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Coverage

What coverage am I entitled to?

Supplementary
Comprehensive

What does the plan pay for?

Do I have to pay a deductible before I can receive benefits?

Does the Plan pay all my expenses?

How can I check whether an expense is covered?

Where do I call for emergency travel assistance?

What coverage am I entitled to?

The coverage you are entitled to depends on:

where you reside, and
whether you are covered under a government health insurance plan.
members of Parliament,

The PSHCP provides two types of coverage:

supplementary, including the Extended health and Hospital provisions, and
comprehensive, including the Extended health, Hospital, and Basic health care provisions, and the Hospital (outside Canada) provision (not available to pensioners)

	You have this coverage	Supplementary	Comprehensive
	You do not have this coverage
Covered under a government health insurance plan
Employee or dependant of a member of the CF or the RCMP, residing in Canada
Pensioner, residing in Canada
Employee or dependant of a member of the CF or the RCMP, on authorized educational leave without pay outside Canada
Not covered under a government health insurance plan
Employee or dependant of a member of the CF or the RCMP posted outside Canada		(no out-of-province coverage*)	(mandatory)
Employee or dependant of a member of the CF or the RCMP outside Canada on loan to serve with an international organisation or on authorized educational leave without pay		(no out-of-province coverage*)
Pensioner residing outside Canada		(no out-of-province coverage*)	(except hospital outside Canada)

* Employees required to travel on official travel status for government business are covered under the emergency medical care while travelling and the emergency travel assistance services during the entire period of official travel status.

Supplementary coverage

This coverage is intended for eligible participants who are covered under a provincial/territorial health insurance plan. In general, the PSHCP supplements the coverage provided under the provincial/territorial plan in the member's province/territory of residence.

	No	Deductible	Co-payment
	Yes
Extended health provision
Emergency medical care while travelling			100%
Emergency travel assistance services			100%
Other benefits			80%
Hospital provision			100%

Extended health provision

This provision covers reasonable and customary charges for specified services and products not covered under government health insurance plans (if you reside outside Canada, which are not covered under the Basic health care provision).

Reimbursement is limited in certain cases, outlined under the description of each item. If you have Comprehensive coverage, you are not eligible for the out-of-province benefits under the Extended health provision.

All member of the PSHCP are covered under this provision.

Hospital provision

This provision reimburses reasonable and customary room and board charges for each day of semi-private or private hospital accommodation, whether you reside in Canada or outside Canada. Coverage is available for differing levels of reimbursement, and there is a maximum amount payable under each level of coverage. deductible and co-payment do not apply under this provision.

All members of the PSHCP must be covered under the Hospital provision.

Comprehensive coverage

This coverage is intended for members and their eligible dependants who are residing with the member outside Canada and who are not covered under a provincial/territorial health insurance plan or in a non-government hospital insurance plan. A person covered under Comprehensive coverage will continue to be covered under this benefit after their return to Canada until such time as they become eligible to be insured under a provincial/territorial health insurance plan.

Please note that employees who reside outside Canada (e.g. USA) but work in Canada, are not entitled to coverage under the Basic health care or the Hospital (outside Canada) provisions.

	No	Deductible	Co-payment
	Yes
Basic health care provision			100%
Hospital (outside Canada) provision (not available to pensioners)			100%

Basic health care provision

The provision reimburses services, excluding hospital services, which are the equivalent as far as possible to those services available to individuals residing in Canada and covered under a provincial/territorial health insurance plan.

The maximum eligible expense for these services is equal to three time the amount otherwise payable based on the current fee schedule in force under the Health Insurance Act 1972 of Ontario on the day when the expense is incurred.

Hospital (outside Canada) provision (not available to pensioners)

This provision provides hospital coverage equivalent, as far as possible, to that available to individuals resident in Canada and covered under a provincial/territorial health or hospital plan. This provision provides reimbursement for reasonable and customary charges for hospital confinement in a general hospital, a hospital of the Canadian Forces or a hospital of the armed forces of a foreign country.

