A new PSHCP deal came into force on July 1, 2023, and we’ve collected the answers to the questions we hear the most from our members.
The following is for informational purposes only. This FAQ does not provide comprehensive details about the plan or the PSHCP benefits. The PSHCP Plan Directive includes the PSHCP terms and conditions and serves as the authority. You can also contact Canada Life for more information.
FAQ on the Public Service Health Care Plan renewal
About the PSHCP
What does the PSHCP cover?
What has been included in the PSHCP renewal?
What is Federal Retirees’ role?
What is the Treasury Board of Canada Secretariat's role?
Why did the PSHCP move from Sun Life to Canada Life?
What about the PDSP?
How do I get a new Canada Life insurance card?
Do I have to present my new card to my pharmacist?
How can I contact Canada Life?
Who do I contact for emergency assistance abroad?
Plan benefits and coverage enhancements
What are the new coverage amounts?
Did my coverage amounts reset on July 1, 2023?
Will the coverage enhancements increase my costs?
What has changed with physiotherapy coverage?
Drug coverage changes
What has changed with the PSHCP’s drug coverage?
What is generic substitution?
Can I still get brand name drugs?
Why did the PSHCP switch to mandatory generic substitution?
Is it dangerous to switch to generic?
What’s changed with dispensing fees?
How much will I be reimbursed for my dispensing fee?
What is the dispensing frequency limit for maintenance medications?
Does Federal Retirees have a preferred partnership with a pharmacy?
What is prior authorization and when will it begin?
Do I have to change my biologic/biosimilar medication?
Is my cancer drug still covered?
Plan renewal process and other questions
Are the changes for this renewal final?
When will the PSHCP be reviewed again?
The new plan doesn’t meet my needs. How were the priorities determined?
Why weren’t my priorities reflected in the new plan?
My transition to Canada Life has been rocky. What is being done to improve the plan member experience?
About the PSHCP
The Public Service Health Care Plan (PSHCP) is one of the largest private health-care plans in Canada. It covers more 1.5 million members, including retired federal public servants and federally appointed judges as well as veterans of the Canadian Armed Forces and RCMP.
The PSHCP is a voluntary plan that reimburses plan members for eligible health care expenses after plan members have taken advantage of their provincial/territorial health-care coverage.
PSHCP coverage includes things like prescription drugs, medical devices and equipment, and services from providers like massage and physiotherapists. Coverage is subject to eligible charges, maximum amounts, and co-payments. The plan also covers a basic level of out-of-province emergency medical expenses for the first forty days of a trip. The Federal Retirees MEDOC travel insurance coordinates with the PSHCP.
To find out more about what the PSHCP currently covers, consult the current plan directive or contact the current plan administrator, Canada Life, at the following coordinates:
- Toll-free at 1-855-415-4414, Monday to Friday from 8 a.m. to 5 p.m. local time
- www.canadalife.com/pshcp
- Canadian Residents outside of Quebec: Winnipeg Benefits Payments, P.O. Box 99451 Station Main, Winnipeg MB R3C 3C7
Quebec Residents: Montreal Benefits Payments, Place Bonaventure, 800 de la Gauchetière Street W, Suite 5800, Montreal, QC, H5A 1B9
Veterans Affairs Client Group: Canada Life, BAS DG 1227, P.O. Box 6000 Station Main, Winnipeg, MB, R3C 3A5
PSHCP plan members Outside of Canada: MSH International, P.O. Box #4903 STN A, Toronto, ON, Canada, M5W 0B1
What is included in the PSHCP renewal that came into effect July 1, 2023?
To learn more about PSHCP enhancements and changes included in the 2023 renewal, refer to the PSHCP Bulletin 45, which provides a comprehensive summary of the plan changes and enhancements. The updated PSHCP plan directive or plan document outlining coverage is also available. The plan directive provides the complete terms and conditions of the PSHCP.
Canada Life has prepared Part I of the Member booklet-at-a-glance which provides information about the Extended Health Provision. Part II of the member booklet will be available at a later date.
What is Federal Retirees role in the PSHCP?
