred in Canada (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to submit a claim for dental services incurred in Canada \nThere are 3 ways to submit a claim to Canada Life: \n1. Have your dental provider submit a claim electronically on your behalf \n2. Submit a claim online (through your PDSP Member Services account or through the My Canada Life at \nWorkTM mobile app) \n3. Submit a claim by mail \n1. Have a claim submitted by your dental provider \nMost dental providers can submit dental claims online to Canada Life on your behalf. Present your PDSP \nbenefit card with your plan number and your certificate number. Your claim will be processed in real time, \nand your eligible expenses will be reimbursed by direct deposit or by cheque. \nNote: Eligible dependants will not receive their own PDSP benefit card and must present the plan number \nand the certificate number seen on the plan member’s PDSP benefit card to dental providers. \nIt is your responsibility to: \n\n- authorize your dental provider to submit claims \n\n- ensure that your personal information, including your plan number, your certificate number and address \nare correct and current in both your PDSP Member Services account and with your dental provider \n\n- at time of claim provide information to your dental provider about any other dental coverage you or your \neligible dependants may have for coordination of benefits \nPDSP Member booklet 25\n2. Submit a claim online (through your PDSP Member Services account or the My Canada Life at \nWork mobile app) \nOnce you have completed positive enrolment and registered for a PDSP Member Services account \n(canadalife.com/pdsp), you can submit claims digitally through the PDSP Member Services website or My \nCanada Life at Work mobile app, if your dental provider has not already submitted the claim on your behalf. \nTo submit a claim online: ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to submit a claim for dental services incurred in Canada”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-submit-a-claim-for-dental-service-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-2", + "marginal_note": "How to submit a claim for dental services incurred in Canada (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "i. Sign in to your PDSP Member Services account or the My Canada Life at Work mobile app. \nii. Select Make a claim. \niii. Choose the appropriate claim type and follow the steps to complete the claim. You will need to \nupload a claim form or receipt signed by your dental provider. \n3. Submit a claim by mail \nTo submit a claim by mail using one of the following options: \ni. Print, complete and sign an authorized claim form. \nYou can either: \n\n- access personalized claim forms by signing in to your PDSP Member Services account (canadalife. \ncom/pdsp) \n\n- select Info centre in the lefthand navigation, then View forms \n\n- select or search for the form you require \n\n- find blank claim forms on the Forms page of the PDSP Member Services website (welcome. \ncanadalife.com/pdsp/forms) \n\n- contact Canada Life to request that a claim form be sent to you by mail \nComplete the claim form with the appropriate information, including: \n\n- your full name and address, including your postal code \n\n- your plan number and your certificate number \n\n- your spouse or common-law partner’s dental plan number and certificate number, if applicable \n\n- your signature \n\n- the appropriate section of the claim form completed by your dental provider including the dental \nprovider’s signature/stamp \nAttach any invoices or receipts that you may have and ensure that they provide full details of the \nservices rendered or purchases made. \nIncomplete claim forms will be returned to you for completion. \nii. Mail a claim form from your dental provider to the following address, along with the originals of \nthe supporting documentation (original receipts, invoices, dental provider statements, and/or \nquestionnaires, etc.). Keep a copy for your own files, Canada Life will not return original receipts after ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to submit a claim for dental services incurred in Canada”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-submit-a-claim-for-dental-service-3", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-3", + "marginal_note": "How to submit a claim for dental services incurred in Canada (part 3)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "claims are processed. \nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7 \nPDSP Member booklet 26 \nWhen submitting a claim under the coordination of benefits provision you must also include any claim \nstatements received from another benefit plan(s).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to submit a claim for dental services incurred in Canada”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-submit-a-claim-for-dental-service-2-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-2-1", + "marginal_note": "How to submit a claim for dental services incurred outside of Canada (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to submit a claim for dental services incurred outside of Canada \nClaims for dental services incurred outside of Canada can be submitted online or by mail. \nSubmit a claim online (through your PDSP Member Services account or the My Canada Life at \nWork mobile app) \nOnce you have completed positive enrolment and registered for a PDSP Member Services account \n(canadalife.com/pdsp), you can submit claims online through the PDSP Member Services website or the My \nCanada Life at Work mobile app. Dental providers outside of Canada are not able to submit claims on behalf \nof the member. \nTo submit a claim online: \n1. Sign in to your PDSP Member Services account or the My Canada Life at Work mobile app. \n2. Select Make a claim. \n3. Select Start a claim. \n4. Select whom the claim is for, then select Continue. \n5. Select Out-of-Canada, then select Continue and follow the steps to complete the claim. \n6. You will need to upload a claim form or receipt signed by your dental provider. \nTo submit a claim by mail using one of the following options: \n1. Print, complete and sign a claim form. \nYou can either: \n\n- access personalized claim forms by signing in to your PDSP Member Services account (canadalife. \ncom/pdsp) \n\n- select Info centre in the lefthand navigation, then View forms \n\n- select or search for the form you require \n\n- find blank claim forms on the Forms page of the PDSP Member Services website (welcome. \ncanadalife.com/pdsp/forms) \n\n- contact Canada Life to request that a claim form be sent to you by mail \nComplete the claim form with the appropriate information, including: \n\n- your full name and address, including your postal code \n\n- your plan number and your certificate number \n", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to submit a claim for dental services incurred outside of Canada”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-submit-a-claim-for-dental-service-2-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-submit-a-claim-for-dental-service-2-2", + "marginal_note": "How to submit a claim for dental services incurred outside of Canada (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "- your spouse or common-law partner’s dental plan and certificate number, if applicable \n\n- your signature \n\n- the appropriate section of the claim form completed by your dental provider including the dental \nprovider’s signature/stamp \nAttach any invoices or receipts that you may have and ensure that they provide full details of the \nservices rendered or purchases made. \nIncomplete claim forms will be returned to you for completion. \nPDSP Member booklet 27\n2. Mail a claim form from your dental provider to the following address, along with the originals of \nthe supporting documentation (original receipts, invoices, dental provider statements, and/or \nquestionnaires, etc.). Keep a copy for your own files, Canada Life will not return original receipts after \nclaims are processed. \nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7 \nWhen submitting a claim under the coordination of benefits provision you must also include any claim \nstatements received from another benefit plan(s).", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to submit a claim for dental services incurred outside of Canada”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-deadline-to-submit-a-dental-claim", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "deadline-to-submit-a-dental-claim", + "marginal_note": "Deadline to submit a dental claim", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Deadline to submit a dental claim \nTo be eligible for reimbursement, Canada Life must receive your claims within 15 months of the date the \nexpenses were incurred. \nAn expense is incurred: \n\n- on the date of your single appointment for dental services \n\n- on the date of your last appointment for dental services that take more than one appointment, such as on \nthe date an appliance is installed \n\n- the date the appliance is installed and the date of each monthly visit, for orthodontic dental services \nClaims submitted after the 15-month period will not be paid unless you can demonstrate that it was \nimpossible for you to submit your claim within 15 months from the date you incurred the expense. \nImportant: Claims submitted more than 24 months after the expense was incurred will not be paid except in \nthe case of legal incapacity. \nIf a child between 21 and 25 years of age, who is a full-time student, receives dental services during an \nacademic break, claims for those services should not be sent to Canada Life until the student has returned \nto school full-time.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Deadline to submit a dental claim”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-explanation-of-benefits-statement", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "explanation-of-benefits-statement", + "marginal_note": "Explanation of benefits statement", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Explanation of benefits statement \nOnce your claim is processed, you will receive a notification by text, email or mail (depending on your \nnotification method of choice) informing you that an explanation of benefits from Canada Life can be accessed \nonline through your \nPDSP Member Services account (canadalife.com/pdsp). The explanation of benefits \nprovides details on how your claim was processed and the amount being reimbursed under the PDSP . \nIf you have signed the Pensioners’ Dental Services Plan (PDSP) Authorization for Claims Submission and \nRe-direction of Payment form, which can be found on the \nForms page of the PDSP Member Services website \n(welcome.canadalife.com/pdsp/forms), for your eligible dependant child(ren)’s claims, payment may be \nissued to your spouse or common-law partner. \nPDSP Member booklet 28", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Explanation of benefits statement”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-overpayments", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "overpayments", + "marginal_note": "Overpayments", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Overpayments \nAdministrative error: In situations where you were reimbursed more than what was eligible under the \nPDSP , Canada Life is authorized to recover the overpayment. You will be advised of the overpayment and \nprovided with different options on how you would like to repay the amount. \nYou can choose one of the following: \n\n- by cheque for the amount of the overpayment or \n\n- by deduction from future claims \nIf you do not acknowledge the overpayment and inform Canada Life of what you would like to do within 30 \ndays, Canada Lif\ne will automatically deduct the overpayment from future claim reimbursements. \nAdjudication Error: In situations where an adjudication error is made or an adjudication decision is \nr\neversed based on additional information, Canada Life will not recover the overpayment but will advise you \nin writing that these expenses will no longer be reimbursed.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Overpayments”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-appeal-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-appeal-1", + "marginal_note": "How to appeal (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "How to appeal \nAn appeal process is available to you if you do not agree with a decision regarding your claim or coverage. \nPlease consult the Pensioners’ Dental Services (PDSP) Appeal Checklist (canada.ca/en/treasury-board-\nsecr\netariat/services/benefit-plans/pensioner-dental-services-plan/appeal-checklist) for more information. \nYou may also wish to review the PDSP Rules ( canada.ca/en/treasury-board-secretariat/services/benefit-\nplans/pensioner\n-dental-services-plan/pensioners-dental-services-plan-rules) to determine if your claim \nis eligible under the PDSP . \nBefore you submit an appeal, you should try to first resolve the issue with: \n\n- Canada Life, if your appeal is claim-related \n\n- the Pension Centre or your pension office, if your appeal is coverage-related \nCanada Life claim-related appeal \nYou have the right to appeal a denial of all or part of your claim if you submit a request within 15 months \nfrom the date Canada Life completed the initial assessment of your claim treatment plan. \nAppeals should be submitted to Canada Life in writing or can be submitted online. If you wish to submit \na Canada Lif\ne appeal over the phone, supporting documents (legible originals or copies) or dental \ninformation must be sent to Canada Life by mail for the review. \nEach request must include why you: \n\n- disagree with the claim decision \n\n- believe the claim is eligible \nIn writing \nMail your supporting documents or dental information to: \nWinnipeg Benefit Payments \nPO box 6025 Station Main \nWinnipeg MB \nR3C 3C7 \nPDSP Member booklet 29\nOnline \nHow to submit a Canada Life appeal online through your PDSP Member Services account \n1. Sign in to your PDSP Member Services account ( canadalife.com/pdsp) and go to the Contact us \npage\n. \n2. Under Subject, select Benefits. ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to appeal”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-appeal-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-appeal-2", + "marginal_note": "How to appeal (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "3. Under Detailed subject, select Submit a Canada Life appeal. \n4. Complete all remaining fields and upload supporting documentation. \nIf you are not satisfied with the decision of this initial Canada Life appeal, you may appeal a second time \nin writing through y\nour PDSP Member Services account ( canadalife.com/pdsp) or call the PDSP Member \nContac\nt Centre (contact Canada Life) and send Canada Life all the claim details and any additional \ninforma\ntion for review. You must explain why you continue to disagree with the claim decision. \nPDSP Board Appeal \nIf you have submitted a Canada Life appeal and are not satisfied with their decision you may submit an \nappeal to the PDSP Board. \nNote: This appeal process is also used to apply for PDSP coverage for a child from whom you stand in place \nof a par\nent. The PDSP Board will review your case and issue a decision. See Pensioners’ Dental Services \n(PDSP) Appeal Checklis\nt (canada.ca/en/treasury-board-secretariat/services/benefit-plans/pensioner-\ndental-ser\nvices-plan/appeal-checklist). \nWhat to include in an appeal \nIf you wish to ask the PDSP Board to review your case, send your appeal in writing by mail to the address \nbelow. Your appeal should include why you disagree with the claim or coverage decision and the following \ninformation: \n\n- the plan member’s name, address, telephone number and email address \n\n- if the appeal is for an eligible dependant, include their full name and date of birth, medical certificate, \nif referring to a medical condition, and any original documentation \n\n- the plan member’s PDSP certificate number \n\n- the category of the appeal: coverage, enrolment or other \n\n- copies of supporting documents such as: \n\n- the explanation of benefits statement from Canada Life \n", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to appeal”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-how-to-appeal-3", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "how-to-appeal-3", + "marginal_note": "How to appeal (part 3)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "- correspondences with Canada Life, the Pension Centre or your pension office related to the appeal \n\n- documentation from the dental provider including a treatment plan, additional medical information \nor a rationale for the dental services \n\n- additional information may be requested by the PDSP Board before an appeal decision is final \n\n- if applicable, the latest decision from the Canada Life process outlining their rationale for denial \n(which could include the explanation of benefits) \nThe PDSP Board may meet bi-monthly, quarterly or less frequently depending on the volume of appeals. \nThe response t\no an appeal may therefore take a few months. \nPDSP Member booklet 30 \nThe decision of the Board is final unless an appellant can provide new information not previously considered. \nWhere to send an appeal \nAppeal documentation must be sent by mail to the Treasury Board of Canada Secretariat at the following \naddress. Medical and dental records as well as information on eligible dependant child(ren) custody are \nconsidered Protected B and cannot be emailed. \nThe Pensioners’ Dental Services Plan \nTreasury Board of Canada Secretariat \nBenefits Programs Operations \n90 Elgin Street \n3rd Floor, Suite 3026 \nOttawa, Ontario \nK1A 0R5", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “How to appeal”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coordination-of-benefits-with-other-plan-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-1", + "marginal_note": "Coordination of benefits with other plans (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coordination of benefits with other plans \nIt is important to always keep your coordination of benefits information up to date with Canada Life and \nyour dental provider(s) to ensure that you and your eligible dependant(s) receive the benefits to which you \nare entitled. You must provide coordination of benefits information each time you submit a claim online or \nby mail. \nConsult with your dental provider to see if they can submit a coordination of benefit on your behalf at time \nof claim. \nIf you are a PDSP member and you have dental benefits coverage under other insurance, such as your \nspouse or common-law partner’s plan, you may be eligible to coordinate your benefits and receive up to \n100% of the actual eligible dental expenses. \nFor example, if you are covered under the PDSP and the Public Service Dental Care Plan (PSDCP), you can \ncoordinate benefits between both plans. If you are a PSDCP member, your claim will first be paid through \nthe PSDCP , followed by the PDSP (some exceptions apply, please consult the \nPDSP Rules (canada.ca/en/ \ntreasury-board-secretariat/services/benefit-plans/pensioner-dental-services-plan/pensioners-dental-\nservices-plan-rules)). The remaining amount, if applicable, would be paid by your spouse or common-law \npartner’s plan. \nThe combined reimbursement from your PDSP and your spouse or common-law partner’s other insurance \ncannot exceed the lesser of either of the following: \n\n- the expenses incurred \n\n- the amount specified in the previous year’s dental fee guide of the province or territory where the services \nwere rendered \nExclusions, frequency limitations and annual maximums for each calendar year apply separately under \neach plan. \nNote: Coordination of benefits between 2 PDSP members is not permitted. A PDSP member cannot ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coordination of benefits with other plans”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coordination-of-benefits-with-other-plan-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-2", + "marginal_note": "Coordination of benefits with other plans (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "be enrolled as both a member and an eligible dependant. You can coordinate your benefits with other \ninsurance plans, provided the other insurance is not the PDSP . \nPDSP Member booklet 31\nIf you and your spouse or common-law partner both have dental plans that are administered by Canada Life, \nreview the following guidelines to determine which plan you should submit your expenses to first. You do \nnot need to submit a second claim for the unpaid balance if you provide the plan number and the certificate \nnumber of your spouse or common-law partner’s dental plan on the claim form or when submitting a claim in \nyour PDSP Member Services account. Canada Life will process the eligible claims under both memberships. \nClaims made under your spouse or common-law partner’s plan number and certificate number will be paid \nto them unless the benefits are assigned to the dental provider. \nIf you or your eligible dependant(s) have dental benefits coverage under other insurance, you must \nprovide this information to your dental provider at time of claim. If your dental provider does not \nprovide coordination of benefits services, you will need to submit the claim to Canada Life with the other \ninsurance’s information. \nCanada Life can help you determine which plan you should claim from first. \nCoordination of benefits guidelines \n\n- For dental services required because of an accidental injury to natural teeth covered under both the \nPublic Service Health Care Plan (PSHCP) and the PDSP , the coverage will be determined under the PSHCP \nfirst. Claims should be submitted to the PSHCP first. \n\n- For specific oral surgical procedures covered under both the PSHCP and the PDSP , the coverage will be \ndetermined under the PDSP first. \n", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coordination of benefits with other plans”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coordination-of-benefits-with-other-plan-3", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-3", + "marginal_note": "Coordination of benefits with other plans (part 3)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "- If you are a member of the PDSP and are also covered under your spouse or common-law partner’s plan \nas an eligible dependant, you should submit your claim to your PDSP first. \n\n- If your spouse or common-law partner is covered under other insurance and is also covered as an eligible \ndependant under your PDSP , your spouse or common-law partner should submit their expenses to their \nown plan first. \n\n- When your eligible dependant child(ren) are covered under both your PDSP and your spouse or \ncommon-law partner’s plan as eligible dependant(s), the plan that pays first is determined by the \nCanadian Life and Health Insurance Association (clhia.ca/web/CLHIA_LP4W_LND_Webstation.nsf/ \npage/28DE0F1EE2ACED4285257841005B27F8!OpenDocument) for coordination of benefits. Under these \nguidelines, the parent whose birthday falls earlier (month and day) in the year must claim the children’s \nexpenses first under their plan. For example, if your birthday is May 1 and your spouse’s or common-law \npartner’s birthday is June 5, you must claim under the PDSP first. \n\n- The maximum amount that you can receive from all plans for expenses is up to 100% of the actual eligible \nexpenses. \nHow to coordinate your claims after separation or divorce from your spouse or common-law partner \nIn case of divorce or separation, where both parents share custody of a child, the following order of \nsubmission must be followed for the eligible dependant child(ren)’s expenses: \n1. the plan of the parent whose birthday falls earlier in the year \n2. the plan of the parent whose birthday comes later in the year \n3. the plan of the spouse or common-law partner of the parent whose birthday falls earlier in the year ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coordination of benefits with other plans”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coordination-of-benefits-with-other-plan-4", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coordination-of-benefits-with-other-plan-4", + "marginal_note": "Coordination of benefits with other plans (part 4)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "4. the plan of the spouse or common-law partner of the parent whose birthday comes later in the year \nPDSP Member booklet 32 \nIf one parent has custody of a child, the following order of submission must be followed for the child’s \nexpenses: \n1. the plan of the parent who has custody of the child \n2. the plan of the spouse or common-law partner of the parent who has custody of the child \n3. the plan of the parent who does not have custody of the child \n4. the plan of the spouse or common-law partner of the parent who does not have custody of the child \nIf you do not have care and custody of your child(ren), you can authorize the person who does have care \nand custody of the child(ren) to submit claims and receive payment for the eligible dependant child(ren). \nTo authorize direct payment to the person who has custody of the child or children, complete and submit \nthe Pensioners’ Dental Services Plan (PDSP) Authorization for Claims Submission and Re-direction of \nPayment form, which can be found on the \nForms page of the PDSP Member Services website (welcome. \ncanadalife.com/pdsp/forms). \nShould you later wish to rescind this authorization, you can do so by writing to Canada Life.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coordination of benefits with other plans”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coverage-under-a-provincial-or-territori", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coverage-under-a-provincial-or-territori", + "marginal_note": "Coverage under a provincial or territorial plan", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage under a provincial or territorial plan \nIf you are entitled to dental benefits under a provincial or territorial plan or any other third-party source of \ndental care assistance for which you have legal right and are also covered under the PDSP , you must submit \nto the other plan first as follows: \nProcess \n1. Submit a claim to your provincial or territorial plan or any other third-party source of dental care \nassistance for which you have a legal right. \n2. Wait for the claim to be processed. \n3. Submit a claim for the remaining eligible expenses to Canada Life with the explanation of benefits \nstatement from the other plan.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coverage under a provincial or territorial plan”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-coverage-under-the-public-service-health", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "coverage-under-the-public-service-health", + "marginal_note": "Coverage under the Public Service Health Care Plan (Accident/Surgery)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Coverage under the Public Service Health Care Plan (Accident/Surgery) \nIf you are a member of both the PDSP and the Public Service Health Care Plan (PSHCP), you benefit from \ncombined coverage for: \n\n- dental services needed as a result of injury to natural teeth provided the treatment occurs within 12 \nmonths of the accident or, in the case of an eligible dependant child under 17 years of age, before \nattaining 18 years of age \n\n- certain types of surgical dental services \nReason for receiving \na dental service \nSteps that you need to take to coordinate benefits \nunder the PDSP and PSHCP \nInjury 1. Send a claim to the PSHCP . \n2. If the claim is not fully reimbursed by the PSHCP , send a claim to the PDSP with: \n\n- a copy of your PSHCP claim form \n\n- a copy of the PSHCP explanation of benefits. \nPDSP Member booklet 33\nReason for receiving \na dental service \nSteps that you need to take to coordinate benefits \nunder the PDSP and PSHCP \nSurgical procedure 1. Send a claim to the PDSP . \n2. If the claim is not fully reimbursed by the PDSP , send a claim to the PSHCP with: \n\n- a copy of your PDSP claim form \n\n- a copy of the PDSP explanation of benefits. \nNote: limitations for oral surgery can be found in 6.6 Dental Benefit (njc-cnm.gc.ca/ \ndirective/d9/v283/s832/en#s832-tc-tm_6) of the PSHCP Directive.