Means the contract between the Directors and the Administrator setting out the services to be provided by the Administrator in respect of the Plan, as amended from time to time.

Administrator

Means the organisation selected to adjudicate and pay claims in accordance with the Plan Document and/or direction from the Directors.

calendar year

Means January 1 to December 31.

chiropodist

Means a person licensed by the appropriate provincial/territorial licensing authority or in those provinces/territories where there is no licensing authority, members of the Canadian Association of Foot Professionals, or in the absence of such association, a person with comparable qualifications as determined by the Administrator.

chiropractor

Means a member of the Canadian Chiropractic Association or of a provincial/territorial association affiliated with it, or in the absence of such association, a person with comparable qualifications as determined by the Administrator.

chronic disease

Means a condition that exists beyond the usual course of an acute disease or beyond a reasonable time for tissue damage to heal. Any condition that lasts longer than six months may be considered chronic.

Compendium of pharmaceuticals and specialities (CPS)

Means the reference manual as amended from time to time, containing information about products intended for human use, which is compiled annually and produced by the Canadian Pharmacists Association for the benefit of health professionals.

co-payment

Means the proportion of eligible expenses, net of deductible, not reimbursed by the Plan which remains the responsibility of the Plan member.

deductible

Means the specific dollar amount that a member must satisfy each calendar year before they may receive reimbursement by the Plan.

dentist

Means a person licensed to practise dentistry by the provincial/territorial licensing authority, or in the absence of such authority, a person with comparable qualifications as determined by the Administrator.

dependant

Means a member's spouse, a dependant child of a member or the dependant child of the member's spouse.

dependant child

Means the person who is an unmarried child of a member or of the member's spouse, including an adopted child, a stepchild and a foster child in respect of whom the member stands in loco parentis, provided such person is:

under 21 years of age,
under 25 years of age and attending an accredited school, college or university on a full-time basis, or
over 20 or 24 years of age who was a dependant child as defined above when they became incapable of engaging in self-sustaining employment by reason of mental or physical impairment, and is primarily dependent upon the member for support and maintenance.

designated officer

Means a person designated by a deputy head to be responsible for receiving and actioning application requests upon verification of eligibility.

durable equipment

Means an eligible device that does not achieve any of its primary intended purposes by chemical action or by being metabolised.

electrologist

Means a person who, as determined by the Administrator, qualifies as a certified electrologist.

employee

Means:

a person who holds an office, or position, or performs services for which the remuneration is payable out of the Consolidated Revenue Fund of Canada or by an agent of Her Majesty in right of Canada,
a person designated by the Treasury Board of Canada as being eligible to join the Plan as listed in Schedule III of the Plan Document, as amended from time to time by the Treasury Board of Canada,
a person who is an employee of a participating employer as listed in Schedule I of the Plan Document, as amended from time to time by the Treasury Board of Canada,
a person who is a member of a civilian component of the forces of a state that is a party to the North Atlantic Treaty Status of Forces Agreement, 1949 who is serving in Canada.

family member

Means a member or a covered dependant.

family unit

Means a member and their covered dependants.

Federal Superannuates National Association

Means an association of federal retirees representing all pensioner members of the Plan.

fee guide

For services provided by dentists, refers to charges established by the provincial/territorial dental association in the province/territory in which the expense is incurred or, in the absence of such association, comparable charges considered reasonable and customary, as determined by the Administrator.

hospital

Means a legally licensed hospital which provides facilities for diagnosis, major surgery and the care and treatment of a person suffering from disease or injury on an in-patient basis, with 24-hour services by registered nurses and physicians. A hospital also is a legally licensed hospital providing specialised treatment for mental illness, drug and alcohol addiction, cancer, arthritis and convalescing or chronically ill persons. This does not include nursing homes, homes for the aged, rest homes or other places providing similar care.

massage therapist

Means a person licensed by the appropriate provincial/territorial licensing body or in the absence of a provincial/territorial licensing body, a person whose qualifications the Administrator determines to be comparable with those required by a licensing body.

member

Means:

an employee or a pensioner who has applied for and has been granted coverage under the PSHCP by a designated officer, or
a member of the CF or the RCMP who has applied for and has been granted coverage for their dependants under the PSHCP.

member of the Canadian Forces (CF)

Means a person who is:

a member of the regular force of the CF,
a member of the CF, other than a member of the regular force, and as an individual or as a member of a class, has been designated by the Treasury Board of Canada as a member of the CF for the purposes of the Plan,
a member of the forces of a state that is a party to the North Atlantic Treaty Status of Forces Agreement, 1949 who is serving in Canada.

month

Means the period of time from a date in one calendar month to the same date in the following calendar month.

National Joint Council (NJC)

Means a consultative body established pursuant to Treasury Board Minute T.272382B of March 1945, providing regular consultation between the government and employee organisations certified as Bargaining Agents on common employee issues.

naturopath

Means a member of the Canadian Naturopathic Association or any provincial/territorial association affiliated with it, or in the absence of such association, a person with comparable qualifications as determined by the Administrator.

nurse

Means a registered nurse, registered nursing assistant, registered practical nurse, licensed practical nurse, or certified nursing assistant who is listed on the appropriate provincial/territorial registry and in the absence of such registry, a nurse with comparable qualifications as determined by the Administrator.

ophthalmologist

Means a person licensed to practise ophthalmology.

optometrist

Means a member of the Canadian Association of Optometrists or of a provincial/territorial association associated with it, or in the absence of such association, a person with comparable qualifications as determined by the Administrator.

osteopath

Means a person who holds the degree of doctor of osteopathic medicine from a college of osteopathic medicine approved by the Canadian Osteopathic Association, or in the absence of such association, a person with comparable qualifications as determined by the Administrator.

participant

Means a person covered under the PSHCP.

pharmacist

Means a person who is licensed to practise pharmacy and whose name is listed on the pharmacists' registry of the licensing body for the jurisdiction in which such person is practising.

physician

Means a doctor of medicine (M.D.) legally licensed to practise medicine.

physiotherapist

Means a member of the Canadian Physiotherapy Association or of a provincial/territorial association affiliated with it, or in the absence of such association, a person with comparable qualifications as determined by the Administrator.

podiatrist

psychologist

Means a permanently certified psychologist who is listed on the appropriate provincial/territorial registry in the province/territory where the service is rendered, or in the absence of such registry, a person with comparable qualifications as determined by the Administrator.

reasonable and customary

Means that amount which is usually charged to a person without coverage and which does not exceed the general level of charges for the specific service or product in the geographic location where the expense is incurred, as determined by the Administrator. Published fee guides of national, provincial/territorial associations of practitioners will be consulted for this purpose where applicable.

RCMP

Means Royal Canadian Mounted Police.

social worker

Means a person who holds a master's degree in social work (MSW) and is listed on the appropriate provincial/territorial registry in the province/territory where the service is rendered, or in the absence of such registry, a person with comparable qualifications as determined by the administrator.

speech language pathologist

Means a person who holds a master's degree in speech language pathology and is a member or is qualified to be a member of the Canadian Speech and Hearing Association or any provincial/ territorial association affiliated with it, or in the absence of such registry, a person with comparable qualifications as determined by the Administrator.

spouse

Means the person who is legally married to the member, or a person with whom the member has lived for a continuous period of at least one year, whom the member has publicly represented to be their spouse and continues to live with as if that person were their spouse, as designated by the member.


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