What does the plan pay for?

Supplementary coverage	Comprehensive coverage
Drugs	Basic health care
Hospital care	Hospital outside Canada (not available to pensioners)
Vision care
Medical practitioners
Medical services and supplies
Dental care
Health care outside my province of residence (not available to those with Comprehensive coverage)

Drugs

To be eligible, expenses must be:

reasonable and customary, and
prescribed by a physician or dentist and dispensed by a pharmacist or physician.

Eligible expenses
Aerochambers	Aerochambers with masks for the delivery of asthma medication, regardless of the age of the patient.
Asthma drug delivery devices	Drug delivery devices to deliver asthma medication, which are integral to the product, and approved by the Administrator.
Baby formula	Specialised formulas for infants with a confirmed intolerance to both bovine and soy protein. The attending physician must confirm in writing that the infant cannot tolerate
Compounded prescriptions	Compounded prescriptions, regardless of their active ingredients.
Erectile dysfunction drugs	Erectile dysfunction drugs, limited to a maximum eligible expense of $500 annually.
Injectable drugs	Injectable drugs, including allergy serums administered by injection.
Life-sustaining drugs	Life-sustaining drugs that may not legally require a prescription and are identified in Schedule VII of the Plan Document.
Prescription drugs	Drugs that legally require a prescription and are identified in the Monographs section of the current Compendium of pharmaceuticals and specialities as a narcotic, controlled drug, or requiring a prescription, except for those specified under What the Plan does not cover.
Replacement nutrients	Replacement therapeutic nutrients prescribed by an accredited medical specialist for the treatment of an injury or disease excluding allergies or aesthetic ailments, provided that there is no other nutritional alternative participant.
Smoking cessation aids	Smoking cessation aids, to a lifetime maximum of $1,000 per participant.
Vitamins and minerals	Vitamins and minerals which are prescribed for the treatment of a chronic disease, when in accordance with customary practice of medicine, the use of such products are proven to have therapeutic value and no other alternatives

Catastrophic drug coverage

This coverage provides added protection for those with exceptionally high prescription drug costs during a calendar year.

Once you have paid $3,000 out of your own pocket for eligible prescription drugs in any one calendar year (not counting the annual PSHCP deductible), reimbursement of additional eligible prescription drug expenses incurred in that year increases from 80% to 100%.

All eligible prescription drug expenses incurred by you and any of your covered dependants, except for the deductible, will be used to calculate your annual out-of-pocket maximum.

Hospital care

Coverage is available in differing levels of reimbursement:

Level I, limited to $60 per day;
Level II, limited to $140 per day, and
Level III, limited to $220 per day.

All participants other than pensioners residing outside Canada

Eligible expenses are reasonable and customary charges for:

semi-private or private hospital room and board charges in excess of the charges for public ward up to the reimbursement maximum for the level you have chosen, excluding hospital charges referred to as co-insurance charges or user fees.

Pensioners residing outside Canada

Eligible expenses are reasonable and customary charges for:

hospital charges up to the reimbursement maximum for the level you have chosen.

Vision care

To be eligible, expenses must be reasonable and customary.

Eligible expenses
Artificial eyes	Artificial eyes and replacements thereof but not within: 60 months of the last purchase in the case of a member or dependant over 21 years of age, or 12 months of the last purchase in the case of a dependant 21 years of age or less, unless medically proven that growth or shrinkage of surrounding tissue requires replacement of the existing prosthesis.
Eye exams	Eye examinations by an optometrist, limited to one examination every two calendar years, commencing every odd year.
Glasses and contacts	Eyeglasses and contact lenses that are necessary for the correction of vision and are prescribed by an ophthalmologist or optometrist, and repairs to them, limited to a maximum eligible expense of $275 every 2 calendar year, commencing every odd year.
Intraocular lenses, glasses, and contacts needed after surgery/ accident	The initial purchase of intraocular lenses, eyeglasses or contact lenses that are necessary for the correction of vision and required as a direct result of surgery or an accident where the purchase is made within six months of such accident or surgery. This benefit is not subject to any limits other than reasonable and customary. The six-month time limit may be extended if, as determined by the Administrator, the purchase could not have been made within the time frame specified.