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Coverage under the Public Service Health Care Plan (Accident/Surgery)”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-prevent-fraud-and-abuse", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "prevent-fraud-and-abuse", + "marginal_note": "Prevent fraud and abuse", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Prevent fraud and abuse \nYou can help protect your dental benefits coverage by following these steps to reduce the incidence of fraud \nand abuse: \n\n- confirm that a service is necessary before you have it performed \n\n- check your invoice to make sure you were charged for: \n\n- the correct amount \n\n- the services or supplies that you received \n\n- review your explanation of benefits statement to ensure that the listed services are correct \n\n- refuse receipts for services or supplies that you did not receive \n\n- do not sign blank claim forms \n\n- check your claims history on your PDSP Member Services account through My Canada Life at Work TM \n(canadalife.com/pdsp) to make sure that you are aware of all submitted claims \n\n- Notify Canada Life if your spouse, common-law partner or eligible dependant child(ren) are no longer \ncovered under the PDSP \nIf you see something suspicious, report it to Canada Life: \n\n- Confidential tip line: 1-866-810-8477 \n\n- Email: confide@canadalife.com", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Prevent fraud and abuse”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-dependant-eligibility-verification-progr", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "dependant-eligibility-verification-progr", + "marginal_note": "Dependant Eligibility Verification Program", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Dependant Eligibility Verification Program \nThe purpose of the Dependant Eligibility Verification Program (DEVP) \nThe purpose is to verify, with supporting documents, that dependant(s) who are enrolled under the PDSP \nare eligible for dental benefits coverage according to the \nPDSP Rules (canada.ca/en/treasury-board-\nsecretariat/services/benefit-plans/pensioner-dental-services-plan/pensioners-dental-services-plan-\nrules). If Canada Life determines that a dependant is no longer eligible, their PDSP coverage will be \nterminated, and you may be responsible to pay back any claims that were reimbursed after the date the \ndependant was no longer eligible. \nPDSP Member booklet 34 \nIf you do not respond to the request for documents supporting the eligibility of your enrolled dependant(s), \nthe processing of claims for your dependant(s) may be suspended or terminated until the required \ndocuments are received and the eligibility under the PDSP is verified. You may be responsible to pay back \nany claims that were reimbursed. \nWhy you were selected \nThis program is based on a random selection of PDSP members who have enrolled dependant(s). You will \nbe asked to provide supporting documents to verify your enrolled dependant(s) meet the eligibility criteria \nunder the PDSP . \nIf you have any questions about the DEVP , you can contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Dependant Eligibility Verification Program”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-annual-student-eligibility-verification", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "annual-student-eligibility-verification", + "marginal_note": "Annual Student Eligibility Verification", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Annual Student Eligibility Verification \nThe purpose of the Annual Student Eligibility Verification (ASEV) \nThe purpose is to verify, with supporting documents, that the enrolled dependant(s) are eligible for dental \nbenefits coverage as a full-time student according to the \nPDSP Rules (canada.ca/en/treasury-board-\nsecretariat/services/benefit-plans/pensioner-dental-services-plan/pensioners-dental-services-plan-rules). \nIf Canada Life determines that a dependant is no longer eligible, their PDSP coverage will be terminated, and \nyou may be responsible to pay back any claims that were reimbursed after the student was no longer eligible. \nIf you do not respond to the request for documents supporting the full-time student eligibility of your \nenrolled dependant(s), the processing of claims for your dependant(s) may be suspended or terminated \nuntil the required documents are received and the eligibility under the PDSP as a student is verified. \nWhy you were selected \nIf you are selected to participate in the ASEV, it is because claims have been submitted over the last year \nfor your full-time student(s). You will be asked to provide supporting documents to verify the student \nstatus every year that claims are submitted for your full-time student(s) until they are no longer eligible for \ncoverage under the PDSP . \nIf you have any questions about the Annual Student Eligibility Verification, you can contact Canada Life.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Annual Student Eligibility Verification”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-canada-life", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "canada-life", + "marginal_note": "Canada Life", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Canada Life \nPDSP Member Contact Centre \n\n- North America (toll-free): 1-855-415-4414, Monday to Friday from 8 am to 5 pm, your local time \n\n- International (collect): 1-431-489-4064, Monday to Friday from 8 am to 5 pm, ET \nDeaf or hard of hearing access to a telecommunications relay service \n\n- Telephone Teletype (TTY) to Voice: 771 \n\n- Voice to Telephone Teletype (TTY): 1-800-855-0511 \nPDSP Member booklet 35\nSecure online chat \nSign in to your PDSP Member Services account through My Canada Life at Work TM (canadalife.com/pdsp) \nand g\no to the Contact Us page. \nSecure email \nSign in to your PDSP Member Services account through My Canada Life at Work TM (canadalife.com/pdsp) \nand g\no to the Contact Us page to email Canada Life. \nMy Canada Life at Work mobile app \nSign in to your PDSP Member Services account through the My Canada Life at Work TM mobile app and select \nMore to go to the Contact Us page. Select Message us, Call us or Mail us.", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Canada Life”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-government-of-canada-1", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "government-of-canada-1", + "marginal_note": "Government of Canada (part 1)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Government of Canada \nFor more information on registration, eligibility of coverage, benefits and pension deductions or to amend \nyour category of coverage, contact the Pension Centre or your pension office. \nPensioner Mail Phone Email \nRetired members of \nthe Public Service and \ntheir eligible surviving \ndependant(s) \nPublic Services and \nPr\nocurement Canada \nGovernment of Canada \nPension Centre – \nMail Facility \nPO Box 8000 \nMatane QC G4W 4T6 \nIn Canada and United \nS\ntates (toll-free): 1-800-\n561-7930 \nMonday to Friday \nfr\nom 7 am to 5 pm ET \n- \n\n- \n\n- \n\n- \n\n- \n\n- \nOutside Canada and \nUnit\ned States \n(collect): 1-506-533-5800 \nMonday to Friday \nfr\nom 7 am to 4 pm ET \nTelephone Teletype (TTY) \n(c\nollect): 1-506-533-5990 \nMonday to Friday \nfr\nom 7 am to 4 pm ET \nPWGSC.PensionCentre-\nCentr\nedespensions. \nTPSGC@pwgsc-tpsgc.gc.ca \nRetired members of the \nR\noyal Canadian Mounted \nPolice (for PDSP purposes \nonly) and their eligible \nsurviving dependant(s) \nPublic Services and \nPr\nocurement Canada \nGovernment of Canada \nPension Centre \nPO Box 8500 \nMatane QC G4W 0E2 \nIn Canada and US \n(t\noll-free): 1-800-502-7090 \nMonday to Friday \nfr\nom 7 am to 5 pm ET \nOutside Canada and US \n(c\nollect): 1-506-533-5800 \nMonday to Friday \nfr\nom 7 am to 4 pm ET \nTelephone Teletype (TTY) \n(c\nollect): 1-506-533-5990 \nMonday to Friday \nfr\nom 7 am to 4 pm ET \npensioncentrercmp. \nc\nentredespensionsgrc@ \npwgsc-tpsgc.gc.ca\nPDSP Member booklet 36 \nPensioner Mail Phone Email \nRetired members of the \nCanadian Armed Forces \nand their surviving \ndependant(s) \nPublic Services and \nPr\nocurement Canada \nIn Canada and US \n(t\noll-free): 1-800-267-0325 \nMonday to Friday \nfr\nom 7 am to 5pm ET \n- \n\n- \n\n- \nOutside Canada and US \n(c\nollect): 613-946-1093 \nMonday to Friday \nfr\nom 7 am to 5 pm ET ", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Government of Canada”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-government-of-canada-2", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "government-of-canada-2", + "marginal_note": "Government of Canada (part 2)", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Telephone teletype (TTY) \n(c\nollect): 1-855-255-9935 \nMonday to Friday \nfr\nom 7 am to 5 pm ET \npensioncentrecaf. \nc\nentredespensionsfac@ \npwgsc-tpsgc.gc.ca Government of Canada \nPension Centre – \nMail Facility \nPO Box 9500 \nMatane QC G4W 0H3 \nRetired members of \nP\narliament \nHouse of Commons \nPension Office \n1451 Coldrey Avenue \nOttawa ON K1A 0S5 \nLocal: 613-957-0440 \nbilingual ser\nvice \nIn Canada and US \n(t\noll-free): 1-800-883-2456 \nbilingual service \nOutside Canada and US \n(c\nollect): 613-957-0440 \nbilingual service \nRetired members of the \nSena\nte of Canada \nSenate of Canada \nPension Office \n40 Elgin Street \nOttawa ON K1A 0A4 \nLocal: 613-415-5875 \nbilingual ser\nvice \nIn Canada and US \n(t\noll-free): 1-800-267-7362 \nbilingual service \nOutside Canada and US \n(c\nollect): 613-415-5875 \nbilingual service \nRetired members of the \nJudges Act \nOffice of Commissioner \nf\nor Federal Judicial Affairs \n99 Metcalfe Street, \n8th Floor \nOttawa ON K1A 1E3 \nLocal: 613-995-5140 \nbilingual ser\nvice \nIn Canada and US \n(t\noll-free): 1-877-583-4266 \nbilingual service \nOutside Canada and US \n(c\nollect): 613-995-5140 \nbilingual service", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Government of Canada”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PDSP-definitions", + "doc_type": "benefits", + "act_code": "PDSP", + "act_short": "PDSP", + "act_name": "Pensioners' Dental Services Plan — Member Booklet", + "section": "definitions", + "marginal_note": "Definitions", + "part": "Pensioners' Dental Services Plan Member Booklet", + "division": "", + "heading": "", + "text": "Definitions \nFor a complete listing of of PDSP terminology definitions, please visit the PDSP Rules ( canada.ca/en/ \ntr\neasury-board-secretariat/services/benefit-plans/pensioner-dental-services-plan/pensioners-dental-\nservices-plan-rules.html#Toc129481894). \nPDSP Member booklet 37\nThis page has been intentionally left blank.\nThis page has been intentionally left blank.\n70-0870-11/24 Nov 2024", + "history": "", + "last_amended": "", + "current_to": "November 2024", + "citation": "PDSP Member Booklet (November 2024), “Definitions”", + "source_url": "https://www.canadalife.com/content/dam/rfp/welcome-sites/pdsp/pdsp-member-booklet.pdf" + }, + { + "id": "benefits-PSMIP-what-is-the-public-service-management-in-1", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-is-the-public-service-management-in-1", + "marginal_note": "What is the Public Service Management Insurance Plan? (part 1)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "What is the Public Service Management Insurance Plan?\nThe Public Service Management Insurance Plan (PSMIP) provides public service employees who are excluded from collective bargaining with the following types of insurance:\n- Group Life Insurance\n- Accidental Death and Dismemberment (AD&D) Insurance\n- Dependants’ Insurance\n- Long-Term Disability (LTD) Insurance\nSome of these types of insurance are available to all members. Other types are restricted to certain senior-level employees.\nThis booklet outlines the major benefit provisions of the PSMIP that apply to excluded public service employees. If you are a member of the Executive Group or are otherwise entitled to the government-paid insurance benefits provided to executives, refer to the Public Service Management Insurance Plan Executive Plan Booklet .\nIndustrial Alliance is the principal insurer and carries out the following:\n- evaluates statements of health\n- approves and denies claims for benefits\n- receives and invests premiums on behalf of the PSMIP\n- monitors the PSMIP’s financial and underwriting experience\n- reports annually to the Board of Trustees on the status of the plan’s finances\n- brings matters of concern to the attention of the trustees\n- responds to matters raised by the trustees or the secretary as the need arises\n- provides members with a summary of the annual report on the PSMIP’s administration and financial affairs\nThe Board of Trustees, which administers the PSMIP, comprises senior government officials appointed by the President of the Treasury Board. As the policy holder, the Board of Trustees has a continuing responsibility to:\n- review the provisions of the PSMIP and recommend changes as required\n- review the financial experience of the PSMIP periodically to ensure its solvency", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What is the Public Service Management Insurance Plan?