The PSHCP Partners Committee oversees the PSHCP. The Partners Committee includes three employer representatives, three representatives from the federal public sector unions, and one pensioner representative from the National Association of Federal Retirees. With extensive support from staff at various organizations, including from Federal Retirees, the Partners Committee puts forward joint recommendations to the Treasury Board on the items that should be included in the renewal or updates to the PSHCP.
Federal Retirees also helps members navigate their benefits coverage and tracks concerns with the plan, which the pensioner representative raises at the Partners Committee.
What is the role of the Treasury Board of Canada Secretariat in the PSHCP?
The Treasury Board of Canada Secretariat, as the employer, is the sponsor of the PSHCP. The PSHCP Administration Authority provides monitoring and oversight of regular operations of the PSHCP, including support in dealing with appeals. Together, they are also responsible for ensuring a smooth implementation of the PSHCP.
The Treasury Board is a committee of the federal cabinet which approves government financial and budgetary policies and decisions, including for pensions and benefits.
Why did the PSHCP move from Sun Life to Canada Life?
The Treasury Board of Canada Secretariat, as the plan sponsor, cyclically engages in a competitive retendering of the PSHCP service contract as part of the public service benefits plan process. The last contract was awarded in 2009.
Following an open procurement process, the government announced that Canada Life was awarded the PSHCP contract on Dec. 1, 2021.
Even though July 1, 2023, was an important date for both initiatives, the change to Canada Life from Sun Life was initiated and implemented by the Treasury Board Secretariat. The procurement of a new insurer for the PSHCP was not part of the renewal negotiations.
What about the Pensioners Service Dental Plan (PDSP)?
The PDSP is separate from the PSHCP. The PDSP will be administered by Sun Life until it moves to Canada Life, Nov. 1, 2024.
Until then, PDSP members should continue to send all dental claims to Sun Life, the current plan administrator.
If you have questions about your PDSP, please contact Sun Life Assurance Company of Canada at 1-888 757-7427 (toll-free in North America) or call 247-5100 in the National Capital Region.
How do I get a new Canada Life insurance card?
You can access your benefit card through the PSHCP Member Services website. You can save it to your mobile device or print it. You can also call the PSHCP Member Contact Centre to request a paper copy to be sent to you in the mail.
Canada Life advises if you have difficulty downloading your card, log out of the plan website, check to see that your browser is permitting pop-ups, and try again.
Plastic benefit cards will not be issued for the PSHCP because of a green initiative supported by the Government of Canada and Canada Life.
Do I have to present my new card to my pharmacist?
Yes, you will need to present your new Canada Life card to your pharmacist as they will need to update your information.
If you have completed positive enrolment and your benefits card is not working, be sure to double check that the pharmacist has inputted the information correctly.
How can I get in touch with someone from Canada Life about plan coverage?
Canada Life has experienced a high volume of calls, making it challenging to reach an agent. Canada Life has taken steps to increase capacity at the call centre.
To contact Canada Life:
- Toll-free at 1-855-415-4414, Monday to Friday from 8 a.m. to 5 p.m. your local time
- www.canadalife.com/pshcp
You should consult the current PSHCP Plan Directive for information about what’s covered.
Canada Life has established an urgent needs escalation process for any life-sustaining prescription drug, service or treatment, or if you are a person with a disability. Only claims that have already been submitted to Canada Life or MSH International can be escalated. Visit Canada Life’s PSHCP member services website for more information.
Who do I contact for emergency assistance abroad?
If you require assistance while traveling outside of Canada, or have comprehensive coverage, contact MSH International directly:
• From Canada or the United States: 1-833-774-2700 (toll-free)
• Outside of Canada and the United States: 1-365-337-7427 (call collect)
• assist@pshcp-msh.ca
Plan benefits and coverage enhancements
What are the new coverage amounts?
New coverage amounts came into effect July 1, 2023. and a list of them can be found in the PSHCP Bulletin 45.
Did my coverage amounts reset July 1, 2023?
No. For example, consider massage therapy. Up to June 30, 2023, plan members could claim up to $300 in eligible massage therapy expenses, reimbursed at 80 per cent. Under the renewed PSHCP, massage therapy is covered up to $500, reimbursed at 80 per cent. Plan members were eligible to claim $300 up to June 30, 2023, and have access to the additional $200 after July 1, 2023. Thereafter, 2024 will be the first full calendar year with the new coverage amounts.