Medical practitioners

To be eligible, expenses must be reasonable and customary, and be for services within the medical practitioner's area of expertise and must require the skills and qualifications of such a practitioner. In addition, in accordance with provincial/territorial regulations, the medical practitioner must be registered, licensed, or certified to practise in the jurisdiction where the services are rendered.

Eligible expenses
Acupuncture	Acupuncture treatments performed by a physician.
Chiropractor	Maximum eligible expense of $500 in a calendar year.
Electrologist (or physician when performing electrolysis treatments)	Treatment for the permanent removal of excessive hair from exposed areas of the face and neck when the patient suffers from severe emotional trauma as a result of this condition. In the case where the services are performed by an electrologist, a prescription is required from a psychiatrist or a psychologist to certify that the patient suffers from severe emotional trauma as a result of this condition. The prescription is valid for three years, and maximum eligible expense of $20 per visit.
Massage therapist	Maximum eligible expense of $300 in a calendar year. Physician's prescription is required and is valid for one year.
Naturopath	Maximum eligible expense of $300 in a calendar year.
Osteopath	Maximum eligible expense of $300 in a calendar year.
Physician and lab fees	Physician's services and laboratory services where such services are not eligible for reimbursement under the participant's provincial/territorial health insurance plan, but where such services would be eligible for reimbursement under one or more other provincial/territorial health insurance plans. Laboratory services include those services which when ordered by and performed under the direction of a physician provide information used in the diagnosis or treatment of disease or injury. Services include, but are not limited to, blood or other body fluid analysis, clinical pathology, radiological procedures, ultrasounds, etc. Where only one province/territory provides reimbursement for a particular service, and that province/territory discontinues the coverage, the issue shall be subject to review by the Trustees as to whether coverage will also be discontinued under the Plan. Claims for such services, following cessation of provincial/territorial coverage, shall be held by the Administrator pending the decision of the Trustees. Where a province/territory begins reimbursement for a particular service, claims for the service shall be held by the Administrator pending a review by the Trustees as to whether the service should be covered in the other provinces and territories.
Physiotherapist	Maximum eligible expense of up to $500 and over $1,000 in a calendar year. Physician's prescription is required and is valid for one year.
Podiatrist / chiropodist	Maximum eligible expense of $300 in a calendar year.
Private-duty nursing	Medically necessary private duty and visiting nursing services provided by a nurse graduated from a recognised school of nursing where such services are prescribed by a physician and are rendered in the patient's private residence, to a maximum eligible expense of $15,000 in a calendar year. The prescription is valid for one year unless otherwise advised by the Administrator.
Prostate cancer monitoring test	Prostatic Specific Antigen (PSA) test used for monitoring following the detection of cancer.
Psychologist	Maximum eligible expense of $1,000 in a calendar year. Coverage will include the services of a social worker in place of psychologist, as long as: you live in an isolated post, listed in Appendix A of the National Joint Council's Isolated Posts and Government Housing Directive, and no psychologist practices in that isolated post. Physician's prescription is required and is valid for one year.
Speech therapist	Maximum eligible expense of $500 in a calendar year. Physician's prescription is required and is valid for one year.
User fees for paramedical services	Utilisation fees for paramedical services which are imposed by the government under the provincial/ territorial health insurance plan in the person's province/territory of residence, where the law permits a person to be reimbursed for such charges.

Medical services and supplies (miscellaneous expense benefit)

To be eligible, the expenses must be:

reasonable and customary charges, and
prescribed by a physician, unless specified otherwise.