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-is-the-public-service-management-in-2", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-is-the-public-service-management-in-2", + "marginal_note": "What is the Public Service Management Insurance Plan? (part 2)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "- review the problems arising from the administration and adjudication of claims\nThis booklet provides general information on the major benefit provisions of the PSMIP. Your departmental compensation services or the Public Service Pay Centre can provide information on the following:\n- eligibility for membership\n- application procedures\n- beginning and cost of coverage\n- coverage during leaves of absence or other periods without pay\n- termination or cancellation of coverage\n- other provisions\nThe complete terms and conditions of the PSMIP are set out in a contract of insurance between the Board of Trustees and the insurer. In any case of conflict between this booklet and the insurance contract, the terms of the contract shall prevail.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What is the Public Service Management Insurance Plan?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-is-the-public-service-management-in-3", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-is-the-public-service-management-in-3", + "marginal_note": "What is the Public Service Management Insurance Plan? (part 3)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Long-Term Disability insurance What is Long-Term Disability insurance? The Long-Term Disability (LTD) component of the PSMIP is an important part of the income-protection arrangements for members. LTD provides a monthly income benefit for employees who are unable to work for a lengthy period of time because of a totally disabling illness or injury. The employer and the employee share the cost of the premium for this insurance. Am I eligible for Long-Term Disability benefits? If you are a member under the LTD insurance plan, you are eligible for benefits for up to 24 months if, as a result of a physical or mental impairment determined by a physician, you are unable to perform the essential functions of your regular job. At the end of this 24 month period, your benefits will be continued if you remain totally disabled and are unable to earn two thirds of the current salary of the position you held before you became disabled. Your LTD benefits will continue as long as you remain totally disabled. Benefits will not continue beyond your 65 th birthday. While you are receiving LTD benefits, you must be under the active care of a physician who is a registered specialist in the field of medicine related to your disabling condition. You must also be receiving medical treatment or participating in a program of rehabilitation approved by the insurer. You are not eligible for benefits if: your disability is the result of a mental or physical impairment that existed before you became insured: this exclusion is lifted if you complete a continuous period of 90 days of active employment while insured for LTD, or after you have been insured for LTD for two years, whichever comes first your disability results from or is related to: a normal pregnancy (without severe complications) commission of a felony self-inflicted injury a mental or physical impairment suffered while on active duty with any armed force your disability results from or is related to an act of declared or undeclared war; this exclusion does not apply to persons who become totally disabled in this way while outside Canada at the direction of the employer Note: If you become disabled, contact your departmental compensation services or the Public Service Pay Centre , even if you are unsure whether or not you qualify for LTD benefits. What happens if I retire before using all my sick leave credits? If you retire voluntarily before exhausting your accumulated sick leave credits, your unused sick leave credits will still be counted and used to determine the date that your LTD benefits will begin. If you are considering terminating your employment prior to exhausting your sick leave credits, contact your departmental compensation services or the Public Service Pay Centre to see if your termination will be considered as a voluntary termination for LTD purposes. How are my Long-Term Disability benefits calculated? If you become totally disabled, your gross annual benefit will be 70% of your insured annual salary at the end of the elimination period (13 weeks or the exhaustion of your sick leave, whichever is later). The definition of salary is the same as that used for the Supplementary Death Benefit under the PSSA Your insured annual salary for the purposes of LTD is equal to your annual salary at the end of the elimination period if it is a multiple of $250, or the next multiple of $250 above that amount. A member who works part time will have the insured annual salary based on assigned hours of work. Payments are made monthly. Other income, whether it be income received as a result of being in receipt of a PSSA benefit or a disability benefit under the Canada Pension Plan (CPP) or Quebec Pension Plan (QPP), will be deducted as an offset from your LTD benefits. Your net benefit, which is the amount payable to you after other income has been deducted as an offset, will be subject to an annual increase related to increases in the cost of living, up to a maximum of 3%. Any retroactive salary increase approved after the date your LTD benefits become payable affects your insured salary and benefit level only when the effective date of the increase precedes the date on which your LTD benefits began. For example, a retroactive salary increase approved in April that took effect from February 10 would affect your LTD benefits only if your benefits began on February 11 or later. Table 1: example of benefit calculation 1. Your annual salary at end of elimination period $47,925 2. Your insured salary (annual salary taken to next highest multiple of $250) $48,000 3. Your gross annual LTD benefit (70% of $48,000) $33,600 4. Less other income you are receiving PSSA benefit $14,000 CPP disability benefit $8,000 5. Your net annual LTD benefit $11,600 6. The amount of monthly LTD payments ($11,600 divided by 12) $967 If the cost of living rose by 2% in the year following the start of your benefits, your net monthly LTD benefit of $967 would be increased by 2% to $986.34 on January 1 following the effective date your benefits start. Your PSSA and CPP or QPP benefits would be adjusted to reflect increases in the cost of living. You would receive the full increase under those plans, and the increase would not be deducted from your LTD benefit. On January 1 of each subsequent year, your LTD benefit would be further increased to reflect increases in the cost of living, up to a maximum of 3% annually. Offsets: what types of income will be deducted from my Long-Term Disability benefits? The following examples illustrate the most common types of income that would be deducted from your LTD benefits: benefits received under the PSSA LTD benefits under the CPP or the QPP, excluding benefits payable to or on behalf of your dependants as a result of your disability benefits under the or similar benefits under a plan of the federal government or any other government LTD benefits paid or available under another group insurance plan, or under a policy issued to you as a result of your membership in a public service employee union or association disability insurance benefits under the legislation of any government, such as income replacement benefits under a no-fault automobile insurance plan loss-of-income benefits received under a third-party damage award The following are examples of income that would not be deducted from your Long-Term Disability benefits: increases related to the cost of living indexation under the PSSA, CPP or QPP return of superannuation contributions where no pension entitlement is available benefits received under a purely private and personal insurance policy, or under a policy issued as a result of membership in a professional association not restricted to the public service severance pay If you do not apply for benefits under the CPP or QPP and if, in the opinion of the insurer, the medical evidence indicates that you would be eligible for CPP or QPP benefits, the insurer has the right to reduce your basic monthly LTD benefit by the estimated amount of your CPP or QPP entitlement. If you subsequently applied for CPP or QPP benefits and were declared ineligible, the reduction would cease, and the amounts previously withheld would be paid to you. Note, however, that if the insurer believes you have grounds for a successful appeal, the reduction may be continued until the conclusion of the appeal process. The treatment of benefits payable under the PSSA as offsets under the LTD component of the PSMIP is illustrated on the chart in Table A1 in the Appendix . If you cease to be employed in the public service, consult your departmental compensation services or the Public Service Pay Centre before opting for a public service pension. They can advise you how your choice of a public service pension will affect your monthly LTD benefit. What will happen to my Long-Term Disability benefits if I earn money in a rehabilitation program? While receiving benefits, you may participate in a rehabilitation program that the insurer has approved in writing. Such a program could be for vocational training or be a period of work for the purpose of rehabilitation. Depending on the circumstances, you may be able to remain in such a program for up to 24 months and still receive some benefits. Normally, the amount of your rehabilitation earnings will not be deducted from your monthly benefits unless your total income while working, together with any benefits you are receiving under the LTD plan, exceeds the current salary of your former position. What if I earn money from other employment? If you earn money from any employment that the insurer does not consider rehabilitative, your benefits will be reduced by the total amount of those earnings. What if I recover but become totally disabled again? If you were in receipt of LTD benefits, recovered from your disability, and then become totally disabled again, the elimination period will be waived according to how long you were back at work: for no more than one month, if the two periods of disability are due to unrelated causes for no more than six months, if the two periods of disability are due to related causes for no more than 12 months, if the two periods of disability are due to the same cause What happens if the group policy terminates? If the group policy were to terminate for any reason after your disability began, the insurer will continue to pay benefits as long as you remain totally disabled during a continuous period. Are my Long-Term Disability benefits subject to income tax? If you qualify for LTD benefits under the PSMIP, the amount you receive will be subject to income tax. After the end of each year, the insurer will send you a form that indicates the total amount of LTD benefits paid to you. The insurer does not automatically deduct taxes at source, except in the case of provincial taxes payable by Quebec residents. If you wish, the insurer will deduct taxes at source based on information you provide. The monthly premiums you pay while you are employed are not tax deductible from earnings. Note the following: if you become eligible for LTD benefits, the total amount of the premiums you have paid from the time you became a member of the PSMIP may be deducted for tax purposes from the amount of your disability income from the PSMIP if the total amount of premiums you have paid exceeds the LTD benefits you receive during the first taxation year in which your LTD benefits begin, you can carry over the excess amount to the following year Consult the Canada Revenue Agency for details if you become totally disabled. Your departmental compensation services or the Public Service Pay Centre can help you determine the amount of premiums you have paid. How do I submit a claim for Long-Term Disability benefits? The insurer is committed to making a prompt and accurate payment of benefits to which you may become entitled. If you become totally disabled and you believe that your disability will last long enough for you to qualify for benefits, notify your immediate supervisor or manager as soon as possible, who will take the next steps with the Public Service Pay Centre or departmental compensation services. To be considered for LTD benefits, the four forms listed below must be completed by you, your employer and your doctor (attending physician). These forms: are required for you to make a LTD benefits claim must be completed as clearly and fully as possible must be submitted with supporting documents to the insurer to begin processing your disability claim The forms should be sent 60 days prior to the end of the elimination period (13 weeks or the exhaustion of your sick leave, whichever is later). If you fail to submit the forms by this time limit, you may not be entitled to some or all benefit payments. Once the insurer receives the four completed forms, your claim will be processed within approximately 10 business days. All four forms are available on the insurer’s website : Employee’s Statement ( F54‑1011A‑57 ) Initial Disability Insurance Medical Statement (attending physician/medical provider) Employer’s Statement ( F54‑1012A‑57 Immediate Supervisor or Manager) Employer’s Statement ( F54‑1013A‑57 Compensation/Human Resource advisor) The forms can be downloaded, completed by hand or electronically, saved as an email attachment, and submitted electronically with electronic signatures to disabilityclaims@ia.ca or faxed or mailed to the insurer according to the instructions on each form. It is your responsibility to provide the insurer with sufficient medical evidence to support your total disability through these forms. If the information is not sufficient to establish that you are totally disabled, the insurer may arrange for you to be assessed by an independent medical specialist. Ask your doctor to provide a full, well-documented report that clearly details the medical evidence supporting the diagnosis and prognosis. Your doctor may wish to supplement the required information on the form with narrative reports