The PSHCP Administration Authority has confirmed that unused annual allocations remain available until the end of the calendar year (2-year benefit period for vision; some benefits are subject to different timelines for eligibility). Similarly, a plan participant who doesn’t incur massage therapy expenses in the first half of 2023 would be entitled to claim $500** in eligible expenses for services incurred between July 1, 2023, and Dec. 31, 2023. Consult the Treasury Board Secretariat’s January 2023 update and information on PSHCP changes for more examples of coverage amounts during 2023.
** Annual allocations/maximums are payable at 80 per cent.
Will the coverage enhancements increase my costs for health-care coverage?
There are two aspects to consider regarding potential cost increases for pensioners. First, pensioner contributions (or premiums) are based on how much pensioners claim against the plan in the year preceding. In any year, if those costs increase then so do pensioners’ contribution rates in the next year.
However, it’s important to remember that measures to help contain costs have been agreed to and will be implemented.
Because the Plan changes took effect in July 2023, any cost impacts from higher usage or claim amounts that are the result of benefit enhancements and cost containment measures will only be partially reflected when pensioner contribution rates or premiums are adjusted in April 2024. The first full year of the renewed plan will be in 2024.
We’ll be monitoring the Plan performance closely, and the PSHCP Partners Committee will review the effectiveness of some Plan changes in 2025. We’ll continue to focus on ensuring members have high-quality health-care coverage, and work to minimize cost impacts for pensioners.
What has changed with physiotherapy coverage?
The plan's design is largely determined via benchmarking to comparable plans. Before July, 1, 2023, physiotherapy was an unlimited benefit (the plan covers up to $500 with an 80 percent copayment; members must pay out of pocket for expenses between $500 and $1,000; and coverage is reinstated after that point).
No comparable plans offer such an extensive benefit. To protect plan sustainability and integrity, changes were made — and that included changes to physiotherapy.
Under the updated plan, the member-paid corridor (for eligible physiotherapy expenses between $500 and $1,000) will be removed. This means that members will receive 80 percent reimbursement on the $1,500 of physiotherapy they claim each year, which this is an improvement for most plan members.
We understand this change poses a challenge for members in need of greater physiotherapy coverage.
As a result of advocacy by Federal Retirees, the Treasury Board announced that members were eligible to avail themselves of the full annual allocation of $1,500 in addition to any amounts claimed up to June 30, 2023. This amount was a gain, as we expected that the Treasury Board would only cover physiotherapy services in the amount of $1,500 for all of 2023.
Starting 2024, PSHCP coverage for physiotherapy services will be for a total amount of $1,500 per year.
Federal Retirees is advocating for a mechanism to allow higher amounts of physiotherapy for vulnerable members, both as a partner on the PSHCP Partners Committee as well as in our meetings with Treasury Board representatives. The physiotherapy benefit is an issue we intend to reopen when the PSHCP is reviewed in 2025, at the mid-point of this renewal agreement.
Members may wish to identify publicly funded provincial and territorial physiotherapy programs which, may cover the conditions leading to frequent use of physiotherapy providers. These programs are often run by hospitals or specialty rehabilitation programs in your local community.
We also note the plan has also introduced several new provisions that provide treatment that may reduce the need for physiotherapy and enable members to take a multidisciplinary approach, such as:
- Injectable lubricants for joint pain and arthritis at $600 per calendar year.
- Occupational therapy at $300 per calendar year.
- Acupuncture at $500 per calendar year as performed by an acupuncturist (previously, acupuncture was capped at $300 and had to be performed by a physician).
- Osteopath at $500 per calendar year.
Drug coverage changes
What has changed with the PSHCP’s drug coverage?
Previously, the plan covered almost every drug authorised by Health Canada regardless of the quality, effectiveness, or appropriateness for your situation. The plan also had very limited terms around reasonable and customary costs for medication, and no restrictions on dispensing fees, meaning excessive markup and/or dispensing fee costs were borne by the plan. In Canada, while drugs are tested extensively for safety, side effects, and usage, there is generally little to no regulation on the cost or relative effectiveness of prescription medications.