Eligible expenses
Ambulance - ground - air	Licensed ground ambulance service to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation, where medically necessary. Emergency air ambulance service to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation.
Artificial limbs	Temporary artificial limbs. Permanent artificial limbs, to replace temporary artificial limbs, and replacements thereof but not within: 60 months of the last purchase in the case of a member or dependant over 21 years of age, or 12 months of the last purchase in the case of a dependant 21 years of age or less, unless medically proven that growth or shrinkage of surrounding tissue requires replacement of the existing prosthesis.
Braces	Braces, including repairs, which contain either metal or hard plastic, excluding dental braces and braces used primarily for athletic use.
Breast prostheses	Breast prostheses following mastectomy and a replacement provided 24 months have elapsed since the last purchase.
Burn apparel	Elasticised apparel for burn victims.
Diabetes treatment supplies	Needles, syringes, and chemical diagnostic aids for the treatment of diabetes, except needles and syringes are not eligible for the 36-month period following the date of purchase of an insulin jet injector device. One insulin jet injector device for insulin dependent diabetics, limited to a maximum eligible expense of $760 during a 36-month period. Insulin pumps and associated equipment for insulin dependent diabetics, when prescribed for a patient by a physician associated with a recognised centre for the treatment of diabetes at a university teaching centre in Canada, excluding repair or replacement during the 60-month period following the date of purchase of such equipment. Blood glucose monitors for insulin dependent diabetics, and for non-insulin dependent diabetics if legally blind or colour blind, excluding repair or replacement during the 60-month period following the date of purchase of such equipment.
Durable equipment	Rental or purchase at the Administrator's option, of cost-effective durable equipment: manufactured specifically for medical use, for use in the patient's private residence, approved by the Administrator for cost effectiveness and clinical value, designated as medically necessary. Used for care, including, but not limited to: devices for physical movement such as: walkers—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible walker repair expenses incurred during the previous 5 years, lifts or hoists—limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible lift/hoist repairs incurred prior to purchase, wheelchairs—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible wheelchair repairs incurred during the previous 5 years (for dependent children, the 60-month maximum may not apply if purchase or replacement is medically necessary). devices for support and resting such as: hospital beds—limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible hospital bed repairs incurred prior to purchase, roho cushions—limited to one every 12 months and a maximum eligible expense of cost less all eligible roho cushion repairs incurred during the previous 12 months, therapeutic mattresses—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible therapeutic mattress repairs incurred during the previous 5 years. devices for monitoring such as: apnea monitors—limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible apnea monitor repairs incurred prior to purchase, enuresis monitors—limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible enuresis monitor repairs incurred prior to purchase. Used for treatment, including, but not limited to: devices for mechanical and therapeutic support such as: transcutaneous electric stimulators (TENS)—limited to one every 10 years and a maximum eligible expense equal to cost less all eligible TENS repairs incurred during the previous 10 years, traction kits—limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible traction kit repairs incurred prior to purchase, infusion pumps—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible infusion pump repairs incurred during the previous 5 years, extremity pumps (lymphapress)—limited to one in a lifetime and an eligible expense equal to cost less all eligible extremity pump repairs incurred prior to purchase. devices for aerotherapeutic support such as: CPAP's, BiPAP's and related dental appliances (where a CPAP or BiPAP cannot be tolerated)—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible CPAP, BiPAP or dental appliance repairs incurred during the previous 5 years, compressors—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible compressor repairs incurred during the previous 5 years, maximists—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible maximist repairs incurred during the previous 5 years. Reimbursement related to durable equipment will be limited to the cost of non-motorised equipment unless medically proven that the patient requires motorised equipment.
Hearing aids	Hearing aids and repairs to them, excluding batteries, limited to the maximum eligible expense of $1,000, less of the cost of all eligible hearing aid claims made in the previous 5 years. The initial purchase of hearing aids if required as a direct result of surgery or an accident where the purchase is made within six months of such accident or surgery. This benefit is not subject to any limits other than reasonable and customary . The six-month time limit may be extended if, as determined by the Administrator, the purchase could not have been made within the time frame specified.
Incontinence supplies	Catheters and drainage bags for incontinent, paraplegic or quadriplegic patients.
Medical supplies	Trusses, crutches, splints, casts and cervical collars. Colostomy, ileostomy and tracheostomy supplies. Bandages and surgical dressings required for the treatment of an open wound or ulcer.
Orthopaedic brassieres	Orthopaedic brassieres, limited to a maximum eligible expense of $200 in a calendar year.
Orthopaedic shoes	Orthopaedic shoes, which are an integral part of a brace or are specially constructed for the patient, including modifications to such shoes, provided the shoes or modification is prescribed in writing by a physician or podiatrist, limited to a maximum eligible expense in any one calendar year of $150. The prescription is valid for one year.
Orthotics	Orthotics and repairs to them, prescribed in writing by a physician or podiatrist, limited to one pair in a calendar year. The prescription is valid for three years.
Oxygen	Oxygen and its administration.
Penile implants	Penile prosthesis implants.
Support hose	Elasticised support stockings manufactured to individual patient specifications or having a minimum compression of 30 millimetres.
Wigs	Wigs, when the patient is suffering from total hair loss as the result of an illness, limited to a maximum eligible expense of $1,000 every 5 years.

