As you approach retirement, you may be thinking about what your health care needs will be in the coming years. Plan members who have retired from the federal public service, the RCMP, and the Canadian Forces, as well as members of the Veterans Affairs client group, are eligible to receive coverage under the PSHCP, provided they receive a public service pension. However, coverage does not continue automatically, and certain restrictions to coverage apply for pensioners living or travelling abroad.
To continue your PSHCP coverage when you retire, you must authorize monthly PSHCP contributions to be deducted from your pension cheque. This authorization is provided when you complete a PSHCP Pensioner Application Form, which you can also obtain from Compensation or your pension office. You do not need to complete positive enrolment again (unless you wish to make a change to your positive enrolment information), and your certificate number stays the same.
You should send your PSHCP Pensioner Application to your pension office as soon as possible to ensure a smooth transition in your coverage. If your application is received within 60 days of the date you retire and receive your pension benefit, coverage is continuous. There may be an administrative delay while your pension benefit and PSHCP file are updated, meaning you may not be able to use your PSHCP Benefit Card to process your claims right away, or a paper claim may be temporarily rejected. Therefore, keep your receipts during this transitional period and submit them to the Plan once you see that the appropriate PSHCP deductions are taken from your pension benefit cheque.
If you decide to apply for the PSHCP as a pensioner at a later date, you will not be able to obtain retroactive coverage. If your Pensioner Application is received by your pension office later than 60 days of you becoming eligible as a pensioner under the Plan, your coverage will begin the first day of the fourth month after your application is received by the designated officer (a three-month waiting period).
Limits to pensioner coverage
Pensioners are not eligible to receive coverage for certain provisions under the Plan.
A pensioner who lives outside of Canada and is not covered under a provincial or territorial health insurance plan is eligible for Comprehensive Coverage, but is not covered under the Out-of-Province Provision (available only under Supplementary Coverage) or the Hospital Expense (outside Canada) Provision, specifically.
The Hospital Expense (outside Canada) provides hospital coverage equivalent as far as possible to the coverage available to Canadian residents covered by a provincial/territorial health care plan. This provision covers expenses such as standard ward accommodation, nursing services, laboratory procedures, and other services that are covered by provincial/territorial plans.
Pensioners are still covered by the Hospital Provision, but it is important to remember that this provision provides reimbursement only for hospital room and board expenses beyond standard ward charges (up to specified amounts), and not for any services rendered in a hospital. For pensioners residing outside Canada, the Hospital Provision covers hospital charges up to the maximum specified in the Summary of Maximum Eligible Expenses for each day of hospitalisation. Therefore, pensioners who are living abroad should obtain coverage for emergency medical services from other providers.
Returning to the federal public service
If you are retired but decide to return to work in the public service, it is your responsibility to advise the pension office of your change in employment status so that your monthly deductions can be amended. You must complete the Employee Application Form and indicate that you were previously covered under the Plan. You will continue to use the same certificate number regardless of your employment status.
CF/RCMP members returning to active duty
Active members of the Canadian Forces and the RCMP are entitled to become Plan members so they can obtain PSHCP coverage for their eligible dependants. Members of the CF and RCMP can also obtain PSHCP coverage for themselves when they are not on active duty if they work for a participating employer under the Plan or if they retire and receive pension benefits based on their service, and would complete the Employee Application Form or Pensioner Application Form, as the case may be.
If you are a member of the CF or RCMP and are returning to active duty, you must submit the Employee Application Form to amend your coverage. You will continue to have the same PSHCP certificate number. If you had pensioner coverage prior to your return to duty, your CF or RCMP pension office will adjust your PSHCP contributions to reflect the Regular Member or Senior Officer contribution rate.