and copies of any tests or investigations conducted. It is your responsibility to ensure that your doctor completes the medical statement and that it reaches the insurer without delay. If more than one doctor is involved in the assessment or treatment of your disabling condition (for example, a medical specialist), ask them all to supply the insurer with detailed medical reports. The insurer’s website also provides a checklist to help you complete your claim package. If your attending physician has difficulty completing the Initial Disability Insurance Medical Statement, contact the insurer to discuss your situation. If your immediate supervisor or manager is not available, your more senior manager may instead complete and submit the Employer’s Statement form (F54-1012A-57 Immediate Supervisor or Manager), provided they indicate to the insurer that they are doing so because of the unavailability of your direct supervisor or manager. In these cases, the name of the unavailable direct supervisor or manager should be indicated on the Employer’s Statement (F54-1012A-57 Immediate Supervisor or Manager) form, on a separate sheet of paper, or in the submission email. If completion by a more senior manager is not an option, contact the insurer . Submission before the end of the elimination period (13 weeks or the exhaustion of your sick leave, whichever is later) gives the insurer an opportunity to inform you of the decision on your claim prior to the first day your LTD benefits become payable. If the claim is approved, payment can be processed on that day. Any omissions or unclear statements in completed forms could result in a delay in settling your claim. Once the claim is received, the insurer has the right to: request additional medical information from your doctor arrange for your examination by independent medical specialists or other service provider(s) When will my Long-Term Disability benefits start? Your LTD benefits will be paid once you have used all your sick leave, provided that the elimination period of 13 weeks has been met. In most cases, the elimination period will consist of a complete absence from work for a period of 13 weeks. In certain circumstances, however, periods of absence due to the same illness or condition that occurred within the year immediately prior to the date of total disability can be used to calculate the elimination period. The first period of absence must have been for a continuous period of one month. These situations must be referred to the insurer for a decision on an individual basis.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What is the Public Service Management Insurance Plan?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-1", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-1", + "marginal_note": "Long-Term Disability insurance (part 1)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Long-Term Disability insurance\nWhat is Long-Term Disability insurance? The Long-Term Disability (LTD) component of the PSMIP is an important part of the income-protection arrangements for members. LTD provides a monthly income benefit for employees who are unable to work for a lengthy period of time because of a totally disabling illness or injury. The employer and the employee share the cost of the premium for this insurance.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-2", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-2", + "marginal_note": "Long-Term Disability insurance (part 2)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Am I eligible for Long-Term Disability benefits? If you are a member under the LTD insurance plan, you are eligible for benefits for up to 24 months if, as a result of a physical or mental impairment determined by a physician, you are unable to perform the essential functions of your regular job. At the end of this 24 month period, your benefits will be continued if you remain totally disabled and are unable to earn two thirds of the current salary of the position you held before you became disabled. Your LTD benefits will continue as long as you remain totally disabled. Benefits will not continue beyond your 65 th birthday. While you are receiving LTD benefits, you must be under the active care of a physician who is a registered specialist in the field of medicine related to your disabling condition. You must also be receiving medical treatment or participating in a program of rehabilitation approved by the insurer. You are not eligible for benefits if: your disability is the result of a mental or physical impairment that existed before you became insured: this exclusion is lifted if you complete a continuous period of 90 days of active employment while insured for LTD, or after you have been insured for LTD for two years, whichever comes first your disability results from or is related to: a normal pregnancy (without severe complications) commission of a felony self-inflicted injury a mental or physical impairment suffered while on active duty with any armed force your disability results from or is related to an act of declared or undeclared war; this exclusion does not apply to persons who become totally disabled in this way while outside Canada at the direction of the employer Note: If you become disabled, contact your departmental compensation services or the Public Service Pay Centre , even if you are unsure whether or not you qualify for LTD benefits.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-3", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-3", + "marginal_note": "Long-Term Disability insurance (part 3)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "What happens if I retire before using all my sick leave credits? If you retire voluntarily before exhausting your accumulated sick leave credits, your unused sick leave credits will still be counted and used to determine the date that your LTD benefits will begin. If you are considering terminating your employment prior to exhausting your sick leave credits, contact your departmental compensation services or the Public Service Pay Centre to see if your termination will be considered as a voluntary termination for LTD purposes.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-4", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-4", + "marginal_note": "Long-Term Disability insurance (part 4)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "How are my Long-Term Disability benefits calculated? If you become totally disabled, your gross annual benefit will be 70% of your insured annual salary at the end of the elimination period (13 weeks or the exhaustion of your sick leave, whichever is later). The definition of salary is the same as that used for the Supplementary Death Benefit under the PSSA Your insured annual salary for the purposes of LTD is equal to your annual salary at the end of the elimination period if it is a multiple of $250, or the next multiple of $250 above that amount. A member who works part time will have the insured annual salary based on assigned hours of work. Payments are made monthly. Other income, whether it be income received as a result of being in receipt of a PSSA benefit or a disability benefit under the Canada Pension Plan (CPP) or Quebec Pension Plan (QPP), will be deducted as an offset from your LTD benefits. Your net benefit, which is the amount payable to you after other income has been deducted as an offset, will be subject to an annual increase related to increases in the cost of living, up to a maximum of 3%. Any retroactive salary increase approved after the date your LTD benefits become payable affects your insured salary and benefit level only when the effective date of the increase precedes the date on which your LTD benefits began. For example, a retroactive salary increase approved in April that took effect from February 10 would affect your LTD benefits only if your benefits began on February 11 or later. Table 1: example of benefit calculation 1. Your annual salary at end of elimination period $47,925 2. Your insured salary (annual salary taken to next highest multiple of $250) $48,000 3. Your gross annual LTD benefit (70% of $48,000) $33,600 4. Less other income you are receiving PSSA benefit $14,000 CPP disability benefit $8,000 5. Your net annual LTD benefit $11,600 6. The amount of monthly LTD payments ($11,600 divided by 12) $967 If the cost of living rose by 2% in the year following the start of your benefits, your net monthly LTD benefit of $967 would be increased by 2% to $986.34 on January 1 following the effective date your benefits start. Your PSSA and CPP or QPP benefits would be adjusted to reflect increases in the cost of living. You would receive the full increase under those plans, and the increase would not be deducted from your LTD benefit. On January 1 of each subsequent year, your LTD benefit would be further increased to reflect increases in the cost of living, up to a maximum of 3% annually.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-5", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-5", + "marginal_note": "Long-Term Disability insurance (part 5)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Offsets: what types of income will be deducted from my Long-Term Disability benefits? The following examples illustrate the most common types of income that would be deducted from your LTD benefits: benefits received under the PSSA LTD benefits under the CPP or the QPP, excluding benefits payable to or on behalf of your dependants as a result of your disability benefits under the or similar benefits under a plan of the federal government or any other government LTD benefits paid or available under another group insurance plan, or under a policy issued to you as a result of your membership in a public service employee union or association disability insurance benefits under the legislation of any government, such as income replacement benefits under a no-fault automobile insurance plan loss-of-income benefits received under a third-party damage award The following are examples of income that would not be deducted from your Long-Term Disability benefits: increases related to the cost of living indexation under the PSSA, CPP or QPP return of superannuation contributions where no pension entitlement is available benefits received under a purely private and personal insurance policy, or under a policy issued as a result of membership in a professional association not restricted to the public service severance pay If you do not apply for benefits under the CPP or QPP and if, in the opinion of the insurer, the medical evidence indicates that you would be eligible for CPP or QPP benefits, the insurer has the right to reduce your basic monthly LTD benefit by the estimated amount of your CPP or QPP entitlement. If you subsequently applied for CPP or QPP benefits and were declared ineligible, the reduction would cease, and the amounts previously withheld would be paid to you. Note, however, that if the insurer believes you have grounds for a successful appeal, the reduction may be continued until the conclusion of the appeal process. The treatment of benefits payable under the PSSA as offsets under the LTD component of the PSMIP is illustrated on the chart in Table A1 in the Appendix . If you cease to be employed in the public service, consult your departmental compensation services or the Public Service Pay Centre before opting for a public service pension. They can advise you how your choice of a public service pension will affect your monthly LTD benefit.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-6", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-6", + "marginal_note": "Long-Term Disability insurance (part 6)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "What will happen to my Long-Term Disability benefits if I earn money in a rehabilitation program? While receiving benefits, you may participate in a rehabilitation program that the insurer has approved in writing. Such a program could be for vocational training or be a period of work for the purpose of rehabilitation. Depending on the circumstances, you may be able to remain in such a program for up to 24 months and still receive some benefits. Normally, the amount of your rehabilitation earnings will not be deducted from your monthly benefits unless your total income while working, together with any benefits you are receiving under the LTD plan, exceeds the current salary of your former position.\nWhat if I earn money from other employment? If you earn money from any employment that the insurer does not consider rehabilitative, your benefits will be reduced by the total amount of those earnings.\nWhat if I recover but become totally disabled again? If you were in receipt of LTD benefits, recovered from your disability, and then become totally disabled again, the elimination period will be waived according to how long you were back at work: for no more than one month, if the two periods of disability are due to unrelated causes for no more than six months, if the two periods of disability are due to related causes for no more than 12 months, if the two periods of disability are due to the same cause\nWhat happens if the group policy terminates? If the group policy were to terminate for any reason after your disability began, the insurer will continue to pay benefits as long as you remain totally disabled during a continuous period.