Dental care

Eligible expenses mean the reasonable and customary charges for the following services and oral surgical procedures performed by a dentist.

Eligible expenses
Accidental injury	The services of a dental surgeon, and charges for dental prosthesis, required for the treatment of a fractured jaw or for the treatment of accidental injuries to natural teeth if the fracture or injury was caused by external, violent and accidental injury or blow other than an accident associated with normal acts such as cleaning, chewing and eating, provided the treatment occurred within 12 months following the accident or, in the case of a dependant child under 17 years of age, before attaining 18 years of age. A physician's prescription is not required. This time limit may be extended if, as determined by the Administrator, the treatment could not have been rendered within the time frame specified. If a member is covered under the Public Service Dental Care Plan, the Dependants Dental Care Plan, the CF Dependants Dental Care Plan or the Pensioners' Dental Services Plan, claims for expenses for oral surgery should first be submitted to that plan. Any amount not covered by that plan may be submitted to the PSHCP. Claims for expenses for accidental injury should first be submitted to the PSHCP.
Oral surgical procedures
*Cysts, lesions, abscesses*	Biopsy soft tissue lesion incision excision hard tissue lesion Excision of cysts Excision of benign lesion Excision of ranula Incision and drainage intra oral—soft tissue intra osseous (into bone) Periodontal abscess incision and drainage
Gingival and alveolar procedures	Alveoplasty Flap approach with curettage Flap approach with osteoplasty Flap approach with curettage and osteoplasty Gingival curettage Gingivectomy with or without curettage Gingivoplasty
Removal of teeth or roots	Removal of impacted teeth Removal of root or foreign body from maxillary antrum Root resection (apiectomy or apicoectomy) anterior teeth bicuspids molars
Fractures and dislocations	Dislocation—temporomandibular joint (or jaw) closed reduction open reduction Fractures—mandible no reduction closed reduction open reduction Fractures—maxillar or malar no reduction closed reduction open reduction open reduction (complicated)
Other procedures	Avulsion of nerve—supra or infra-orbital Frenectomy—labial or buccal (lip or cheek) Lingual (tongue) Repair of antro-oral fistula Sialolithotomy—simple Sialolithotomy—-complicated Sulcus deepening, ridge reconstruction Treatment of traumatic injuries repair of soft tissue lacerations debridement, repair, suturing Torus (bone biopsy)

Lowest cost alternative

When two or more courses of treatment for oral procedure or accidental injury are considered appropriate, the Plan will pay for the lesser of the two treatments.

Health care while I am outside my province of residence

Emergency medical care while travelling

Each participant is covered for eligible medical expenses incurred as a result of an emergency while travelling on vacation or on business. The maximum eligible expense per participant is $500,000 (Canadian) per period of travel (not exceeding 40 consecutive days).

