Coverage-Related Appeals

You are responsible for ensuring that you have the appropriate level of coverage and that the correct contribution rates are being deducted from your salary or pension cheques. If you believe that your level of coverage does not reflect your desired protection or contribution under the Plan, you should first contact the area responsible for the administration of your benefits (Compensation or your pension office). If the issue cannot be resolved at that level, you have the opportunity to submit an appeal regarding your coverage. The rules that apply changes in coverage are described in the Plan Document and summarized below.

Retroactive Change in Coverage

“I forgot to reduce my coverage from Family to Single.”

You must amend your coverage if you no longer require coverage for dependants.

As a PSHCP member, you are responsible for amending your coverage in cases of divorce, the death of your spouse, or when your only dependant is no longer eligible under the Plan (e.g. a dependant child turns 21 and is not in school full-time). Changes to your coverage level are not automatic. If you no longer require family coverage, you must submit an application form to Compensation or your pension office and indicate that you wish to amend your level of coverage.

In cases where you no longer have any eligible dependants but you did not amend your coverage within 60 days of the event, you can submit an appeal requesting a refund of PSHCP contributions. However, even when such appeals are denied beyond the Plan provisions, a refund  may be granted only as far back as January of the calendar year when the designated officer of your employer or pension office received your amendment request.

“I was physically/mentally unable to amend my coverage.”

Discretionary authority may be used to refund members' contributions for a period not exceeding five years under extenuating circumstances, such as where a person acting in a fiduciary capacity (e.g. an executor or power of attorney) takes over the affairs of a person who is no longer capable of looking after their own affairs.

Substantiating documents or evidence in the review of such appeals may be requested.