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-7", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-7", + "marginal_note": "Long-Term Disability insurance (part 7)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Are my Long-Term Disability benefits subject to income tax? If you qualify for LTD benefits under the PSMIP, the amount you receive will be subject to income tax. After the end of each year, the insurer will send you a form that indicates the total amount of LTD benefits paid to you. The insurer does not automatically deduct taxes at source, except in the case of provincial taxes payable by Quebec residents. If you wish, the insurer will deduct taxes at source based on information you provide. The monthly premiums you pay while you are employed are not tax deductible from earnings. Note the following: if you become eligible for LTD benefits, the total amount of the premiums you have paid from the time you became a member of the PSMIP may be deducted for tax purposes from the amount of your disability income from the PSMIP if the total amount of premiums you have paid exceeds the LTD benefits you receive during the first taxation year in which your LTD benefits begin, you can carry over the excess amount to the following year Consult the Canada Revenue Agency for details if you become totally disabled. Your departmental compensation services or the Public Service Pay Centre can help you determine the amount of premiums you have paid.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-8", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-8", + "marginal_note": "Long-Term Disability insurance (part 8)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "How do I submit a claim for Long-Term Disability benefits? The insurer is committed to making a prompt and accurate payment of benefits to which you may become entitled. If you become totally disabled and you believe that your disability will last long enough for you to qualify for benefits, notify your immediate supervisor or manager as soon as possible, who will take the next steps with the Public Service Pay Centre or departmental compensation services. To be considered for LTD benefits, the four forms listed below must be completed by you, your employer and your doctor (attending physician). These forms: are required for you to make a LTD benefits claim must be completed as clearly and fully as possible must be submitted with supporting documents to the insurer to begin processing your disability claim The forms should be sent 60 days prior to the end of the elimination period (13 weeks or the exhaustion of your sick leave, whichever is later). If you fail to submit the forms by this time limit, you may not be entitled to some or all benefit payments. Once the insurer receives the four completed forms, your claim will be processed within approximately 10 business days. All four forms are available on the insurer’s website : Employee’s Statement ( F54‑1011A‑57 ) Initial Disability Insurance Medical Statement (attending physician/medical provider) Employer’s Statement ( F54‑1012A‑57 Immediate Supervisor or Manager) Employer’s Statement ( F54‑1013A‑57 Compensation/Human Resource advisor) The forms can be downloaded, completed by hand or electronically, saved as an email attachment, and submitted electronically with electronic signatures to disabilityclaims@ia.ca or faxed or mailed to the insurer according to the instructions on each form. It is your responsibility to provide the insurer with sufficient medical evidence to support your total disability through these forms. If the information is not sufficient to establish that you are totally disabled, the insurer may arrange for you to be assessed by an independent medical specialist. Ask your doctor to provide a full, well-documented report that clearly details the medical evidence supporting the diagnosis and prognosis. Your doctor may wish to supplement the required information on the form with narrative reports and copies of any tests or investigations conducted. It is your responsibility to ensure that your doctor completes the medical statement and that it reaches the insurer without delay. If more than one doctor is involved in the assessment or treatment of your disabling condition (for example, a medical specialist), ask them all to supply the insurer with detailed medical reports. The insurer’s website also provides a checklist to help you complete your claim package. If your attending physician has difficulty completing the Initial Disability Insurance Medical Statement, contact the insurer to discuss your situation. If your immediate supervisor or manager is not available, your more senior manager may instead complete and submit the Employer’s Statement form (F54-1012A-57 Immediate Supervisor or Manager), provided they indicate to the insurer that they are doing so because of the unavailability of your direct supervisor or manager. In these cases, the name of the unavailable direct supervisor or manager should be indicated on the Employer’s Statement (F54-1012A-57 Immediate Supervisor or Manager) form, on a separate sheet of paper, or in the submission email. If completion by a more senior manager is not an option, contact the insurer . Submission before the end of the elimination period (13 weeks or the exhaustion of your sick leave, whichever is later) gives the insurer an opportunity to inform you of the decision on your claim prior to the first day your LTD benefits become payable. If the claim is approved, payment can be processed on that day. Any omissions or unclear statements in completed forms could result in a delay in settling your claim. Once the claim is received, the insurer has the right to: request additional medical information from your doctor arrange for your examination by independent medical specialists or other service provider(s)", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-long-term-disability-insurance-9", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "long-term-disability-insurance-9", + "marginal_note": "Long-Term Disability insurance (part 9)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "When will my Long-Term Disability benefits start? Your LTD benefits will be paid once you have used all your sick leave, provided that the elimination period of 13 weeks has been met. In most cases, the elimination period will consist of a complete absence from work for a period of 13 weeks. In certain circumstances, however, periods of absence due to the same illness or condition that occurred within the year immediately prior to the date of total disability can be used to calculate the elimination period. The first period of absence must have been for a continuous period of one month. These situations must be referred to the insurer for a decision on an individual basis.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Long-Term Disability insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-other-insurance-is-available-to-me-1", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-other-insurance-is-available-to-me-1", + "marginal_note": "What other insurance is available to me? (part 1)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "What other insurance is available to me?\nThe PSMIP provides public service employees who are excluded from the collective bargaining process, or their families, with benefits in the event of accident or death. The PSMIP offers four types of optional insurance, which you may obtain at your own expense.\nTo be covered for optional insurance, you must complete an application form. You can apply for coverage under the following:\n- Basic Life Insurance: a lump-sum benefit roughly equal to your annual salary, payable to your beneficiary in the event of your death from any cause\n- Supplementary Life Insurance: an additional layer of insurance identical to that provided by Basic Life Insurance\n- Accidental Death and Dismemberment (AD&D) Insurance: a lump-sum benefit payable to your beneficiary if you are killed in an accident (on or off the job), or to you directly if you are maimed in an accident\n- Dependants’ Insurance: a lump-sum benefit to you in the event of the death or dismemberment of one or more of your dependants\nApplications for Basic Life and Dependants’ Insurance made more than two months after you or your dependants become eligible to join the PSMIP must be accompanied by evidence of insurability that is satisfactory to the insurer. For example, a member who enters into a relationship that satisfies the definition of spouse, and who does not apply for Dependants’ Insurance within two months of having satisfied the requirements of the definition, must provide evidence of the spouse’s insurability in a form that is satisfactory to the insurer when submitting an application.\nThe applications for Supplementary Life Insurance may be made at any time and must be accompanied by evidence of insurability that is satisfactory to the insurer.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What other insurance is available to me?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-other-insurance-is-available-to-me-2", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-other-insurance-is-available-to-me-2", + "marginal_note": "What other insurance is available to me? (part 2)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Life insurance benefits payable under the PSMIP are in addition to any Supplementary Death Benefit payable under the PSSA.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What other insurance is available to me?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-other-insurance-is-available-to-me-3", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-other-insurance-is-available-to-me-3", + "marginal_note": "What other insurance is available to me? (part 3)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Basic Life Insurance How is Basic Life Insurance calculated? Your Basic Life Insurance is based on your salary adjusted to the nearest $1,000 (for example, all salaries in the range of $47,500.01 to $48,500.00 would be rounded to $48,000). This $48,000 figure is the adjusted salary. The definition of salary is the same as that used for the Supplementary Death Benefit under the PSSA. If you are a part-time employee, your annual salary for the purposes of insurance is determined by reducing the full-time salary for your occupational group and level, in proportion to the relationship of your assigned hours of work to normal full-time hours in that group. That amount is then rounded to the nearest $1,000. The amount of Basic Life Insurance is one year’s adjusted salary (as described above) up to age 65. On the first of the month following your 66 th birthday, the basic amount becomes 90% of one year’s adjusted salary. It becomes 80% of one year’s adjusted salary one year later, and so on. Coverage will never be less than 10% of one year’s adjusted salary while you remain a member of the PSMIP. The amount of this insurance will be revised immediately to reflect any changes in salary due to annual increments, economic increases or promotions. In the case of a retroactive salary change, coverage will change on the first of the month following the month in which the change was authorized. The premium rates for Basic Life Insurance are related to your sex and age. You are responsible for paying 100% of the premiums. If you die from any cause while insured under Basic Life Insurance or Supplementary Life Insurance, the amount of life insurance in force at that time will be paid to your beneficiary. You may name your own beneficiary. Your beneficiary may be: one person or more than one person a minor a charitable organization your estate Your beneficiary would receive any life (Basic and Supplementary) insurance and accidental death benefits payable under the policy. To change beneficiaries at any time (subject to any applicable provincial or territorial law), complete the PWGSC-TPSGC 2028-1 - Public Service Management Insurance Plan form. If you do not name a beneficiary, or if your beneficiary predeceases you, benefits will be paid to your estate.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What other insurance is available to me?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-other-insurance-is-available-to-me-4", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-other-insurance-is-available-to-me-4", + "marginal_note": "What other insurance is available to me? (part 4)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Supplementary Life Insurance Is there any additional insurance available? If you decide to take Basic Life Insurance under the PSMIP, you may also elect to take Supplementary Life Insurance, subject to the insurer’s approval. The amount of Supplementary Life Insurance is equal to the amount of Basic Life Insurance, and together these would bring your total protection to twice your adjusted salary. Evidence of your insurability that is satisfactory to the insurer is needed for Supplementary Life Insurance, no matter when you apply. As for Basic Life Insurance, the premium rates for Supplementary Life Insurance are related to your sex and age.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What other insurance is available to me?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-other-insurance-is-available-to-me-5", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-other-insurance-is-available-to-me-5", + "marginal_note": "What other insurance is available to me? (part 5)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Accidental Death and Dismemberment (AD&D) Insurance How does AD&D Insurance work? The maximum principal sum available through AD&D Insurance is $250,000. It is available in units of $25,000. You may select any number of units, up to 10, unless you are a part-time employee, in which case the maximum number of units available to you depends on your assigned hours of work. Your departmental compensation services or the Public Service Pay Centre can provide full details. If you sustain any of the losses listed in Table 2 solely through external accidental means, the following benefits will be paid in addition to any life insurance or LTD benefits payable under the LTD Plan: Table 2: schedule of amounts of insurance Type of AD&D Benefit Life Principal sum Both hands or both feet Principal sum Sight of both eyes Principal sum One hand and one foot Principal sum One hand or one foot and sight of one eye Principal sum Speech and hearing Principal sum Quadriplegia (total and irreversible paralysis of all four limbs) Principal sum Paraplegia (total and irreversible paralysis of both lower limbs) Principal sum Hemiplegia (total and irreversible paralysis of one arm and one leg on the same side of the body) Principal sum One leg or one arm Three quarters of the principal sum One hand or one foot Half of the principal sum Speech or hearing Half of the principal sum Sight of one eye Half of the principal sum Thumb and index finger (of the same hand) One quarter of the principal sum As an example, if you carried five units of this insurance and were killed in a car accident, your beneficiary would receive $125,000 (the principal sum). If, instead, you lost one foot, you would receive $62,500 (half the principal sum). Losses must be suffered within 90 days from the date of the accident. The total amount payable for all losses sustained in any one accident is limited to the principal sum. These benefits are not payable in the event of loss arising from suicide or self-inflicted injury. Benefits are not payable if the loss results from war or any act of war, unless the incident occurs while you are outside Canada at the direction of the employer, such as on a posting, on assignment or in travel status. Benefits are also not payable if the loss was caused by disease, bacterial infection, taking poison, or participating in any riot or civil strife.