Eligible expenses mean the reasonable and customary charges in excess of the amount payable by a government health insurance plan, if they are required for emergency treatment of an injury or disease that occurs within 40 days of the date of departure from the province/territory of residence.

Eligible expenses
Doctors' services	Services of a physician.
Evacuation (including ambulance services)	Medical evacuation, which may include ambulance services, when suitable care, as determined by the Administrator, is not available in the area where the emergency occurred.
Family assistance	Family assistance benefits up to a combined maximum of $2,500 for any one travel emergency, as follows: the maximum payable for dependant children under age 16 who are left unattended because the participant or the participant's covered spouse is hospitalised and an escort (if necessary) is the cost of economy airfare for return transportation, return transportation if a family member is hospitalised and as a result the family members are unable to return home on the originally scheduled flight, and must purchase new return tickets. The extra cost of the return airfare is payable, to a maximum of the cost of economy airfare, a visit of a relative if the family member is hospitalised for more than 7 days while travelling alone. This includes economy airfare, and meals and accommodations to a maximum of $150 per day, for a spouse, parent, child, brother or sister. This benefit also covers expenses incurred if it is necessary to identify a deceased family member prior to release of the body, meals and accommodations if the participant or a covered dependant's trip is extended due to hospitalisation of a family member. The additional expenses incurred by accompanying family members for accommodations and meals are provided to a maximum of $150 per day.
Hospitalization and hospital services	Public ward accommodation and auxiliary hospital services in a general hospital.
Repatriation	Return of the deceased in the event of death of a family member. The necessary authorisations will be obtained and arrangements made for the return of the deceased to the province/territory of residence. The maximum payable for the preparation and return
Return to province/territory of residence	One way economy airfare for the patient's return to their province/territory of residence. Airfare for a professional attendant accompanying the patient is also included where medically required.

Emergency travel assistance services

The PSHCP provides a toll-free number which gives participants and their dependants 24-hour access to a world-wide assistance network.

Provided services
Advances	Advance payment on behalf of the participant or a covered dependant for the payment of hospital and medical expenses. To arrange for advance payment of hospital and medical expenses, the participant must sign an authorisation form allowing the Administrator to recover payment from the provincial/territorial health insurance plan. The participant must reimburse the Administrator for any payment made on their behalf which is in excess of the amount eligible for reimbursement under the provincial/territorial health insurance plan and the PSHCP.
Arranging of care	Transportation arrangements to the nearest hospital that provides the appropriate care or back to Canada.
Medical care	Medical referrals, consultation and monitoring.
Message service	A message service for family and business associates; messages will be held for up to 15 days.
Referrals	Legal referrals.
Telephone interpretation	A telephone interpretation service.

Assistance services are not available in countries of political unrest. The list of countries, as maintained by the Administrator , will change according to world conditions.

Neither the Administrator nor the company providing the assistance network is responsible for the availability, quality or result of the medical treatment received by the participant or for the failure to obtain medical treatment.

Official travel status

Employees required to travel on "official travel status" for government business are covered under the emergency medical care while travelling and the emergency travel assistance services during the entire period of "official travel status". Although there is no time limit to be on "official travel status", the $500,000 (Canadian) benefit coverage limit still applies.

Referrals

Referral services must be:

performed when the participant physically leaves the province territory of residence,
following a written referral by the attending physician in the person's province/territory of residence,
for a service that is not offered in the person's province/territory of residence.

Eligible expenses under this benefit will be limited to the reasonable and customary charges in excess of the amount payable by a provincial/territorial health insurance plan and to a maximum eligible expense of $25,000 per illness or injury.

Eligible expenses
Doctors' services	Services of a physician or surgeon.
Hospitalization and hospital services	Public ward accommodation and auxiliary hospital services in a general hospital.
Laboratory services	Laboratory services including those services which when ordered by and performed under the direction of a physician provide information used in the diagnosis or treatment of disease or injury. Services include, but are not limited to, blood or other body fluid analysis, clinical pathology, radiological procedures, ultrasounds, etc.