This led to significant increases in drug spending with limited member benefits. Methods of addressing these cost pressures have evolved since the PSHCP was last updated. To address these increases, the plan introduced new rules around drug coverage.
The PSHCP now has:
- Mandatory generic substitution or reimbursement
- Limits on dispensing fees and their frequency
- Prior authorization for specialty medications
In addition, compound drugs now require at least one ingredient to have a drug identification number (DIN) to be eligible for reimbursement under the PSHCP.
Finally, the out-of-pocket maximum for catastrophic drug coverage increased moderately, from $3,000 to $3,500. Catastrophic drug coverage allows for eligible drug expenses to be reimbursed at 100 per cent when their out-of-pocket drug expenses exceed the amount(s) noted.
Generic medications
Generic substitution means that all prescription drugs covered by the PSHCP will be reimbursed at 80 percent of the cost of the lowest-priced alternative generic drug unless a Brand Exception Form is completed by the prescriber and approved by Canada Life. A legacy period began July 1, 2023, for plan members to make this transition if they are on brand-name drugs. Mandatory generic substitution comes into effect Jan. 1, 2024.
You can find the Brand Exception Form on Canada Life’s Forms page.
Can I still get brand name drugs?
Yes. If you cannot take the generic version of the drug you are prescribed due to medical reasons, you may submit a request for brand name prescription drug coverage to continue to be eligible for reimbursement of the brand name drug. The form must be completed by the prescriber and approved by Canada Life.
If you still wish to have a brand name medication but do not want to complete the required form or have no medical reason to remain on the brand name, you can still choose to fill the prescription for the brand name, but you will have to cover the difference in cost.
Why did the PSHCP switch to mandatory generic substitution?
Before July 1, the PSHCP had an unusually high number of claims requiring no substitutions. This did not correspond to medical evidence of what should be expected from a plan member population like the PSHCP. By introducing mandatory generic substitution, members will still have access to name brand drug coverage when it is medically necessary, and the new policy will help the plan contain costs, which may make a difference when it comes to PSHCP contribution rates for pensioners.
From July 1 to Dec. 31 2023, previously covered prescribed brand name drugs were reimbursed at 80 per cent of their cost.
After the legacy period, all prescription drugs covered under the PSHCP will be reimbursed at 80 per cent of the cost of the lowest-priced alternative generic drug unless an exception is completed by the prescriber, sent to Canada Life and approved.
The belief that generic drugs are inferior to or less effective than brand-name drugs is inaccurate. In rare cases the non-active ingredients of generic medications, such as binders, fillers, and dyes can pose problems for some individuals. Generic drugs are equivalent to brand name drugs; they must be the same in terms dosage of the active ingredient, safety, effectiveness, strength, stability, quality and how they’re taken. This along with adverse reactions to generic medications are strictly watched by Health Canada, where some of our own members work or have worked. Approximately 70 percent of PSHCP members who are retired already use generic medications.
When it comes to transitioning from a brand name drug to a generic medication, be sure to speak with your health-care providers as soon as possible. This will help your care providers understand your benefits coverage limitations and timelines and be prepared to file any paperwork that will be needed if you are medically required to remain on a brand name drug. Always have the input and monitoring of your prescribing health-care provider before changing anything with your medications, including if you are switching from brand name to generic drugs.
Dispensing fees
What’s changed with dispensing fees?
Two aspects of how dispensing fees are reimbursed by the PSHCP have changed: the amount the PSHCP reimburses for dispensing fees, and the number of dispensing fees covered per year for maintenance medication.
How much will I be reimbursed for my dispensing fee?
Starting July 1, 2023, the PSHCP reimburses up to $8 for the pharmacy dispensing fee, reimbursed at 80 per cent. This cap does not apply to biologic or compound drugs, which may require special handling and dispensing, nor will it apply to drugs that have safety or special storage considerations.
Plan members should choose their pharmacy wisely to ensure they can maximize the covered amount. If your drug store charges more than what the PSHCP covers, you will be required to pay the difference.