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What other insurance is available to me?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-other-insurance-is-available-to-me-6", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-other-insurance-is-available-to-me-6", + "marginal_note": "What other insurance is available to me? (part 6)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Dependants’ Insurance What kind of coverage is available for my dependants? This coverage consists of life insurance and AD&D Insurance for your dependants, who are defined as: your spouse that is, a person to whom you are legally married or a person who resides with you and has resided with you for a period of at least one year and whom you have publicly represented as your spouse all your unmarried children over the age of 14 days but not yet 21 years old (25 in the case of full-time students enrolled in a school or university) who are not employed on a regular, full-time basis and who are dependent on you for support The amounts of insurance are as follows: life insurance of $5,000 on the life of your spouse and $2,500 on the life of each child: on the first of the month following your 65 th birthday, all amounts are reduced to $1,250, if one of your dependants dies from any cause while insured, the amount of life insurance in force on the life of the dependant will be paid to you AD&D Insurance in a principal sum of $5,000 on the life of your spouse and $2,500 on the life of each child: the principal sums are reduced to $1,250 after you reach age 65; the proportions of the principal sum payable for a loss suffered by one of your insured dependants, and all other conditions, are identical to those of the AD&D Insurance available to you as described in Table 2", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What other insurance is available to me?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-other-insurance-is-available-to-me-7", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-other-insurance-is-available-to-me-7", + "marginal_note": "What other insurance is available to me? (part 7)", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Living Benefit What is the Living Benefit? The Living Benefit, which came into effect in February 1994 , provides members who are terminally ill with a portion of the life insurance benefit that would otherwise be payable to their beneficiary on their death. What is a terminal condition? A terminal condition means an injury or illness that is expected to result in death within 24 months and from which there is no reasonable prospect of recovery as determined by the insurer based on medical evidence provided. How is the Living Benefit calculated? The amount payable is 50% of the total amount of your life insurance or $50,000, whichever is less. How do I apply for the Living Benefit? To request the Living Benefit, contact the insurer. You will be required to provide all medical information necessary to permit the insurer to determine whether you are suffering from a terminal condition as defined in the PSMIP. You and your beneficiary will be required to sign a Living Benefit Agreement. Are there any restrictions? A Living Benefit is not payable if all or a portion of your life insurance is to be paid to your former spouse as part of a divorce agreement. If I receive a Living Benefit, what effect will it have on the amount payable on my death? The amount payable as a Living Benefit will be deducted from the amount otherwise payable under the PSMIP to your beneficiary. No interest will be charged.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What other insurance is available to me?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-basic-life-insurance", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "basic-life-insurance", + "marginal_note": "Basic Life Insurance", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Basic Life Insurance\nHow is Basic Life Insurance calculated? Your Basic Life Insurance is based on your salary adjusted to the nearest $1,000 (for example, all salaries in the range of $47,500.01 to $48,500.00 would be rounded to $48,000). This $48,000 figure is the adjusted salary. The definition of salary is the same as that used for the Supplementary Death Benefit under the PSSA. If you are a part-time employee, your annual salary for the purposes of insurance is determined by reducing the full-time salary for your occupational group and level, in proportion to the relationship of your assigned hours of work to normal full-time hours in that group. That amount is then rounded to the nearest $1,000. The amount of Basic Life Insurance is one year’s adjusted salary (as described above) up to age 65. On the first of the month following your 66 th birthday, the basic amount becomes 90% of one year’s adjusted salary. It becomes 80% of one year’s adjusted salary one year later, and so on. Coverage will never be less than 10% of one year’s adjusted salary while you remain a member of the PSMIP. The amount of this insurance will be revised immediately to reflect any changes in salary due to annual increments, economic increases or promotions. In the case of a retroactive salary change, coverage will change on the first of the month following the month in which the change was authorized. The premium rates for Basic Life Insurance are related to your sex and age. You are responsible for paying 100% of the premiums. If you die from any cause while insured under Basic Life Insurance or Supplementary Life Insurance, the amount of life insurance in force at that time will be paid to your beneficiary. You may name your own beneficiary. Your beneficiary may be: one person or more than one person a minor a charitable organization your estate Your beneficiary would receive any life (Basic and Supplementary) insurance and accidental death benefits payable under the policy. To change beneficiaries at any time (subject to any applicable provincial or territorial law), complete the PWGSC-TPSGC 2028-1 - Public Service Management Insurance Plan form. If you do not name a beneficiary, or if your beneficiary predeceases you, benefits will be paid to your estate.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Basic Life Insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-supplementary-life-insurance", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "supplementary-life-insurance", + "marginal_note": "Supplementary Life Insurance", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Supplementary Life Insurance\nIs there any additional insurance available? If you decide to take Basic Life Insurance under the PSMIP, you may also elect to take Supplementary Life Insurance, subject to the insurer’s approval. The amount of Supplementary Life Insurance is equal to the amount of Basic Life Insurance, and together these would bring your total protection to twice your adjusted salary. Evidence of your insurability that is satisfactory to the insurer is needed for Supplementary Life Insurance, no matter when you apply. As for Basic Life Insurance, the premium rates for Supplementary Life Insurance are related to your sex and age.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Supplementary Life Insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-accidental-death-and-dismemberment-ad-d-", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "accidental-death-and-dismemberment-ad-d-", + "marginal_note": "Accidental Death and Dismemberment (AD&D) Insurance", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Accidental Death and Dismemberment (AD&D) Insurance\nHow does AD&D Insurance work? The maximum principal sum available through AD&D Insurance is $250,000. It is available in units of $25,000. You may select any number of units, up to 10, unless you are a part-time employee, in which case the maximum number of units available to you depends on your assigned hours of work. Your departmental compensation services or the Public Service Pay Centre can provide full details. If you sustain any of the losses listed in Table 2 solely through external accidental means, the following benefits will be paid in addition to any life insurance or LTD benefits payable under the LTD Plan: Table 2: schedule of amounts of insurance Type of AD&D Benefit Life Principal sum Both hands or both feet Principal sum Sight of both eyes Principal sum One hand and one foot Principal sum One hand or one foot and sight of one eye Principal sum Speech and hearing Principal sum Quadriplegia (total and irreversible paralysis of all four limbs) Principal sum Paraplegia (total and irreversible paralysis of both lower limbs) Principal sum Hemiplegia (total and irreversible paralysis of one arm and one leg on the same side of the body) Principal sum One leg or one arm Three quarters of the principal sum One hand or one foot Half of the principal sum Speech or hearing Half of the principal sum Sight of one eye Half of the principal sum Thumb and index finger (of the same hand) One quarter of the principal sum As an example, if you carried five units of this insurance and were killed in a car accident, your beneficiary would receive $125,000 (the principal sum). If, instead, you lost one foot, you would receive $62,500 (half the principal sum). Losses must be suffered within 90 days from the date of the accident. The total amount payable for all losses sustained in any one accident is limited to the principal sum. These benefits are not payable in the event of loss arising from suicide or self-inflicted injury. Benefits are not payable if the loss results from war or any act of war, unless the incident occurs while you are outside Canada at the direction of the employer, such as on a posting, on assignment or in travel status. Benefits are also not payable if the loss was caused by disease, bacterial infection, taking poison, or participating in any riot or civil strife.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Accidental Death and Dismemberment (AD&D) Insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-dependants-insurance", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "dependants-insurance", + "marginal_note": "Dependants’ Insurance", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Dependants’ Insurance\nWhat kind of coverage is available for my dependants? This coverage consists of life insurance and AD&D Insurance for your dependants, who are defined as: your spouse that is, a person to whom you are legally married or a person who resides with you and has resided with you for a period of at least one year and whom you have publicly represented as your spouse all your unmarried children over the age of 14 days but not yet 21 years old (25 in the case of full-time students enrolled in a school or university) who are not employed on a regular, full-time basis and who are dependent on you for support The amounts of insurance are as follows: life insurance of $5,000 on the life of your spouse and $2,500 on the life of each child: on the first of the month following your 65 th birthday, all amounts are reduced to $1,250, if one of your dependants dies from any cause while insured, the amount of life insurance in force on the life of the dependant will be paid to you AD&D Insurance in a principal sum of $5,000 on the life of your spouse and $2,500 on the life of each child: the principal sums are reduced to $1,250 after you reach age 65; the proportions of the principal sum payable for a loss suffered by one of your insured dependants, and all other conditions, are identical to those of the AD&D Insurance available to you as described in Table 2", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Dependants’ Insurance”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-living-benefit", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "living-benefit", + "marginal_note": "Living Benefit", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Living Benefit\nWhat is the Living Benefit? The Living Benefit, which came into effect in February 1994 , provides members who are terminally ill with a portion of the life insurance benefit that would otherwise be payable to their beneficiary on their death.\nWhat is a terminal condition? A terminal condition means an injury or illness that is expected to result in death within 24 months and from which there is no reasonable prospect of recovery as determined by the insurer based on medical evidence provided.\nHow is the Living Benefit calculated? The amount payable is 50% of the total amount of your life insurance or $50,000, whichever is less.\nHow do I apply for the Living Benefit? To request the Living Benefit, contact the insurer. You will be required to provide all medical information necessary to permit the insurer to determine whether you are suffering from a terminal condition as defined in the PSMIP. You and your beneficiary will be required to sign a Living Benefit Agreement.