Basic health care provision

Eligible expenses
Ambulance	Ambulance services.
Doctors' services	Services of a physician including: physician's services in the participant's home, the physician's office, clinic or in a hospital, diagnosis and treatment of illness and injury, one annual health examination, treatment of fractures and dislocations, surgery, including surgery performed by a Doctor of podiatric medicine (DPM) when performed in the United States of America, administration of anaesthetics, x-rays for diagnostic and treatment purposes, obstetrical care, including prenatal and postnatal care, laboratory services and clinical pathology when ordered by and performed under the direction of a physician.
Optometrist services	Services of an optometrist.
Paramedical services	Services of a chiropractor, osteopath, podiatrist, or physiotherapist.

Hospital (outside Canada) provision (not available to pensioners)

Eligible expenses include reasonable and customary hospital charges for each day of hospitalisation in a general hospital, a hospital of the CF, or the armed forces of a foreign country, and may include the following:

Eligible expenses
Diet counselling services	Use of diet counselling services when prescribed by a physician.
Drugs in hospital	Drugs, prescribed and administered in hospital by any attending physician.
Hospital ward accommodation	Standard ward accommodation.
Hospital out-patient services	Out-patient services provided by a hospital.
Laboratory services	Laboratory, radiological and other diagnostic procedures.
Nursing services in hospital	Necessary nursing services when provided by the hospital.
Operating/delivery room	Use of operating and delivery rooms, anaesthetic and surgical supplies.
Services of hospital staff	Services rendered by any person paid by the hospital.
Speech therapy services	Use of speech therapy facilities when prescribed by a physician.

Do I have to pay a deductible before I can receive benefits?

For each calendar year, there is a minimum deductible. Only eligible expenses incurred during the year that exceed the deductible are eligible for reimbursement under the Extended health provision, except for the:

emergency medical care while travelling, and
emergency travel assistance services,

to which no deductible applies. In addition, no deductible applies to benefits under the hospital provision or the hospital (outside Canada) provision.

The annual deductible amount is $60 per person. If a member has family coverage, but only one member of the family unit incurs eligible expenses in a calendar year, the annual deductible of $60 will apply to those expenses. Where eligible expenses are incurred in a calendar year in respect of more than one member of a family unit, the combined deductible amount which must be exceeded for all members of that family unit is $100.

Does the Plan pay all my expenses?

Except where otherwise stated, the Plan will reimburse the member 80% of the reasonable and customary charges incurred for an eligible service or product once the annual deductible has been satisfied, subject to the Plan's stated maximums for the service or product. This is the maximum eligible expense. The co-payment is the remaining 20% of such eligible expenses paid by the member.

How can I check whether an expense is covered?

If you have any questions about your PSHCP benefits, you can contact the Administrator by calling:

1-888-757-7427 (toll-free in North America), or
613-247-5100 in the National Capital Region.

Customer Service Representatives are available from 7:00 a.m. to 8:00 p.m. (EST), Monday through Friday.

In some cases, it is advisable that you contact the Administrator before purchasing certain expensive medical equipment or treatments. In these cases, the Administrator may confirm the eligibility of the expense or explain the specific information required to later process the claim.

For example, if you plan to incur expenses for the following benefits, you should consider first contacting the Administrator:

private duty nursing services,
durable equipment such as hospital beds, mechanical lifts, etc.
wheelchairs,
out-of-province referral benefit,
temporary and permanent artificial limbs,
in vitro fertilization (IVF).

Where do I call for emergency travel assistance?

If emergency travel assistance is needed, a 24-hour help line is available. Multilingual coordinators can access a worldwide network of professionals who offer help with medical, legal, or other travel-related emergencies. Call the 24-hour toll-free number:

1-800-667-2883 in Canada and the United States, or
call collect 519-742-1342 in all other countries.


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