Exceptions may apply to some provinces/territories due to pharmacy regulations. Due to provincial pharmacy regulations, neither the dispensing fee cap or dispensing fee frequency limit are being applied in Quebec. Please contact your provincial health authority for details.
Contact Canada Life for more information about these exceptions.
What is the dispensing frequency limit for maintenance medications?
Effective July 1, 2023, maintenance drugs – usually those used to manage things like blood pressure, cholesterol, stomach hyperacidity, and some mental health concerns – need to be filled in three-month intervals. Plan members are eligible to claim up to five maintenance drug dispensing instances per year. This will roughly correspond to filling prescriptions along a 90-to-100-day interval.
This provision does not apply where the co-payment for a three-month supply will be more than $100, nor will it apply for some prescribed drugs (for example, drugs that are defined as controlled substances, or for compliance packaging/blister packs); or where there are special storage requirements (i.e., requiring deep-freeze temperatures). There may be exclusions based on pharmacy regulations in some provinces/territories.
Due to provincial pharmacy regulations, the dispensing fee frequency limit is not being applied in Saskatchewan. Please contact your provincial health authority for details.
Due to provincial pharmacy regulations, neither the dispensing fee cap or dispensing fee frequency limit are being applied in Quebec. Please contact your provincial health authority for details.
You can find the Dispense Fee Frequency Limit Exception Form on Canada Life’s Forms page.
If plan members wish to get their maintenance drugs in shorter intervals, they can still do so, but the dispensing fee will only be reimbursed up to a maximum of five intervals per year for maintenance drugs . Exceptions may apply due to pharmacy regulations in some provinces and territories.
Federal Retirees currently does not have a preferred pharmacy partnership for reduced prescription medication refill fees, but this is something the PSHCP Partners Committee agreed to explore so that members can make the most of the covered dispensing fee amount. We encourage members to consider their financial and health-care needs and find a pharmacy that will meet those needs.
Specialty medications and prior authorization
What is prior authorization and when will it begin?
Prior authorization programs are commonly used by health benefits and insurance plans to help ensure plan members are being optimally treated with clinically and cost-effective treatments when it comes to specialty drugs. Specialty drugs include biologics and biosimilars, which can be extremely costly.
Prior Authorization is a process administered by the plan administrator (in this case, Canada Life) where certain drugs need to be pre-approved before they are reimbursed under the PSHCP. It is an evidence-based program to ensure members are receiving reasonable treatment and is supported by medical professionals at Canada Life.
PSHCP prior authorization took effect July 1, 2023.
Members or their eligible dependants on existing treatments as of July 1, 2023, are subject to permanent exceptions for ongoing medications.
Exceptions do not apply to PSHCP members on biologic medications where a biosimilar is available.
If a PSHCP member is on a biologic drug where there is a biosimilar available, Canada Life may contact the member directly regarding the switch to a biosimilar equivalent drug. If a person cannot take the biosimilar version of the drug due to a medical reason, they may apply for an exception.
New treatments that began after July 1, 2023, are subject to the PSHCP Prior Authorization Program, for which pre-approval is required for certain prescription drugs.
The list or formulary of drugs that require prior approval is available on Canada Life’s PSHCP Member Services website under Prior Authorization Forms. You can also contact Canada Life to request a form by mail.
The prior authorization program uses independent medical evidence to ensure plan members are getting the drug that is most suited to their circumstances, and decisions are made on evidence-based treatment protocols and in a very timely manner.
Where a member does not agree with a prior authorization decision, they may ask Canada Life to review their file. Once all avenues of review with Canada Life have been exhausted, the member may submit an appeal to the PSHCP Administration Authority.
If you were on any of the prescription drugs that are part of the prior authorization formulary (or list) before July 1, you do not have to go through the prior authorization process – your coverage will continue. However, if a biosimilar is available, members may be required to switch their biologic drug to a biosimilar after July 1, 2023. Affected members have been and will continue to be contacted by Canada Life.
If after July 1 if you were prescribed for the first time a new biologic drug that is on the prior authorization formulary, you are required to undergo the prior authorization process to have your medication pre-approved for reimbursement under the PSHCP. Your prescribing health-care provider will need to complete a form(s) and liaise with Canada Life.