\nAre there any restrictions? A Living Benefit is not payable if all or a portion of your life insurance is to be paid to your former spouse as part of a divorce agreement. If I receive a Living Benefit, what effect will it have on the amount payable on my death? The amount payable as a Living Benefit will be deducted from the amount otherwise payable under the PSMIP to your beneficiary. No interest will be charged.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Living Benefit”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-termination-of-employment", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "termination-of-employment", + "marginal_note": "Termination of employment", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Termination of employment\nWhat happens to my insurance coverage when I cease to be employed in the public service? If you leave the public service, your life insurance will cease, subject to a 31-day extension period. During that extension period, you will be able to obtain an individual private life insurance policy, including some types of term insurance regularly issued by your insurer without medical examination and regardless of your state of health. Such a policy: may be for any amount equal to or less than the amount for which you were last insured under the group policy will be available at the insurer’s standard rates for your age, based on any special non-medical hazards (for example, hazards that an aircraft pilot could experience) to which you may be exposed If your own PSMIP Basic Life Insurance ceases, Dependants’ Insurance will also cease. However, your Dependants’ Life Insurance may also be converted to an individual private policy. AD&D and LTD Insurance cannot be converted to private policies. They terminate on the day you leave the public service. You must make your own arrangements directly with the insurer to convert your insurance to a private policy.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Termination of employment”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-happens-to-my-insurance-coverage-wh", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-happens-to-my-insurance-coverage-wh", + "marginal_note": "What happens to my insurance coverage when I cease to be employed in the public service?", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "What happens to my insurance coverage when I cease to be employed in the public service?\nIf you leave the public service, your life insurance will cease, subject to a 31-day extension period. During that extension period, you will be able to obtain an individual private life insurance policy, including some types of term insurance regularly issued by your insurer without medical examination and regardless of your state of health. Such a policy:\n- may be for any amount equal to or less than the amount for which you were last insured under the group policy\n- will be available at the insurer’s standard rates for your age, based on any special non-medical hazards (for example, hazards that an aircraft pilot could experience) to which you may be exposed\nIf your own PSMIP Basic Life Insurance ceases, Dependants’ Insurance will also cease. However, your Dependants’ Life Insurance may also be converted to an individual private policy. AD&D and LTD Insurance cannot be converted to private policies. They terminate on the day you leave the public service.\nYou must make your own arrangements directly with the insurer to convert your insurance to a private policy.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What happens to my insurance coverage when I cease to be employed in the public service?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-general-information", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "general-information", + "marginal_note": "General information", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "General information\nWhat is the waiver of premium benefit? If you become totally disabled to the point where you qualify for LTD benefits, or where you would qualify if you belonged to the LTD portion of the PSMIP your optional life and LTD insurance will be continued in force without payment of further premiums from the date your salary ceases until your recovery, death or 65 th birthday, whichever comes first. This benefit is subject to proof of total disability. You must provide this proof when you first make a claim and from time to time as set forth in the policy.\nCan I appeal the insurer’s decision? If you disagree with the insurer’s decision on an insurance application or a claim for your LTD benefits, you can appeal to the insurer. If the insurer’s decision remains unchanged, the Board of Trustees can review your case. The Board can only make recommendations to the insurer and cannot overrule their decisions. If you want the Board of Trustees to review your case, write to the following: Secretary to the PSMIP Board of Trustees Employee Relations and Total Compensation Sector Treasury Board of Canada Secretariat 90 Elgin St 3 rd Floor Ottawa ON K1A 0R5\nPrivacy and protection of personal information Who can access personal information in my file? Personal information used to adjudicate your claim for LTD benefits is held by the insurer. Authorized employees or other persons working for or on behalf of the insurer are allowed access to this information while performing their duties, as outlined above. You have the right to have access to the information on file and correct it if needed. You must make any such request in writing to the insurer.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “General information”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-what-is-the-waiver-of-premium-benefit", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "what-is-the-waiver-of-premium-benefit", + "marginal_note": "What is the waiver of premium benefit?", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "What is the waiver of premium benefit?\nIf you become totally disabled to the point where you qualify for LTD benefits, or where you would qualify if you belonged to the LTD portion of the PSMIP your optional life and LTD insurance will be continued in force without payment of further premiums from the date your salary ceases until your recovery, death or 65 th birthday, whichever comes first. This benefit is subject to proof of total disability. You must provide this proof when you first make a claim and from time to time as set forth in the policy.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “What is the waiver of premium benefit?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-can-i-appeal-the-insurer-s-decision", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "can-i-appeal-the-insurer-s-decision", + "marginal_note": "Can I appeal the insurer’s decision?", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Can I appeal the insurer’s decision?\nIf you disagree with the insurer’s decision on an insurance application or a claim for your LTD benefits, you can appeal to the insurer. If the insurer’s decision remains unchanged, the Board of Trustees can review your case. The Board can only make recommendations to the insurer and cannot overrule their decisions. If you want the Board of Trustees to review your case, write to the following:\nSecretary to the PSMIP Board of Trustees Employee Relations and Total Compensation Sector Treasury Board of Canada Secretariat 90 Elgin St 3 rd Floor Ottawa ON K1A 0R5", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Can I appeal the insurer’s decision?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-privacy-and-protection-of-personal-infor", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "privacy-and-protection-of-personal-infor", + "marginal_note": "Privacy and protection of personal information", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Privacy and protection of personal information\nWho can access personal information in my file? Personal information used to adjudicate your claim for LTD benefits is held by the insurer. Authorized employees or other persons working for or on behalf of the insurer are allowed access to this information while performing their duties, as outlined above. You have the right to have access to the information on file and correct it if needed. You must make any such request in writing to the insurer.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Privacy and protection of personal information”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-contact-information", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "contact-information", + "marginal_note": "Contact information", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Contact information\nWho can I contact for more information? Your departmental compensation services or the Public Service Pay Centre can provide you with further information on: conditions of membership application procedures commencement, continuation, termination or cancellation of coverage claim procedures\nHow can I contact the insurer? You can contact the insurer at the following: Long-Term Disability benefits Telephone (toll-free): 1-800-830-1255 Email: disabilityclaims@ia.ca Fax (toll-free): 1-877-781-1583 Mail: iA Financial Group Group Life and Disability Claims Department (PSMIP) PO Box 4643, Station A Toronto, ON, M5W 5E3 Life Insurance benefits Telephone (toll-free): 1-800-830-1255 Email: PSMIP@ia.ca Fax (toll-free): 1-877-781-1583 Mail: iA Financial Group Group Life and Disability Claims Department (PSMIP) PO Box 4643, Station A Toronto ON M5W 5E3 You should quote the following when contacting the insurer regarding a claim: group policy number (G68-1400) name of the member nature of the claim employing department (or agency) of the member or the office held by the member The claim forms and details regarding procedures will be sent to you or your beneficiary.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Contact information”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-who-can-i-contact-for-more-information", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "who-can-i-contact-for-more-information", + "marginal_note": "Who can I contact for more information?", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Who can I contact for more information?\nYour departmental compensation services or the Public Service Pay Centre can provide you with further information on:\n- conditions of membership\n- application procedures\n- commencement, continuation, termination or cancellation of coverage\n- claim procedures", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Who can I contact for more information?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-how-can-i-contact-the-insurer", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "how-can-i-contact-the-insurer", + "marginal_note": "How can I contact the insurer?", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "How can I contact the insurer?\nYou can contact the insurer at the following:\nLong-Term Disability benefits\n- Telephone (toll-free): 1-800-830-1255\n- Email: disabilityclaims@ia.ca\n- Fax (toll-free): 1-877-781-1583\n- Mail: iA Financial Group Group Life and Disability Claims Department (PSMIP) PO Box 4643, Station A Toronto, ON, M5W 5E3\nLife Insurance benefits\n- Telephone (toll-free): 1-800-830-1255\n- Email: PSMIP@ia.ca\n- Fax (toll-free): 1-877-781-1583\n- Mail: iA Financial Group Group Life and Disability Claims Department (PSMIP) PO Box 4643, Station A Toronto ON M5W 5E3\nYou should quote the following when contacting the insurer regarding a claim:\n- group policy number (G68-1400)\n- name of the member\n- nature of the claim\n- employing department (or agency) of the member or the office held by the member\nThe claim forms and details regarding procedures will be sent to you or your beneficiary.", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “How can I contact the insurer?”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + }, + { + "id": "benefits-PSMIP-appendix", + "doc_type": "benefits", + "act_code": "PSMIP", + "act_short": "PSMIP", + "act_name": "Public Service Management Insurance Plan — Main Plan Booklet", + "section": "appendix", + "marginal_note": "Appendix", + "part": "Public Service Management Insurance Plan Main Plan Booklet", + "division": "", + "heading": "", + "text": "Appendix\nThe following table outlines the treatment of benefits payable under the Public Service Superannuation Act (PSSA) as offsets from Long-Term Disability (LTD) benefits.\nTable A1: treatment of benefits payable under the Public Service Superannuation Act (PSSA) as offsets from Long-Term Disability (LTD) benefits Circumstance Public Service Superannuation Act benefit options Offset from Long-Term Disability Plan 1. Termination with less than two years’ service Return of contributions No offset 2. PSSA disability retirement approved Immediate annuity Lump-sum payment Offset immediately in full amount Offset immediately by amount equal to immediate annuity until full amount of lump sum has been offset 3. PSSA disability retirement applied for but not approved Deferred annuity at age 60 Annual allowance from age 50 onward Transfer value Return of contributions Offset at age 60 Offset when payable Monthly offset at age 60 by amount equal to deferred annuity but capped when total of transfer value or lump sum has been offset 4. Application for PSSA disability retirement not made Immediate annuity Deferred annuity at age 60 Annual allowance from age 50 onward Transfer value Return of contributions Offset immediately by full amount Offset immediately by amount of equivalent immediate annuity unless you prove that an application for a disability retirement had been declined; capped when total of transfer value or return of contributions has been offset Where such proof is provided, offsets as in circumstance 3", + "history": "", + "last_amended": "", + "current_to": "", + "citation": "PSMIP Main Plan Booklet, “Appendix”", + "source_url": "https://www.canada.ca/en/treasury-board-secretariat/services/benefit-plans/management-insurance-plan/main-plan-booklet.html" + } +] \ No newline at end of file