Members and their eligible dependants prescribed new biologic treatments after July 1, 2023, where a biosimilar is available, will be switched to a biosimilar treatment. Switching programs are developed in collaboration with medical expertise. These substitution programs are becoming an industry standard and have been adopted by most provincial drug plans.
If a person cannot take the biosimilar version of the drug they are prescribed due to a medical reason, they may apply for an exception. The prescriber can fill out a Request for brand name prescription drug coverage form.
The Request for Brand Name Drug form can be found on Canada Life’s PSHCP Member Services website under forms.
(Biosimilar drugs are comparable, cost-effective versions of biologic drugs, and are proven to be as safe and effective as biologics.)
Is my cancer drug still covered?
The PSHCP will see minimal changes to the drugs covered. Prior authorization (or requirement for pre-approval) affects a narrow sub-set of prescription drugs, usually biologics or specialty drugs. The list or formulary of affected drugs is available on Canada Life’s PSHCP Member Services website.
Plan renewal process and other questions
Are the changes for this renewal final?
Yes, the changes that have been announced are final. They have been approved by the PSHCP Partners Committee and by the Treasury Board.
When will the PSHCP be reviewed again?
This PSHCP deal lasts four years, until 2027, with a mid-point review expected in 2025. Federal Retirees will ensure the plan is reviewed within that timeline. If there are coverage enhancements or other changes, you’d like to see in the next round of PSHCP renewal, please let us know!
Members will also have the chance to send their input for further PSHCP improvements on a survey.
Priorities for the PSCHP renewal were determined following a 2017 Federal Retirees survey of nearly 19,000 members which consulted members on their needs and experiences with the plan. More than 8,500 responses were received. When asked for their top priorities for PSHCP improvements, members said that vision care, eliminating restrictions to accessing physiotherapy and message therapy, better paramedical and hearing aid coverage, improvements to hospital coverage and to emergency travel benefit enhancements, were most important to them. The deal we have delivered meets each of those needs.
Several extensive studies and reports on the PSHCP were conducted to better understand gaps in the plan and what it covers, as well as opportunities to make the plan more cost-effective. These studies were conducted starting in 2016, and updated in 2019, to ensure we had the best data possible when discussing the plan.
Finally, the results of the PSHCP renewal depended on the input and acceptance of other parties, including the bargaining agents as well as the plan sponsor, the Treasury Board of Canada Secretariat. It also required the approval of the Treasury Board, a committee of the Cabinet.
The improvements gained are not enough. Why weren’t my priorities reflected?
We understand that health care — from drugs to osteopaths, from hearing aids to wheelchairs — can be costly, and it can be frustrating if you feel coverage for your specific needs is not high enough.
The PSHCP covers more than 1.5 million people, from employees to pensioners to dependents. The enhancements that were gained, along with plan changes, were considered to protect the integrity and sustainability of the plan and costs to pensioners, while also being balanced across as many benefit categories as possible.
We understand that the transition to Canada Life has been challenging for some members.
The pensioner representative on the PSHCP Partners Committee engaged with Treasury Board from the outset and clearly outlined expectations for a smooth transition. The Association also identified what was needed to support retirees during the process, including a reliable call centre and clear, timely communication as well as support for paper enrolment forms and for vulnerable plan members.
The contract for the PSHCP is an agreement between the Government of Canada and Canada Life. It is their joint responsibility to deliver a seamless transition, and to monitor and correct performance issues.
The Association has taken member feedback seriously and is keeping a record of member experiences. We will continue to share our members’ experiences and priorities with Treasury Board to ensure retirees receive the support and services they pay for and are entitled to.
Canada Life has taken steps to improve the plan member experience. More information is available on Canada Life’s PSHCP website.
Helpful Links
Public Service Health Care Plan Member Services website
PSHCP Plan Directive
PSHCP Member booklet-at-a-glance
Canada Life forms
Public Service Health Care Plan Administration Authority
PSHCP Bulletin 45
Public Service Health Care Plan Maximum Eligible Expenses